Episode 8: Educate! Educate! Educate!

 Welcome to Talking All Things Cardiopulm. I am your host, Dr. Rachele Burriesci, physical therapist and board-certified Cardiopulmonary clinical specialist. This podcast is designed to discuss heart and lung conditions, treatment interventions. Research, current trends, expert opinions, and patient experiences.

The goal is to learn, inspire, and bring cardiopulm to the forefront of conversation. Thanks for joining me today, and let's get after it.

Hello, hello and welcome to episode eight of Talking All Things Cardiopulm. I am your host, Dr. Rachele Burriesci. So today's title is “Educate, Educate, Educate,” because that is exactly what we're going to be talking about. We need to be educating our patients. I had a new client this week and the big takehome was that he was so happy to have been educated about his diagnosis because no one had really taken the time to do that. And educating is part of our job. If you are a physical therapist, if you're in the healthcare space, education and teaching, is half the battle. When we educate our patients, we can give them not only just information, but understanding of what is happening to them.

It can be very scary to have a new diagnosis. It can be very scary to have to deal with a new normal and giving talking points, giving them explanations to why they're feeling the way they're feeling, explaining signs and symptoms or expectations of a disease or even disease progression. Some diseases, especially in the lung world, is pretty much irreversible. The goal isn't to reverse an issue. The goal is to become more efficient in the person that you are in this moment, so that you can have quality of life. There are so many opportunities in any evaluation or session with your patient to teach them something. If you're performing an assessment, if you're performing a special test, if in my case, auscultating or performing chest wall assessment. Walk them through it, talk out loud, tell them what you're looking for. Now there is a point where you don't want to give too much information at the start of something so that you might skew a result, but they want to know this is their body. They want to know why you're doing what you're doing.

I have a new stethoscope that allows recordings. So after I auscultated, I was able to play the sounds that I heard to the patient. That was really cool for them. They've never heard anything like that. They don't know why a sound means what it means. They don't know why they're ausculated every session. Give them the information. It doesn't have to be a two-hour powerpoint presentation to teach. As healthcare professionals, we are teachers, we are coaches. We have to be able to explain why we're doing what we're doing. At the end of the day, it's their body and they're living with whatever issue they have, even if it's low back pain.

If you're choosing to do an intervention, if you're choosing to do a special test, talk them through it. Patients want to know. I think a lot of times we underestimate patient's ability to follow healthcare verbiage. Give them the real words. You don't have to decrease or, or lower or simplify everything. Give them the real words.

If, the words aren't coming through, then simplify. If it's not coming through, then simplify again. But don't underestimate your patients. I cannot tell you how frequently patients teach me something on the daily, the amount of meds that they're taking, the ability to say the name correctly, the dosage, the understanding what the meds are for.

Now, there is the other side of the spectrum.  The other side of the spectrum is that they're taking 10, 15 meds and they have no idea what each one does or why they're taking it. And when you don't have the education or knowledge behind it, it makes it much easier to say, you know, what, do I really need to take this?  Is this really doing anything? But if they understand why they are taking each thing, why they're doing a specific exercise, then there's going to be more ownership. When you educate, you give your patients control, and sometimes these situations feel like you have no control, so you want to give them the power of control and knowledge back, because the more they can understand, the more likely they are to follow through.

I'll give a very specific, my new client is on oxygen, and he has multiple types of devices. He has portable canisters, he has large canisters, small canisters, he has an oxygenator, he has a main oxygenator on the main floor that has about 200 to 500 feet of tubing. I mean, the tubing was impressive and he really was navigating it well because it gives me anxiety with how much tubing there is, but he had a new oxygenator delivered and he asked me if I knew how to use it. I asked when you received this, did anyone go through how to use it? How to set it up? Any of it? And he's like, Nope. Here's the box. I got this, and here's the manual. I teach my students, I teach my colleagues that oxygen is a drug. You have to have an appropriate prescription for that drug. You need to know how to titrate that drug. And patients are sent home on a regular basis with oxygen and not much education behind it. How to use it, how to wear it, what's appropriate, what's not appropriate, what should they be looking for?

What's the difference between pulsatile and continuous? These are important facts that you need to discuss and educate. I had a patient the other day who is on oxygen. He had been sent home on oxygen and he just up titrates himself when he feels short of breath. That is not an appropriate way to deal with oxygen.

Do you own a pulse ox? Yes. Are you checking your pulse ox before you titrate up or down? Okay. That's an education point. What do you do when you have to walk across the room? What do you do when you have to go to the bathroom? What are, what are you doing in those moments? Oh, I just take off my oxygen. Has anyone talked to you about why you're on oxygen and the purpose of oxygen and if you need oxygen at rest, well, you're definitely going to need it with exercise, typically the answer is,

These are important facts that your patients need to understand to be successful, you have to set your patients up for success. They have to understand why they're doing what they're doing. They don't necessarily know that it's bad to take off the oxygen to walk across the room. That just is easier because no one has told them how to navigate around that.

Educate your patients. They want to know, teach them the words, and teach them how to ask appropriate questions. Part of this is they don't know what to ask. One of the, you know, per from personal experience too, is asking the right questions at a doctor's appointment, asking the right questions, being prepared, knowing what to ask is such a skill.

If you can educate them on what things mean, then they can ask appropriate questions. You can help them set up questions. Teach them to write their questions down before going into the appointment. Think about all the things that they may not understand or need more explanation on.

What is your goal oxygen? That is a basic question for someone who is placed on oxygen and the patient should know that answer, there should be an education point on that. What does it mean to go below that oxygen level? What should you pay attention to? What would be a good time to come back to the hospital? Let them have the knowledge to make good decisions so that we can set them up for success instead of readmission.

