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Editorial February 2010
The Difficult Challenges of Counseling in Today’s Environment
Ronald T. Burkman, MD
The challenges for practicing ObGyns continue to grow. The potential effects of health care reform, concerns about liability, and changes in the nature and expectations of the workforce have made many practitioners uneasy and uncertain about what the future holds for them. On top of this, we face challenges with the discovery of new technologies and pharmacologic therapies almost daily.
How do we counsel patients requesting information on these discoveries when we can barely keep abreast of these changes ourselves? Further, although drugs and technology have had their place in advancing the health of women, it is also clear that lifestyle issues are of great importance to one’s health.
Thus, as gynecologists, we are called upon to address diet, tobacco and alcohol use, exercise, supplements, and complementary medicine, as well as emerging recommendations such as the new mammographic and Pap test criteria. Similarly, in obstetrics, we address many of these same issues but to them we add exposures that may affect fetal health and, in particular, the rapidly growing field of prenatal diagnosis. For example, with the expanded use of proteomics requiring very small amounts of cells for analysis, fetal diagnoses may ultimately be made from fetal cells in the maternal circulation, thus obviating the need for more invasive testing.
There is little time in the day to absorb this glut of new information in a way that we can readily incorporate it into our practices and provide effective counseling. We all desire to dispense information on a given topic area that is consistent, accurate, appropriate for the individual needs of a patient, and effective. However, do our patients really understand and retain the facts we verbally provide? When we counsel them verbally, is the message clear and understood? Despite the plethora of written handouts that supply significant information on a given topic, are they effective in conveying the key counseling points?
Because both patients and health care providers often are
on tight time frames, one can question whether the current standard approaches are getting the job done. Further, it is well known that the learning styles of today’s generations X and Y are different. They relate far more to visual images than written or even spoken words. The decline
or disappearance of traditional newspapers in most cities and their replacement by the rapidly paced imagery of television programs like Headline News would support this shift. Thus, there
is a need for new, innovative approaches to counseling.
We must establish which types of counseling approaches on complex health issues will effectively meet the educational needs of the majority of our patients. Using current information technology, counseling programs can be developed that are interactive, contain visual as well as audio material, and are computer-based through CD-ROM or Internet-based programs. Ideally, such programs will also test a patient’s comprehension of the material upon completion. Also, they could be individualized for patients with special needs by providing different pathways within the program based on interactive responses. Once appropriate platforms are established, additional information can be offered as the need arises.
Although the initial investment to develop the computer platforms and educational material will be substantial, it will be worth our effort. Unless we utilize such technology, the likelihood that our patients will be either misinformed or unable to comprehend what we say will increase. In my view, as
we focus on electronic medical records for the future, supplementing them with this type of component will be crucial as well.
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Ronald T. Burkman, MD, Editor-in-Chief |
