Simplified medical explanations for patients

[Aunt Val]

I work in primary care and see a lot of patients who have very low health literacy and sometimes low levels of general education.  With some there is also a language barrier (various Pacific Islander and Asian languages).  So I find myself having to educate patients about their medical conditions in simple terms while trying to still being generally accurate in the information I give.  Most of my patients are adults.

Examples of typical situations I run into:

1.  Trying to explain to a 50-year-old obese man with BP of 170/100 who "feels fine" why it would be a good idea to change his eating habits and start a blood pressure medication.

2.  Trying to discuss a new diabetes diagnosis with someone who also "feels fine" but has a blood glucose over 300.  Why it is not a good idea for that person to continue to eat rice 2-3 times daily even though that's the cultural norm.

3.  Why you have to take different medications for different amounts of time, and why you need to follow my specific directions for your particular medication.  For example, you might only take Tylenol when your head hurts.  You can stop taking it once your headache goes away.  But you need to take an antibiotic for a full 10 days, even if your throat stops hurting after the first 2 days.  And you need to keep taking your metformin indefinitely to treat your diabetes; you can't just take it for 2 weeks and think that your diabetes is cured.

4.  Explaining latent vs. active TB.

 

Some of the explanations I use:

For HTN -- When you have high blood pressure, your heart is working too hard.  It can hurt your heart, kidneys, eyes, and your whole body, even before you know it.  When you start to feel sick, it might be too late to fix the problem, and bad things can happen, like having a heart attack or stroke.

For diabetes -- Cut back on white foods like rice, pasta, and bread.  Those foods turn into sugar in your belly and will make your blood sugar higher, which will make you more sick.  For the next 3 months until I see you again, try to eat rice only once a day instead of 2-3 times a day.  Eat more colorful foods like vegetables.  Less white, more colors.

Also for diabetes -- If you have too much sugar in your blood, the sugar will eat the nerves in your feet.  Then you won't be able to feel your feet.  You might have to get your toes or your feet cut off.

For latent TB -- You have TB germs inside your body.  Right now they are just sleeping in there, but sometimes they can wake up.  We have to get a chest x-ray to look inside and make sure the germs aren't waking up and making your lungs sick.  (I use a similar explanation about germs sleeping and then waking up for shingles.)

For antibiotics -- If you stop taking this medicine early, the germs that are making you sick will just hide, but they're not dead yet.  Then they will come back out and make you even sicker, and the medicine might not work anymore.  You have to take this medicine for 10 days so that all the germs are dead.  Use up all the pills in the bottle.  Don't save any for later.  And don't share with anyone else.  If someone else around you gets sick, they need to come in and get their own medicine.

 

So I'm curious.  What simplified explanations do you all use to communicate medical information with patients?  Any thoughts for improvement for the ones I've listed above?  Often when I use these and similar explanations, patients seem appreciative.  I want patients to understand and be motivated to improve their health, but I don't want to insult their intelligence.

[SedRate]

I use a similar approach with some differences like bacteria instead of germs, attack instead of eat, not active instead of sleeping. If pts don't seem to understand that, then I simply it further.

For chronic/progressive issues like HTN and DM, I tell them that they may "feel fine" now but damage is being done. We have a chance to slow down/stop that damage now before it's too late and causes really bad things like stroke, loss of feeling, amputation, etc.

If applicable, I use carpenter (MSK, bone), electrician (cardiac), or plumber (vascular, uro) references. Those seem to really help. 

[thinkertdm]

I talk to the patient to get a sense of their background, then use analogies based on that they can understand.  For example, I tell them their neuropathy is like a telephone cord that’s been bent too many times, and all you can hear is static.  
Sometimes you have to get creative, but it helps having a varied background.  I once told a fellow he had a “mass” in his arm, not realizing he had no idea what a mass was.  
Hypertension turns into pressure in pipes, sleep apnea is like a cheap straw with a thick milkshake (the dang straw keeps collapsing); diabetes is energy going into a car.  Fatty liver is like a filter on a vacuum that gets clogged…

biggest thing is to talk to them and see what they already understand, then build on that.  If they get annoyed or feel you are talking down to them, I just explain that that’s how I understand it, by making it super simple.  

[Aunt Val]

On 5/14/2023 at 11:56 AM, thinkertdm said:

I talk to the patient to get a sense of their background, then use analogies based on that they can understand.  For example, I tell them their neuropathy is like a telephone cord that’s been bent too many times, and all you can hear is static.  
Sometimes you have to get creative, but it helps having a varied background.  I once told a fellow he had a “mass” in his arm, not realizing he had no idea what a mass was.  
Hypertension turns into pressure in pipes, sleep apnea is like a cheap straw with a thick milkshake (the dang straw keeps collapsing); diabetes is energy going into a car.  Fatty liver is like a filter on a vacuum that gets clogged…

biggest thing is to talk to them and see what they already understand, then build on that.  If they get annoyed or feel you are talking down to them, I just explain that that’s how I understand it, by making it super simple.  

I love these illustrations!  Thanks.  I often ask patients, "So what do you already know about _________?"  Can be an opportunity to hear their base level of understanding and clear up any previous misconceptions.

[Febrifuge]

The ability to read how effectively the other person is understanding and to offer metaphors and comparisons, rephrasing the same idea in different ways, are a couple of the reasons I strongly support a liberal arts background rather than just pre-med or biology. These are skills, and they can be learned, but they don't get learned well when you're trying to memorize drug metabolism pathways. 

[UGoLong]

I work with a similar population.

For heart failure, I talk about making sure the weakened heart is pumping blood and not water, which is why the diuretic and fluid restrictions. That a nonspecific beta blocker makes the arteries bigger downstream so that the weakened heart can push more blood with less effort. Why the medication addressing heart remodeling is to make the heart stronger. Why we're waiting 90 days to repeat the echo because, if we both do a good job with all of this, they might avoid needing surgery for a defibrillator. And so on. 

[rev ronin]

19 hours ago, Febrifuge said:

The ability to read how effectively the other person is understanding and to offer metaphors and comparisons, rephrasing the same idea in different ways, are a couple of the reasons I strongly support a liberal arts background rather than just pre-med or biology. These are skills, and they can be learned, but they don't get learned well when you're trying to memorize drug metabolism pathways. 

My undergrad was in computer information systems; I was trained to be a systems analyst or analyst/programmer. Essentially that job is translating back and forth between computer geek and business geek. Throw in a lot of adult education experience, and by the time I was in PA school, I got to be rather good at explaining complex medical or physiological things to poorly medically educated people. Essentially, I just added a new set of jargon to the underlying skills.

[Patho]

Never thought standardized testing would ever be useful but the SAT analogy section was very good.

I often compare the human body anatomy and physiology to the way houses and cars operate (supporting structures, pipes, electrical systems, lubricating systems, etc.) 

There are definitely better ways to educate patients by using every day analogies.