Now for your last video. This time you'll use Side B because the patient brought none of her family members to the visit. In this clip you'll observe the doctor making a care plan with her patient. Notice how the doctor maintains a family-centered perspective and seeks to create a plan that fits within the patient's family context even though the patient's family is not present. She does this by using a relational question. Can you spot it?

Please use the last section of the FCOF (on Side B) to record your observations. Remember to add comments. If you need an explanation of any of the skills listed in this section please read below the video.

1. Develop plan with patient and family member input

Most likely your patient and his/her family member(s) did not go to medical school. They need your expertise in figuring out how to solve their health problems, but keep in mind that the problems needing solving are theirs, not yours. Even if you know how to perfectly fix their problems, they are still the ones who need to fix them. The solution could be as simple as drinking lots of fluids, getting lots of rest, or taking a medication; or it could as complex and intrusive as surgery, long-term therapy, or drastic lifestyle change. Whatever the treatment, if you do not have their input, buy-in, and agreement with what you recommend then you might as well not recommend it because they'll likely not follow through. Ensure that your treatment plan fits within the context of the patient's life and family life by asking for and including their input from the start.

If the a patient's family members are not present at the visit you can still develop a treatment plan that includes the family's perspectives and buy-in by using relational questioning (see previous page for explanation of relational questioning).

2. Invite questions

Have you ever passed someone in the hall and greeted them with, "What's up?" or "Hey, how are you?" Were you really asking them how things are going in their life or were you just saying hello? Sometimes when we ask the same questions over and over they tend to become more of a gesture than a true inquiry. If at the end of the medical visit, while moving toward the door, you say "Any questions?", have you truly inquired if they have any questions? Instead, stay seated, make eye contact, and say something like, "What questions do you have for me?" Pause and allow them to think. When they have none, ask the family member's, "Do you have any questions?" Be fully present with them till the end of the visit.

4. Ask the patient and/or family member to explain the plan (Teachback)

Friends, family members, advertisers, colleagues, teachers, politicians, and many other people say a lot of things to your patients everyday, each with varying degrees of importance and relevance. What you have to say could literally save their lives, yet one survey (1) of patients found that up to 80% said they forgot what their doctor had instructed them to do after leaving the office. It is critical that you verify whether they understood what you have told them. "Teachback" is a good way to do this. Simply ask them to explain back to you the plan so you can verify their understanding. For example, "We've talked about a lot of things today. Help me make sure I communicated clearly by explaining back to me what you're going to do now." Or you could simply ask, "How are you going to explain our plan to your spouse when you get home?"

5. Discuss any need for other professional involvement

You have a broad set of essential skills, but obviously some patients' needs are outside your scope of practice. This is of course true for patients' complex biological needs requiring specialty care, but it is also the case with complex psychosocial and emotional needs. One of the best ways you can help your patients is by identifying these needs and arranging family-centered specialty care. Don't just recommend specialty help and then hand them a phone book; instead, give specific referrals to specific individuals or agencies. If you don't know any specifically, learn them.

References

1. Schillinger, D., Piette, J., Grumbach, K., Wang, F., Wilson, C., Daher, C., ... & Bindman, A. B. (2003). Closing the loop: physician communication with diabetic patients who have low health literacy. Archives of internal medicine, 163(1), 83-90.