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Interviewer: Three things patients should ask and three things all doctors should be sure their patients understand. That's coming up next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Sometimes as a patient when you're in clinic with a physician, you leave and you're like, "I don't know what's wrong with me and I don't know what to do about it," and you're just confused. But if you ask these three questions, and if you're a provider you make sure patients understand the answers to these three questions you could solve all the problems. We're going to find out more about the Ask 3 Program. Darren Doman, he's the Patient Education Specialist here at University of Utah Health Care. What is the Ask 3 Program and it sounds magical?

Doman: It is pretty magical. It's an initiative put together by the National Patient Safety Foundation and it's meant to just help improve communication between health care providers and their patients in efforts to improve health outcomes. So basically they synthesize every visit into three main questions.

Interviewer: Okay.

Doman: First, "What is my main problem?"

Interviewer: Yeah okay.

Doman: That's a good question.

Interviewer: That's a great question. That's why you're there.

Doman: Exactly.

Interviewer: Yeah.

Doman: Put a label on it, give it a name. The second question is, "What do I need to do about it?" And then the third question is, "Why is it important for me to do that?"

Interviewer: I love that because I think it synthesizes in very, three very quick little questions. Like when you're a patient you leave and you don't understand what just happened and you're trying to figure out, "What could I have done to change it?" I think this is perfect.

Doman: Absolutely and there's some research out of Great Britain that shows that when it comes to an outpatient doctor patient interaction, 80% of people leave that visit without accurately recalling any information that the doctor told them.

Interviewer: So it would be hard for them to tell their husband, their wife, their kids, anybody.

Doman: Exactly, but when they probed the 20% that remembered something a little bit closer, only half of them actually got it right.

Interviewer: Really?

Doman: So it's really 9 out of 10 people leave the doctor's office not able to remember accurately what the doctor told them.

Interviewer: That's pretty incredible and that's based on research.

Doman: Based on research out of the UK.

Interviewer: All right so the Ask 3 Program, "What's my main problem?" "What do I need to do?" "Why is it important for me to do this?" Is there any research on showing if people ask these questions what retention rates are?

Doman: Well the most current research that I read was showing that patients aren't actually asking these three questions.

Interviewer: Okay.

Doman: So we need to take a step back, revamp the program, and maybe think about it a little bit differently. Which I think is a perfect opportunity for us to talk to providers and say, "You know, here's three great questions. If your patients aren't asking these questions, why don't you just help them out and give them this information?"

Interviewer: Yeah just make sure that they understand these three things.

Doman: Exactly and that speaks to the need for open communication between patients and doctors to really get the message home. Patients need to be asking the questions, doctors need to be telling the patients the right things, and they need to be checking to make sure that the message was received.

Interviewer: So it sounds like a good idea as a patient if I go in that maybe when it starts getting a little confusing I just need to fall back on those three, you know? Because sometimes the issues get a little muddled right?

Doman: Absolutely, and just bring it back to, "Okay what's the main problem?"

Interviewer: "What do I need to do?"

Doman: And, "Why is it important to do it?"

Interviewer: And as a provider it might be a good idea after you tell them these three things to ask them, "Okay do you understand what your problem is? Tell me what it is." When I was in my communication classes that's all part of listening, it's all part of checking to make sure the person understand what you just said to them is to ask them to tell you what you just said to them.

Doman: Absolutely and providers who are really keyed into this can do it very artfully. They can say, "I think your main problem is this," and then, "Later when you get home what are you going to tell your spouse that your main problem is?" Just to check and see.

Interviewer: Yeah, because a lot of times we assume that the person understood us and we don't want to insult their intelligence by insinuating on some level that they didn't, but a lot of times people don't. I mean there's a lot of a thing that can go wrong with communication, it's not either individuals fault.

Doman: It's true, and double checking message received is never a bad idea.

Interviewer: What's keeping patients from asking these three questions do you think?

Doman: When it comes to patients asking questions in doctors' visits I always think its fear based. They don't want to look stupid in front of their care provider. Maybe they kind of know the answer but they're a little bit afraid of actually hearing somebody else say it. So there are reasons why they might not pipe up and actually ask.

