Nurse practitioners are known for their focus on patient communication. According to the findings of a survey conducted by the Merck Manuals at a recent medical conference, of 210 NPs surveyed, 88% said they spend at least half of appointment time educating patients on diagnoses, treatments and prescriptions. Most NPs find such educational interactions very rewarding. Yet a surprising amount of their communication time is devoted to interpreting and explaining medical information (and misinformation) patients have found on their own.
This is particularly crucial given that when asked to characterize the health literacy of their patients, almost half of NPs said patients’ lack of understanding is a barrier to maintaining their health. What’s more, NPs listed low patient health literacy as a leading challenge to the NP/patient relationship (along with shortened appointment times and the increased documentation requirements in current electronic health records).
Between low practitioner confidence in patient knowledge and shortened appointment times, a quick, effective exchange of current medical information is essential.
Patients Preparing for Appointments
Today, it’s easy for patients to fire up their search engines before visiting their NP or doctor. Ninety-five percent of NPs surveyed believe patients attempt to diagnose themselves before their appointment. NPs say that preparation takes many forms:
Doing online research (59%)
Talking to a physician/nurse they know (31%)
Printing materials to bring to the appointment (10%)
Overall, pre-visit reading is considered a positive thing by NPs. More than three out of four (78%) NPs surveyed prefer their patients do research before an appointment. But turning that research into a self-diagnosis can create new demands on even the most experienced communicator. The impact patient research has on the visit varies considerably depending on the patient.
“With certain patient personalities, it’s going to be bad no matter what because they think they know more than they do,” said Michael, an NP from Utah surveyed at the conference. “But for some people, I think prior research helps the experience because they hear me repeat what they’ve already read. That builds trust and confidence.”
Not All Research Created Equal
Although research can lead to a more productive visit, results vary greatly depending on where patients get their medical information.
“Sometimes patients see a commercial on TV and research it, and automatically diagnose themselves with a condition they don’t necessarily have. Then they want therapy or treatment that’s not appropriate,” said Jessica, an NP from Texas surveyed at the conference. “So one of the biggest challenges is working through the misinformation and educating them as to why they don’t have what they think they have.”
Now that many patients are reading scientific research or detailed reports of scientific research, NPs, physicians and nurses increasingly find themselves educating patients on basic research methods and interpretation of statistics. They also are referring patients to articles and research that are well-sourced and medically accurate. The Merck Manuals STANDS criteria for identifying credible medical information is one easy-to-use reference.
Bridging the Practitioner-patient Gap
Even accurate medical information often requires translating and decoding by the NPs. Typically, this means NPs must interpret clinical, research-based material for patients.
“I think patients and providers need to be on the same page,” Michael said. “So for instance, having a core reference that you can use for education in the office as well as something that you can use to get a deeper medical background is very helpful.”
The quagmire of blog posts, articles, slideshows, pop-up ads and commercials patients must wade through isn’t going away. For better or worse, patients will continue to do research of varying quality before appointments. In some cases, this research will elevate patients’ understanding and the level of care they receive. But our survey revealed NPs are also acutely aware of new challenges that come when patients read inaccurate, outdated and biased info online.
In this new reality, the role of NPs in educating patients has never been more important. The medical community must work together to promote the use of trusted, accurate medical information and to help patients be more discerning in the sources they use to improve their own health knowledge.