Handouts can help patients with a myriad of problems. See why the personalized touch can make them even more effective.
Patients not only appreciate handouts, they often suggest new ideas for them.
Jot down notes for handouts during visits, check them every few days, and then change old handouts or create new ones.
Schedule appointments solely to review responses to your handouts. Responses to them will help identify problems that concern your patients.
You can buy them. You can download them. You can get them from many places.
Patient handouts are everywhere. Everyone's practice is different, however. Your patients are your patients because they like you.
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You don't have to be a professional writer to generate your own patient information sheets. You know your patients. You know their problems.
Patients appreciate handouts that say"By Dr. [You]." And patients will suggest new ideas for your handouts. Your part in creating a handout is to keep a record of their suggestions.
I have a computer in my office and a legal pad on a counter in the exam room, and that's where I write notes about handouts that are needed and comments from patients. It's easy to jot a quick note during a patient visit. I check them every couple of days and use them to change old handouts or create new ones.
Let's start with an example. What's a problem that many patients have in your practice? In ours, it's obesity. No surprise there.
I spend a lot of time talking to patients, but telling people to lose weight just doesn't work. Many try commercial weight loss programs and don't stick with them or lack the time or money these programs require.
ASK FOR A FOOD DIARY
I have learned to initially approach overweight and obese patients by talking about keeping a food diary. Just mention food diary and you first will hear a groan. But then I say, "Just give me 1 week. That's all. Do it for me. Just 1 week."
We used to give patients a form we devised, but at the end of the day, we more often than not found it in the circular file. Now we tell our patients to keep a diary in whatever way is easiest for them. It can be on scratch paper, in a notebook, on their palm-whatever works. When patients return to the office, we make a copy of their diary, so they have a copy and I have one, too. We then can go over it together.
We do give patients a handout with some guidelines for their food diaries (download a version below). This handout has evolved thanks to feedback from my patients. At first, I told them to keep a diary of everything they ate and how much. But when a patient said, "I eat if I'm bored," I added "why you eat" to the handout. This addition prompted a discussion about what this patient could do instead of eating when she was bored. Some options that came out of that discussion:
call a friend;
do something frivolous, such as playing a computer game;
get far away from the kitchen;
write down things you have always wanted to do (this patient wanted to study art history and took a night class at a local college);
do something physical, such as dancing, exercising to an exercise program on television, or taking a walk with a friend; or
learn chess and play while you are on the phone.
Another patient's answer to the question of why he ate was, "Well, those chocolate cupcakes sit on the table when my thin, active daughter is studying." He couldn't walk past a dish of chocolate or a bowl of nuts without mindlessly digging in.
This comment led to a discussion about mindful eating. The notes that went into my legal yellow pad about mindful eating included: "Stop. Think. Are you hungry?" The patient said the answer to this question usually was no, so we had him take a drink of water and then wait 30 minutes. If he still was hungry after 30 minutes, then he would allow himself to eat. More than 90% of the time, the urge to eat had passed after 30 minutes, and he was doing something else.
Because we found that a lot of people eat while watching television, we added "where you eat" to our handout. This habit is difficult to stop, but once you make this disconnect with some patients, they lose a few more pounds.
For example, a woman who relaxed after a hard day at work by eating her dinner in front of the television found that she just kept eating because there was a connection. To her, watching television equaled food. Now, she first eats in the kitchen and then watches television. If she has the urge to eat and watch television at the same time, she sips a cup of chamomile tea.
?We added "with whom you eat" to our handout when a patient realized that she did not make healthful choices when she had dinner a couple of times a week with her sister. This fact was difficult for her to discern. She hadn't made the connection on a conscious level. When we reviewed her food diary, we saw the densely caloric foods every time she ate dinner with her sister. There was a deeper problem to deal with when she realized her sister was "pushing" fries and dessert. She finally learned to politely say no and instead orders double broccoli and fruit for dessert (to those who scoff at her side dish choice, she was not demented; she just liked broccoli).
From our food diary handouts, we discovered that many people have no idea how many calories they consume.
For example, one patient had two energy bars every day for her mid-afternoon snack. She was having a problem with her weight, of course. So we asked her bring in the labels for these bars. She said each bar was only 200 calories, because that's what she saw on the wrapper. When we looked at the label, however, we discovered that there were actually two servings in each bar and that each serving was 200 calories. So she was ingesting 400 calories per bar instead of 200 calories. That meant that her afternoon snack was 800 calories.
This interaction led to another handout about how calories matter (download below).
WORK WITH PATIENTS
Another patient said she was too busy to exercise. Exercise seems to scare people. I needed to help her increase her physical activity.
I asked her to keep a physical activity log (download a version below). This handout served as a discussion point. I found out that my patient lived three blocks from her job and drove to work. So, asking her to walk to work was one easy solution to her health issue. The patient said she didn't have time to go to a gym. She had the misconception that exercise necessitated a gym membership. Now, she walks six blocks a day. When it rains, she drives her car to work.
She has 20-minute breaks in the morning and afternoon at work. We discussed walking 10 minutes up and down the halls. This effort has had two great benefits: after her walk, she didn't feel like eating a mid-morning snack, and some co-workers began walking with her. She eats lunch in the cafeteria at work. So we added a 10-minute walk in the halls after lunch. On the weekends, we added a 20-minute bicycle ride.
Our handout asks patients about the time they wake up. Some people can take a walk or use a home treadmill before they go to work, but others, like me, just can't do that. It's enough for me to just get out of bed, shower, slap on some makeup, and get out the door.
Physical Activity Log
LEARN FROM PATIENTS
Because we physicians don't have a lot of time, I recommend scheduling appointments solely to go over your patients' responses to your handouts.
We are all different, and that's why making our own handouts works so well. We can tailor them to our patients. We can learn from our patients' reactions to these handouts. They will bring up problems that concern them-problems that need to be addressed. Just make a quick note about their responses. And when you have a chance, look over your notes. You will be able to identify areas of greatest concern to your own patient population, and then you will be on your way to creating thought-provoking, insightful, and helpful handouts, all by Dr. [You].
The author is a practicing family physician, journalist, and medical educator. She shares a practice with her husband, Eugene Eisman, MD, an internist-cardiologist. Send your feedback to firstname.lastname@example.org Also engage at http://www.twitter.com/MedEconomics/ and http://www.facebook.com/MedicalEconomics/.