On Patient Education

I gave a talk at one of the local acupuncture schools a while back about Community Acupuncture. I had a lot of fun. The students were interested in this new idea and were thoughtful. They asked good questions. They also ask me how did I find time to do Patient Education. You know - about diet and lifestyle modifications. I told them two stories.

Just before I went to acupuncture school, I was a family nurse practitioner. In that role I did a lot of well woman exams – the “yearly” pap and pelvic, etc., put women on birth control pills and counseled peri-menopausal women about hormone replacement therapy (HRT). When it came time for me to go for my exam, I went to the MD at the HMO my job paid for. She asked me about HRT. I was past menopause and this was in the time they were touting HRT as prevention for cardiovascular events, rather than after the big study came out that said HRT was causing CV events in the first year. The big risk at the time was an increase in breast cancer after taking HRT for 5 years in women who had never had children.

I told her what my job was, that I had taken HRT for 5 years, that I hadn’t had children and I was not interested in further HRT.

She said, “OK, but…” and lectured me about how I should go back on HRT to prevent a heart attack.

I was so angry with that woman I could hardly speak. I told her no, got dressed and left wondering anyone had ever taught her to assess her patient for readiness and appropriateness for Patient Education – or even to listen to her patients before she gave me Patient Education.

I had an Ac patient who had elective bunion surgery scheduled for a few months away. She came to acupuncture because she was stressed. Her small business wasn’t doing well, she wanted to be married to her live-in boyfriend but he didn’t want marriage and this was stressing her morally. She was in her 50’s, worrying about how she was going to make it as she got older. This conversation took place in my office. After, we went to the community room. I took her pulses, put needles in and left her with the other people, soft instrumental music and the water fountain going. She came back the next week and said, “I canceled my bunion surgery – I’m too run down. I started eating better and I started exercising. I can’t believe I let myself get this stressed out!” I had not done anything but listen to her story and murmur sympathetically. No Patient Education.

I told the students that people often know what they need to do to improve their lives. They just don’t do it. I said I wait for people to ask me about what they can do to help themselves. If I don’t have time to talk with them that visit, I give them any written information I have on the topic and schedule an extra 10 minutes for the next visit. What I don’t do anymore is insult people by giving them information they didn’t ask for.