You know your stuff. This episode is about how you're using your medical knowledge during patient education.

Specifically, you’ll learn about one crucial shift you can make in your language to improve your patient education.

EPISODE TRANSCRIPT

Hi This is 10 minutes to better patient communication. I'm Dr. Anne Marie Liebel.

In this series, I take one communication question or issue that doctors have raised, dig deeper into with some research, then give you a strategy that you can use in your practice today. And I do it all in about 10 minutes.

A while ago, I wrote a piece called 5 steps to improve your patient education. I promised I would gradually dig deeper into each of the 5 steps. Last month I dove into the topic of patients' background knowledge and how it can help you.

This time, it's about your subject matter. Your medical knowledge. Specifically, about how you handle your medical knowledge during patient education.

I was talking with a wound care clinician. Describing a common scene in her practice, she said,

We tell patients, It's important, you should get out of your [wheel]chair for 3 minutes a day!' And the patient nods, and everyone goes away, and that's it.

One way or another, all providers do patient education. Whether it's a few minutes out of a 15 minute encounter, or it's a hefty chunk of your everyday.

I'm going to tell you one thing you can do one important change you can make right now that will improve your patient education. And it has to do with how you handle your medical knowledge in the patient encounter.

To do this, we're going to the bank.

The work of Paolo Freire has informed health care research for nearly 40 years. It's gaining in popularity you may have heard of critical pedagogy.

In the health sector, Freire's work has been used in public health, community health, mHealth, & health literacy interventions.

One of his best known concepts regarding education is what he calls the banking model.

In the banking model, Freire describes what may sound familiar to many people. He observed that education, in typical classrooms, looked and sounded more like banking than actual teaching and learning:

Not a pretty picture. Education-as-transfer from those who have something of value, to those who don't.

The banking model is a popular concept in part because it's so accurate and widespread. You may know how it feels to be on the passive-learner side. Many of us were educated at least partly in this kind of banking' way.

I said this episode was about your medical knowledge and how you use it in patient education. What does that have to do with the banking model?

Banking-model-teaching has many side effects. One is that we've become accustomed to seeing the teacher as the holder. The one with all the money. All the power. All of whatever's worth having.

Expertise certainly has value. You, as medical experts, worked for years to acquire important information, and to develop professional insights explicitly to share them and apply them. And the providers I speak with all have a desire to share and apply their expertise with all their patients.

The problems come from banking-style education. It makes the education process less effective for everyone, as it operates on flawed assumptions. Here are three of these flawed assumptions.

As Freire says about the banking model, [quote] Worse yet, it turns [students] into containers,' into receptacles' to be filled' by the teacher. [End quote] Passive recipients. Not people with lives, thoughts, histories, or resources.

It can be easy to see patients this way. There are many pressures toward doing so.

Let's say your patient just took some sort of assessment. Or maybe they answered some questions. These often show what the patient doesn't know, and focus your attention on what they don't do, what they don't have. And though it's important to know these needs, the needs, or areas of deficit, can easily become the focus. Banking style education positions the patient as an empty vessel needing filling rather than a person in front of you.

How do you resist the banking model? What can you do to combat a deficit perspective on your patients?

When educating a patient, shift your starting point from what your patient needs, to what your patient has. Put another way:

What about that problem? Their needs? You're still going to address them; that's the point, it just won't be where you start the education process.

Start with what your patient does. Start with what your patient knows. Start with what your patient has.

Changing your starting point can be as simple as a shift in language.

Let's go back to the conversation with the wound care clinician.

At best, it was a banking transfer of information and nothing more.

I talked to her about shifting her language. About starting her patient education by seeing patients not as empty containers to be filled, but as people who know things, and do things. I suggested her language could reflect this.

We smiled. It could be that easy.

That subtle shift in language was an important change. The first phrase You should get out of your chair for 3 minutes' presumes what patients don't know and don't do. The second phrase How long do you get out of your chair' focuses on what the patient does know and does do.

We quickly brainstormed some more.

These phrases put more emphasis on the patient as capable, active, and involved. A person with a life. Not the empty container of the banking model, waiting passively to be filled.

These subtle but important changes in language also have the potential to reveal more information about the patient, her surroundings, and her background knowledge and assumptions about her condition. All of these are helpful building blocks for patient education, for real learning that lasts.

Shifting your language to start with what patients already do, know, and have, also helps you catch where things might be going wrong. Patients may have misconceptions.

I've been explaining a bit about the banking model.

Freire's language is strong as he takes critical aim at the taken-for-granted ways of educating many of us experienced. I hope you'll check out his most famous work, Pedagogy of the Oppressed, as well as some of the important critiques and extensions of his work. All the links are in the show notes at health communication partners dot com.

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