Printed materials are the mainstay of any parent education
program. They are an inexpensive form of intervention and
have the following advantages:
- Increase the amount of information that can be
transmitted to and absorbed by the parent.
Most parents would like to know everything about their
child's condition. Most physicians want to be their
educator, but time constraints in the office limit the
amount of information the physician can discuss with
parents. With parent handouts the physician can
highlight the more crucial aspects of home treatment and
rest assured that the instruction sheets will cover the
details. The information sheets supplement the
physician's counseling and teaching. In a sense, these
information sheets serve as a physician extender that
expands the physician's influence over the patients'
health care.
- Increase the number of people who receive this
information.
The patient instructions can be read by other caretakers
who are not present during the office visit. These
caretakers may include the father, grandmother, child
care provider, or baby sitter.
- Counteract forgetfulness and improve parent compliance
with treatment regimens.
Written instructions reinforce verbal ones.
Forgetfulness is the most common cause of noncompliance.
Most people can remember only two or three instructions.
Normally people forget 50% of what was said during an
office visit within 5 minutes after leaving the office.
At times of crisis, people remember even less. Several
studies have shown that compliance is increased if the
specific recommendations are written out, but the
physician rarely has time to write out all instructions.
Written instructions are especially important with
complex problems, e.g., enuresis, ADD, and asthma. To
achieve a true understanding of such conditions, the
parent needs to reread and rethink the information.
These printed instructions increase the parents'
accountability by making it impossible for them to say
that they were not instructed to provide a specific type
of care. The printed instructions can serve as a form
of contract if the physician requests that the parent
read it, ask questions, and then sign it before leaving
the office.
- Save physician time.
Printed instructions can increase office efficiency.
Initially the physician saves the time required to write
out instructions for each patient.
Some of the time required for verbal presentation of the
treatment plan is also saved. Instead of trying to
cover everything, the physician has time to cover the
parents' main agenda. The physician can limit the
verbal instructions to two or three main points and let
the parents read the details before or after the visit.
If routine information is covered in an instruction
sheet--e.g., for the common cold--the physician can use
his or her time to address more complex issues, such as
the nuts and bolts of how to suction the nose of a fussy
3-month-old.
Telephone calls about forgotten instructions are also
avoided. Written instructions are especially helpful
for first-time parents or parents who need "constant"
teaching.
- Reduce repetition and boredom.
Physicians need handouts covering the most repetitive
problems. For example, during epidemics of diarrhea,
coughs, and colds physicians often can't remember
whether they have already given the parent currently in
their presence their routine spiel on that condition.
Routine information can be transmitted with printed
instructions, often before the patient is examined.
- Help the physician get back on schedule.
The most common office stress is getting behind in the
appointment schedule. Sometimes physicians feel that if
they try to answer all of each parent's questions, they
won't have any time left to see more patients. Written
information can improve office efficiency and get the
physician back on schedule. Some physicians have found
that after they make a diagnosis, they can give the
parent something to read, see another patient, and then
come back to discuss specific questions with the
previous parent.
Written instructions can also help with demanding
parents who want more information from the physician.
One option is to refer them to a subspecialist for a
second opinion, but another is to give them printed
information--e.g., about ventilation tubes or infectious
mononucleosis--and reappoint them for a follow-up visit.
- Protect against malpractice risk.
Printed instructions document the exact treatment
instructions, drug dosages, and follow-up plan. For
example, one of the more common ways for the delayed
diagnosis of meningitis to present is in a child who is
receiving antibiotics for an ear infection. The handout
on ear infections states clearly to call immediately if
the child becomes worse or if the fever or earache
persists for more than 48 hours on antibiotics.
Clarification of the indications for recontacting the
physician is essential in providing quality medical care
(e.g., in cases of croup and head trauma). In emergency
room settings, parents can sign on the encounter form
that they have received specific written instructions.
- Reduce unnecessary telephone calls.
The Pediatric Advisor handouts encourage appropriate
calls and discourage inappropriate ones. By providing
the details of home treatment, the handouts on common
illnesses reduce telephone calls for information only.
The handouts on specific illnesses (e.g., asthma)
prevent call-backs about drug dosages. The handouts
clarify for each topic when to call the
physician--immediately, during office hours, or not at
all (i.e., when it is safe to continue to treat a child
at home). They prevent unnecessary calls about minor
symptoms (over 50% of calls) from worried parents. More
importantly, they prevent undercalling from parents who
might overlook serious symptoms--e.g., a lethargic
newborn, drooling, signs of dehydration, swollen
scrotum, bulging soft spot, stiff neck, and purpura or
petechiae.
Keep in mind that parents don't like to make unnecessary
phone calls since it often requires several attempts
before they can get through to your office.
- Increase parent satisfaction.
Most parents love printed materials. They like to leave
the physician's office with a piece of paper. Giving
parents something tangible is one way to show we care.
Information sharing also shows that we consider them
partners in health care and that we respect their
thinking and common sense. If given in the waiting
room, information sheets show that we value their
waiting time.
In the case of recurrent illnesses--e.g., colds and
diarrhea--printed handouts save parents time and money.
This is important to them, especially if they both work
outside the home.
If parents post handouts on their refrigerator and the
physician's name is printed on them, these handouts can
become a marketing tool that attracts new families to
the practice.
- Help with the delegation of tasks to office staff.
These computer-generated instruction sheets can serve as
standard protocols (standing orders) in a physician's
office. The office nurse can use them to debrief the
patient after the physician has arrived at a diagnosis.
They can be used as standard protocols for triaging
incoming telephone calls in an efficient and safe
manner. The requests for telephone advice seem to be
increasing, possibly because working parents don't want
to come in unless absolutely necessary. The
time-consuming routine task of telephone triage and
giving advice can be delegated safely.
