Lawrence B. Harkless, DPM Dean College of Podiatric Medicine and Professor of Podiatric Medicine and Surgery

Western University of Health Sciences Pomona California

Just Because You Taught Me Doesn’t Mean I Learned

Perspectives on Teaching You, Your Patients and Your Students

PURPOSE

•  To share some of my experiences and philosophy. • To increase the effectiveness of your interaction with your patients. • To improve the outcome of the clinical care you provide to your patients. • What do you want them to know? • How do you know that they learned it?

Why Things Fail?

•  Ambiguity of Expectation •  Lack of Memory

Where Are The Trainers?

•  Train up a child in the way he should go and when he is old he will not depart from it. Proverbs 22:6

•  Be •  Behave •  Become

You, Your Patient and Your Student Identity

•  Who You Are – Mind Body Soul

•  Whose you are – We are Gods workmanship.

•  Why you are – To Serve. Service is the price you pay for the

space you occupy. •  Where you are going

– Spiritual Gifts-EKG with Passion •  Where you came from

PERSONAL FACTORS Peripheral Neuropathy Age/Gender Beliefs Emotions Psychology Knowledge Quality of Life Depression

BEHAVIOR Monitoring Protective Action

ENVIRONMENT Peripheral Neuropathy-Lack of painful “prompts” Social situation Education

Perrin et al The Psychological Aspects of DM Foot Diabetes Educator 34:3 May /June 2008

ENVIRONMENTAL FACTORS

•  The social and physical setting in which we

Live, Work and Play

•  Influences Behavior and Cognition

•  The reactions of others (spouse, friends, others

with diabetes)

•  Can promote or discourage behavior

•  Socioeconomic position and social isolation

PERSONAL FACTORS

DEMOGRAPHIC Age Gender Education Location Socioeconomic status

COGNITIVE Beliefs Knowledge Attitudes

BIOLOGICAL The presence of disease such as peripheral neuropathy

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FOCUS HISTORY •  Identify their value system – why are they here in

your office/clinic? •  What do they expect to receive? •  Listen – what is important to them? - “I want to lose weight so I can get on the floor

and play with my grandchildren.” •  What are their goals? Are they appropriate

targets? - “I want to lose 80 pounds…100 pounds” •  Prompt, as needed, to maintain focus.

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WHY DO WE NOT ALWAYS HEAR THE IMPORTANT HISTORY?

•  We want short, direct answers. •  We are rushed; never enough time. •  We ask Yes/No type questions. “Do you brush

after each meal? When, how often do you?” •  If they start talking, rambling wastes time. •  Do we detect inconsistencies? Then follow-up. •  Do we provide a sense of safety and trust? •  Are we judgmental?

Shut Up The Patient Is Giving You The Diagnosis

Banting and Best

HOW DID YOU GET TO BE SMART?...

•  Why do you believe what you believe?

- Family/cultural beliefs - Life experiences; observations - Education/training - Research – your own or reading about others - Professional experience – Treating similar

patients with similar problems

LEARNING OPPORTUNITES

•  59y/o LAF Type 2 Diabetes pre op clinic for correction of Hallux Valgus(Bunion) and a overlapping Hammer toe 2nd

•  Social Hx •  Husband deceased 6months prior to visit

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INFORMATION GIVING

•  Limit the amount of information given at one time

•  Ask for and discuss patient’s/student’s feelings & biases about information

•  Know when to stop giving information •  Wait for the patient’s cues for more

information •  Give all relevant facts; including negatives

“No Memory Is As Firm As Faded Ink”

Chinese Proverb

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EDUCATION IS PART OF CARE

•  The patient must be educated because the daily activities determine final outcome.

•  No matter how good you are or how much you know, your success is determined by the daily care plan followed by the patient.

•  Transfer of information is the foundation of our success in changing outcomes from negative to positive

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YOU ARE AN EDUCATOR/TRAINER

•  A Coach…you cannot make the touchdown but you can inspire and motivate your patient to make the touchdown.

•  A cheerleader…positive reinforcement, Atta boys…or “I can see your effort to…”

•  If the patient is SBGM appropriately but the numbers are not at target, praise the activity, commitment and record keeping of the tests.

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HELPFUL APPROACHES… •  The targets are…

- What are you willing to do? •  Be specific – more or less is not productive

- Tell me numbers, how many, so I can count - We cannot improve what we do not measure

•  Supply simplified summaries of research - So their decision will improve - Provide rationale for desired behaviors.

•  Why did that happen?...

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Contracting With the Patient/Prescription for the Student/

Resident •  Accept that patients may not agree with your

recommendations – negotiate. •  Explain what will be the benefit or expected

outcome of changed behavior – What’s in it for the patient.

•  Be specific, not more or less, how many… •  We cannot improve what we do not measure. •  Follow up on the “homework”.

Learning

•  Hearing and Listening •  Looking and Seeing •  Knowledge and Understanding •  Wisdom

Performance Evaluation

•  Study to show thyself approved a workman unto God that needed not be ashamed rightly dividing the word of truth

2nd Timothy 2:15

Going to School vs Getting an Education

 Education

•  Knowledge

•  Belief

•  Motivation

•  Change

REMEMBER… We worked hard to be professionals.

We are proud to be professionals. As professionals, we have ethics, standards of

care that are wonderful.

But remember… The Ark was built by amateurs and the Titanic was built by professionals.