Retention in Patient Empowerment

Our clients seek us out to understand the 'why' behind their pelvic problem and the 'how' to make it function better...and that's not always an easy topic.  Patient education, scratch that, patient 'empowerment' is one of the most important tools we can give a client, so I was quite surprised when I read yesterday that "40-80% of medical information provided by healthcare practitioners is forgotten immediately" furthermore, "the greater the amount of information presented, the lower the proportion correctly recalled" (McGuire, 1996).  Woah! I always felt there was an art to patient education, especially in pelvic health which poses its own unique set of challenges. The pelvis is one of the most emotionally vulnerable, anatomically complex areas of the body whose functions significantly impact one's quality of life. So, how can we improve patient understanding and retention? Evaluating and treating conditions of the pelvis requires a heightened demand for patient presence, professionalism and ability to disseminate complex concepts in an easy-to-understand manner.

Patient ease and neural unwinding

Often times before even beginning treatment I need to listen to the patient's perception of their situation, it's impact and the neural 'wiring and firing' that could support or impede their treatment. Some clients come to me having just received a diagnosis that they are identifying with, even owning, but don't completely understand. Before the patient ever makes their first appointment, they may have made a concsious decision about what to resign from their life or how to 'deal' with their new norm. It's time to unwind. 

Wessel et al, wrote about 'attentional narrowing' which occurs when stressful events, such as receiving a diagnosis, perpetuate stressful emotion. The diagnosis can become the central message making it difficult to process other helpful information. Listening for mind mapping or the story that a patient is living can provide wonderful cues about where to begin with education or provide reassurance and offer a plan. 


The confused mind says "no."

You're smart, but avoid information overload! The confused mind says 'no,' shuts down or the patient may end up beating up on themselves for cognitive difficulty.

It goes without saying, avoid difficult medical terminology. This is one of the biggest factors in forgetting information or inability to synthesize it in the first place. 

Refrain from too much patient education during an internal assessment. Patient retention is usually better after they are dressed and comfortable or at least review your findings.

In sales they say, "1 fact, 1 story." You could bombard your patient with all of the benefits of an exercise or a new self-care strategy, but it's good to keep it simple. For example, "this standing hip flexor stretch could really help your back pain and improve your urgency..." (then paint the picture of how it will fit into their story)..."I know you are really busy taking care of your children so maybe we can do it in standing so that you can work it in while you are waiting in line at the grocery store or watching them play."

A good rule of thumb in presenting or patient education; "Tell them what you are going to tell them, tell them, then tell them what you told 'em." This came from my dear cardiopulmonary professor Dr. Scot Irwin. We will expand upon this in next weeks blog post: 'Visit Structure and Patient Control.'

Less Audio, More Visual

Do you remember struggling to grasp the 3-dimensionality of the pelvic floor and its supported contents during your first pelvic floor course? Now, imagine trying to wrap your head around the functional interplay of the pelvic floor and the bladder or bowel without your course manual or slideshow content. Ooof!! 


I love my pelvic model. I just love it. Day 1, prior to internal assessment, I show my patients how the pelvic floor muscles provide the four pelvic floor functions 1.) sphincter control 2.) support 3.) sexual appreciation and 4.) stabalization, focusing on the function that is most pertinent for their referral. Can't afford one? Well, maybe you are closer that you think. Check out this pelvic floor model from Vision Specifics for 80 bucks!

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Did you know that in most instances, medical advice is spoken, but patients are more successful in remembering written content? Patient adherance to home programs improves with visual content. Having your patient handouts in one place, professionally created & easy to read is SO helpful! Unfortunately, most of us are spending hours creating content or re-scribbling common patient education points during treatment. I've been there. It is so inefficient. The Bladder Book contains patient education handouts pertinent to bladder health for the medical practitioner. Each handout costs about $3; a worthy investment and time-saver. 


Social media has proven that we are attached to our cell phones and like to look at ourselves. Just kidding, but seriously...if the patient is having difficulty working in their exercise of could work on their form, ask if they wouldn't mind if you film them (with their cell phone) while you are instructing them in technique. And, if they don't like looking at themselves, then ask them if they would like to film you. 



Think back to one of your biggest 'Ah-HA!' moments...maybe it was in school, or church, or in a medical practitioners office. Who delivered the information? What impressions did they leave? Maybe you don't remember precisely what they said, but you learned and it was a defining moment for you. Just don't forget, it's not just the knowledge we impart for our patients, but often it's a much greater message and one we never precisely spoke. 

“I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” -Maya Angelou


Author: Susannah Haarmann, PT, WCS, CLT

Reference list:

McGuire LC. Remembering what the doctor said: organization and older adults' memory for medical information. Exp Aging Res 1996;22: 403-28 

Wessel I, Van der Kooy P, Merckelbach H. Differential recall of central and peripheral details of emotional slides is not a stable phenomenon. Memory 2000;8: 95-109


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Susannah is a board-certified Women's Clinical Specialist by the American Physical Therapy Association. She is a private practice owner in Asheville, North Carolina, teaches nationally in pelvic health and internationally in breast oncology rehabilitation. Susannah is the Author of the Your Core PT book series; patient handouts on bladder and bowel function and body care after breast cancer treatment.