PFT was another conversation point that we had, and patients are doing this type of test to assess what type of lung disease they have.  When you look at the report, it's pretty detailed and there are a lot of letters. I teach this to students and colleagues and people who are trying to sit for their CCS. It takes a bit of time to understand what those PFT mean. Can you break down that information? Do you yourself, as a clinician, understand it? Could you explain it to your patient? What on those PFTs are important?  I went through the PFTs with him. They asked which numbers matter? What do they mean?  We discussed what an FEV1 is, how much air you get out in one second, and that's the first thing that we look at. If it is low, then the next thing we look at is the ratio. And if the ratio is low, that usually points us to obstructive disease. When the ratio is normal or high, it's usually very common of restrictive, because you have an issue with volume. So the next number you need to be looking at is total lung capacity. How much air can you bring in? We talked about the size of a balloon and the thickness of a balloon and how hard it is to pull air into restricted lungs. It finally made sense. Educate your patients. They want to understand, and my patient gave a great analogy about breathing, and I was like, that's awesome. That's exactly right. He said, most people don't understand restrictive disease. He said, I have a problem getting the air in while other people have a problem getting the air out. I have a problem getting the air in, they have a problem at the exhaust. We have two different issues.

That was correct. It was just how he was able to able to put words around it.  Sometimes you will educate patients and it might not make sense. It might be too much. A good clinician will educate. A good clinician will be able to break down the information. A good clinician can explain something in multiple ways with multiple descriptions, with multiple analogies to get the point across; what's pertinent for your patient to understand?  Why does it matter?

One of the reasons why I love cardiac and pulmonary rehab so much is the education component. The program is set to educate patients to improve their outcome. To improve their risk factors, to prevent triggers to prevent relapse, readmission. It's meant to set you up for success. In a perfect world, cardiac and pulmonary rehab would be given before there's a problem, as a preventative rehab. Why is it important to have a heart-healthy diet? Why is it important to increase fruits, vegetables, fiber? Why is it important to decrease unhealthy fats? Because of the pathophysiologic process that leads to chest pain, stent placement, CABG, etc.

You've already had those things now let's prevent recurrence after they fix the issue. They're on a ton of meds. Meds are expensive. Why are you on this med? What is this medication for? If you don't know, look it up. Help them look it up. Look it up together. Have a pharmacist go through it. Direct them to the pharmacist, direct them to their physician with specific questions about those meds.  If you cannot do it yourself, delegate out. Give them the tools to ask the appropriate person that question. There are many questions that I defer or will defer. Is it outside my scope? Is it a decision made by the physician? Do I just not know any of those reasons?  If it's maybe something regarding a test that hasn't come in yet and that they're waiting for results, defer, not in your scope to release that information.  But if it's a known disease/diagnosis and it's a known risk factor and it's a known treatment or assessment tool, explain to them why. My patient had a six-minute walk test performed, and I asked, how far were you able to walk? He said, I have no idea. I said, okay. Next time you talk to whoever, ask that question.  That's an important question. You just performed a test. How did you do on that test? When you take a test, do you want to know how you did? It's important to educate. Tell them what you're looking for. Explain that you're going to maybe do that test after the program. Give them the understanding as to why you are doing what you're doing.

Give your patients control. Give them knowledge, because when you do, they're going to have buy-in. Give them the option to make the right decision. Most of the time when a patient doesn't do something that is expected of them, it's because they didn't know that they had to do it. Let's eliminate that piece of the puzzle.

There are patients that do not follow instructions who maybe don't want to know the why and likely that patient isn't going to have the best outcome. But for the most part, patients want to know, and they want to be in control, and they want to know how to make it better, but they need to know why.

The point of today, and this is really going to be a short episode, is to give your patients the power of knowledge. Knowledge is power. It puts them in the driver's seat. It puts them in control of their own life. It gives them the opportunity to make good decisions or safe decisions for that matter. But if they don't know, it's not possible.

It does take more time. But a good clinician will explain the why. A good teacher will explain the why. If you don't know the why, the care for it doesn't always come forward. Give them the information that they need. It doesn't have to be a PowerPoint. It just needs to be practical, short and sweet. Gets the job done. Explain what you're doing. Teach them. Give them the tools to ask good questions. Give them the tools to progress, give them the tools to know when something is safe or abnormal or maybe actually reason to go to the hospital or to call the physician.

Give them information so that when they do see the physician, they know what to ask.  I know from personal experience, you go into that room, you think you're ready to go, and you didn't ask any of the questions that you thought you were going to ask or you leave and say, crap. I wanted to ask this, and I totally forgot again. And now you have to wait till next time. Help your patients be proactive about their condition, about their progress, about their life, their quality of life, for that matter.

So my parting words are educate, educate, educate. Your patients need to understand, they want to know, and they will do better when they know and understand why. The next time you're working with a patient, think about what you can educate them on what they might need more instruction on, and maybe ask them, to follow up with them.

Do they have good recall of what you did last time? Do they have recall about signs and symptoms to look out for?  It is in their best interest to know.  Don't be afraid to educate. Don't be afraid to use the real words. Give your patient the power of knowledge. Give your clients the power of knowledge, whoever you might be working with.

I think that's all I got for you today.  If you have any questions, if this hits home for you, reach out, shoot me a DM on the Instagrams, throw me an email, text me at 9133084494. I hope this was helpful. I hope this hits home for you. I hope you are doing these things and when you are, just know that your patients are getting max benefit from your education.

I hope you all have a wonderful day in whatever you have to do, get after it.