Patients should prepare for their office visits

Education adds to appointment effectiveness

Patients should be learning about asthma even before their first doctor appointment. Pediatrician Thomas Plaut, MD, says the early start makes patient education more efficient. At the very least, the doctor’s waiting room could be the first place to introduce the patient to asthma booklets before an appointment.

Plaut requires parents of his asthma patients to read a 304-page book he wrote, Children with Asthma: A Manual for Parents, before he will see them. Then they have to fill out a two-page questionnaire and write a story about their child’s asthma.

"If they don’t do it, it doesn’t make sense for them to see me," he says. "I work at a routine, assuming patients have done that."

While most physicians probably won’t make such formal requirements, Plaut recommends they at least provide educational material in the waiting room. This way, patients or parents can do a quick study of asthma terms and medications before they meet with the physician.

"You want your patients to come in knowing something, so you work out a decent plan with them," he says.

Plaut contends this advance education could have a significant impact on the physician visit because the patient will be able to better communicate symptoms and problems.

To test his theory, he has sent out copies of another book he has written, One Minute Asthma, to a few physicians he knows. He asked them to participate in this project: First their receptionists hand out the 56-page booklet to patients and ask them to read four specific pages and any other pages that interest them, while they wait for their consultation.

During the physician’s exam, the doctor will ask the patient these three questions:
- Once your asthma is under control will you be able to run as long and as hard as you want?
- During an asthma episode, does the lining of your airways swell due to inflammation?
- What major types of asthma medicines can you name (preventers, maintainers, and relievers)?

The physician will ask the patients for any comments they have on the booklet. Physicians also fill out a one-page survey about whether they found any difference in communication tone, attitude, or understanding between these patients and three patients chosen at random who did not receive the booklet.

The survey, which began in late 1998, is not yet complete but Plaut reports he has received positive feedback so far.

"The interesting thing is the doctors are noticing that the people who have read these four pages are much easier to communicate with than the people who have not read them," he says. "They said it changed the visit."

L. Jane McDowell, MD, a practicing allergist in Muncie, IN, who has used Plaut’s asthma booklet for years, says she has found it to be very effective for patient education. "It’s an excellent teaching tool," she says. McDowell often uses the booklet as part of her consultation with patients and reads portions to them. "I have found it is much more effective to read some portions of the book to the patient. I read to them so I can underline things in the book and explain techniques."

Also, she gears the patient teaching to what most interests a particular patient, such as discussing exercise or dust allergies.

McDowell read the entire book to an 83-year-old patient, who spent a morning with her after a blizzard kept her other patients at home. "Her son had brought her to the office in his four-wheel-drive vehicle," she says.

"I called her back a couple of days later to report on lab tests, and she said, If I had had that book 30 years ago, I don’t think I would be in as bad of shape as I am now,’" McDowell adds.

[For more information contact:

Joni Bertsch, RN, Performance Improvement Coordinator for the Pediatric and Teen Unit, Ball Memorial Hospital, 2401 W. University Ave., Muncie, IN 47303. Telephone: (765) 757-3342.

Wilma Light, MD, Allergist, 1100 Ligonier St., Latrobe, PA 15650. Telephone: (724) 539-4551.

L. Jane McDowell, MD, Practicing Allergist, Muncie Allergy Center, 4505 N. Wheeling Ave., Muncie, IN 47304. Telephone: (765) 284-4050.

Thomas Plaut, MD, Pediatrician, Director of Asthma Consultants, Pedipress Inc. 125 Red Gate Lane, Amherst, MA 01002. Telephone: (413) 549-3918. Fax: (413) 549-4095. Web site: www.pedipress.com.

For information about One Minute Asthma, which sells for $5 per copy for 1-9 copies or $2 per copy for 10-99 copies, and other similar publications, contact Pedipress Inc., 125 Red Gate Lane, Amherst, MA 01002. Telephone: (800) 611-6081.]