By Lawrence M. Pawola, PharmD, MBA

When consumers have more information, do they indeed make better decisions? With the availability of a variety of magazines and newsletters documenting the best this and the best that, do we as consumers make better decisions for our lives? With the Internet coming on strong as the world's ad hoc but official knowledge source, there shouldn't be any bad decisions, right? If everyone had all of the best information in front of them, then wouldn't they always make the right decisions? Even the automotive brands with the lowest safety ratings or the worst mileage still have their loyalists. Well, you get the picture.

Two Cases
I would like to talk about two cases where well-meaning information was provided to patients without securing the intended results.

Mrs. X, a patient in our cardiology clinic, has been receiving prescriptions for warfarin for many years. I, among other clinicians in our clinic, have personally instructed her not to purchase any medication without contacting us or talking to her pharmacist first. Because she was a long-term patient, we were confident she understood her medication and disease-state issues. In spite of our confidence and previous warnings, Mrs. X recently purchased some vitamin C "for a cold" on the advice of one of her friends. Her monthly INR showed something was wrong, yet she struggled with thinking of vitamin C as a drug that could have impact on her warfarin. After all, she told me, "It was only a vitamin..."

Mrs. Y received a prescription for metformin from one of our physicians and went to her local pharmacy to get it filled. Like most pharmacies filling a new prescription, a patient information sheet was given to Mrs. Y; while reading it, she became upset. In addition to the information sheet being four pages long (and probably losing interest upon becoming confused), she became concerned about the side effects she was to expect after taking her first dose. "Is this all really going to happen to me?" Like most newly diagnosed type 2 diabetics, Mrs. Y has been struggling to absorb all the new information she has been given about her condition, in addition to the four page "about your medication — Metformin" sheets she received from her pharmacy. The problem is that she didn't take any of her medication until she came back to our clinic for her next monthly check-up. Why? She said, "I was scared."

The above cases involve patients who received a great deal of well-intended information from their healthcare providers and still made the wrong, and possibly fatal, decisions. The above cases also represent failures of healthcare professionals to recognize the need for continually reinforcing health education. Mrs. X had been told numerous times not to take OTC medications because of the possible drug interactions with her warfarin; Mrs. Y was overwhelmed with more information than she could assimilate and shut down, allowing another month go by without her diabetes being treated. Why did this happen?

Too Much Data
In our modern society, patients have access to a phenomenal amount of data, some of which is very good, while some may be devastating in the wrong hands. Additionally, patients have developed enormous and at times often unrealistic expectations about their health providers and treatments while being bombarded with health data through the media. Unrealistic expectations are many times the primary reason patients become frightened, frustrated, angry, and dissatisfied with results. Often, a patient's expectation is so high that a favorable outcome is seen as a disappointment, or a well-known complication of therapy is perceived as negligence.

As healthcare providers, we must not take our patients' education for granted. We must not assume that patients are comfortable with their medical situations. Patient education is among the primary responsibilities of all healthcare professionals. We must make the time to explain, probe, question, and interact in a pleasant way so that the patient can absorb, assimilate, formulate additional questions, and ultimately understand with comfort and trust. We must revisit issues with long-term patients, assuring they are constantly "in tune" with treatments and protocols. We must use our experience to stress the importance of good care, continued follow up, and expected outcomes, not just once, but over and over again. We must take into account patients' abilities to hear and effectively process all of the information they are receiving, and in particular those patients with newly diagnosed chronic disease states.

Call to Action
Reinforcing health education is particularly critical in the ambulatory setting where the patient is out of the provider's constant acute care control. Thorough education in the ambulatory setting keeps patients healthy, keeps chronic disease states from worsening, and reduces overall healthcare costs. The patient should become your partner to reduce the chance of serious health issues later in life. In today's world where outcomes are under increased scrutiny, informed and empowered patients are better able to achieve healthier outcomes through improved communication and the development of trust with their healthcare providers.

It is always discouraging when patients ignore my advice to stop smoking or change their diet or take their antibiotic until finished. But, I also recognize patients are human beings who resist change, particularly when the change is to withhold something they enjoy. We each assimilate information differently, many times choosing to selectively hear what is pleasing to us while ignoring the rest. Since we are humans, we are always looking for the next best this or that, and often don't like to hear anything that may be perceived as criticism.

I have found it important to follow up, question, observe, and be pleasant so that there is greater chance my patients will buy into my suggestions and ultimately see the benefits. This process is repeated at each patient visit. Every patient interaction is an educational opportunity that must be fine-tuned to the needs of the individual to maximize the possibility for mutual respect and cooperation. Our patients may not know it, but their lives depend on our ability to properly address their education needs.