Why patient education is a pain.

Summary

Hospitals face financial challenges and struggle with the unpredictable time demands of patient education, particularly informed consent, which is critical for ethical and legal reasons but not adequately supported by digital tools or standardized training.

Abstract

The article discusses the economic struggles of hospitals despite favorable market conditions, with nearly half of German hospitals anticipating a net loss. It highlights the significant role of patient education, especially informed consent, in hospital operations, noting that the time required for this task is unpredictable and often consumes a large portion of doctors' time. The article suggests that while doctors generally wish to spend quality time with patients, the reality of tight schedules and the repetitive nature of patient education can be burdensome. It also points out the lack of a standardized approach to informed consent and the absence of significant digitalization in hospitals to aid this process. The article proposes identifying empathic champions within hospitals to share best practices for more efficient and empathetic patient education, which could lead to a better experience for both doctors and patients.

Opinions

The main expense in hospitals is wages, largely due to the time doctors spend on patient care and administrative tasks.
Informed consent is a critical task for doctors, mandated by the Declaration of Helsinki and legally important, yet it is time-consuming and unpredictable.
Doctors are often burdened by the redundancy of patient education, which can be seen as profane given their high level of training.
There is a lack of a valid standard for informed consent forms and practices, with each hospital potentially having its own best practice to cover liabilities.
Digital tools are underutilized in hospitals, and there is a need for significant digitalization to improve the informed consent process.
Identifying and learning from empathic champions in patient education can lead to improved practices and patient experiences.
The current state of patient education is seen as a "black box" for doctors, with the time needed for proper information varying greatly among patients.

And what you can do about it.

Despite the current economic upside, hospitals seem not to participate from favorable market conditions like zero interest rate, high employment status or excellent infrastructure.

According to a recent study by consulting firm Roland Berger almost 50% of the hospitals in Germany are expecting a net loss for this year compared to 32% in 2018 and 31% in 2017.*

Challenges in patient education.

The main expenses driver in hospitals are wages. Doctors spent the majority of their time with the patient and with administrative tasks. No surprise here. One important task of doctors is to do a proper informed consent with the patient. Meaning to educate the patient about the upcoming operation including the necessity, alternatives and risks involved. This is not only ethical mandatory since the Declaration of Helsinki in 1964.** It is of legal importance for the doctor and hospital involved. But the amount of time spend with patient is rarely predictable and makes structuring the day a challenge. Some well informed patients may require 10 minutes, others one hour or more.

Patient education often is a black box for doctors when it comes to estimating the time needed to properly inform the individual patient.

Most doctors actually want to spend quality time with their patients, but tight daily schedules and economic considerations are weighing on them. Additionally, patient education involves standard information and explanations that quickly become redundant and profane for the highly trained clinical staff. Nevertheless they have to do the practice of informed consent in person and individual — which is a good thing because there is communication involved on both sides.

Every patient is individual, but so are the doctors. One might be very empathic and has the patience to answer every question no matter how minor. Another might have a less empathic, more analytical approach in order to get the patient to consent. Either way, this important task is not part of the regular academic curriculum for physicians. There is also no valid standard for informed consent forms and practices. Basically, each hospital might have a best practice in place based to cover potential liabilities.

Can digital tools help?

Digital interfaces, tools and workflows have given us means to do things more efficiently or beneficial in almost every parts of our lives. We do see some usage of digital aids in the hospital — some Doctors utilize WhatsApp (in lack of useful alternatives) to discuss x-rays and ask colleagues questions — yet, we do not see significant digitalization in the hospital environment.

Until there are meaningful digital advancements, doctors may try to do this instead to better the informed consent process for the benefit of the patients and their own work.

Identify empathic champions.

Find the one person in your hospital, that is deeply empathic and loves to talk to patients.

Ask them how they are handling the task of patient information. How they are asking the right questions to guide patients to a brisk informed consent process but also leave them feeling calm and confident.

Try to implement these best practices into your next informed consent session with a patient.

Play your experience back to this person and other physicians in oder to better informed consent for everyone involved.

Just try and start with one element, maybe it is a newly formulated either/or question that makes it easier for the patient to reply shortly without the need to provide you with much more context in fear of leaving something essential unsaid.

The everyday life as a physician in a hospital is stressful. Through best practices and with deep empathy for humans we strive to help doctors and patients alike to get a better experience, faster recovery and make patient education a delight.

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