Interviewer: But at that point it's important beyond your ego, beyond anything else, to clearly understand what's going on, what you need to do, and how important it is.

Doman: Sure, yeah.

Interviewer: And how about physicians, is there a barrier to them adopting kind of just these three questions making sure patients identify it? Is it something they ever thought about before?

Doman: I think it takes that moment of just engaging your brain and checking in rather than getting into too much of a routine. Everybody kind of gets their routine going, they kind of do it the same way they've always done it, in and out, keep the flow going. But if we can actually engage with the patients say, "Here's my new routine, here are these three important things that I need every patient to understand," I think we're going to have a better go of patient interaction, better communication, and ultimately better health outcomes.

Interviewer: Any final thoughts on the Ask 3 Program? I think it's brilliant.

Doman: I think its brilliant too, and just getting the word out to patients and providers alike that it's a conversation. It shouldn't be one-sided doctor talking all the time. The patient should have some input as well and if the patient doesn't know quite what to ask here's three good questions. Anybody who asks these isn't going to look stupid in front of their doctor.

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Interviewer: You know how when you go to a new town and you go into the hotel and you turn on the TV and there's a channel that the hotel provides that tells you what's going on in the town, gives you great entertainment information. Did you know that there's a channel like that here at University of Utah Hospital that also gives great health information? Bet you didn't. You're going to find out about that next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Patient Education TV is in every single hospital room at the University of Utah Hospital and it's a great resource if the patients used it, but that's kind of part of the problem right now. We're with Darren Doman; he's a Patient Education Specialist at The University of Utah Hospitals. Tell us about Patient Education TV and what's your problem that you have with it right now?

Doman: Patient Education TV is a great resource for patients. I think it would really help with the work load of nurses, other health care professionals, by letting patients answer a lot of their own questions. It works very much like a hotel welcome channel. Every TV in the hospital defaults to channel 79 which is the home channel for Patient Education TV, and it narrates instructions for how to operate it. So right off the bat the patient should be able to pick up the phone get the remote and dial into the system. It's a little bit clunky. You have to dial into the phone and answer a couple of voice prompts before you get assigned a channel where you can drive the programming, and you'll find on our menu slides all sorts of information.
There's information about visiting hours, or where loved ones could eat, or if they're from out of town where they might be able to stay, or how to reserve a spot in the RV lot for people who have an RV and want to stay for a week while a loved one is in the hospital. There's information about Pastoral care and what the guest services folks have to offer. I'm sure that these are questions that come up from patients to staff all the time and if staff were driving the patient to Patient Education TV they wouldn't have to give their spiel all the time about this service because it's right there on the TV.

In addition to the information on the menu slides there's a bank of about 125 health related videos. The patients can watch and learn a little bit more about why they're in the hospital or different procedures that they're having or even just watch a welcome to the unit. We've been doing some custom videos lately that have been really popular with the patients because they get a feel for what the unit is all about, how it operates, and what to expect.

Interviewer: So as a health care provider these spiels that you have that are five minutes long for every patient I mean that can add up over time so just directing them to this resource where they're there anyway they can find out the information on their own, could save a lot of time. How would this work? So a patient's in the bed step number one the health care provider comes in and says, "Hey this is something you might be interested in." Is that how that would go or...?

Doman: Sure, "Here's a service that we offer you might want to check it out," and if they're on the maternity ward and they're kind of a savvy 20, 30 something they might be able to navigate it and figure it out themselves. If it's somebody who's got their arm in a cast, or they're elderly and not real tech savvy, you might have to walk them through it the first time, but I've tried to make it as easy as possible. We have channel guides in each of the patient rooms. This tends to be really important information for the patients, they always want to know what's on the TV, and now we have a channel guide. On the back of the channel guide I've put operating instructions for the Patient Education TV System. That should help walk them through it, but still if a provider can kind of show them the first time how to dial it up and look at it I think we're going to be better off.
I'm piloting a series of slides that talk about pain management strategies so rather than just relying on pain killers and drugs, what are some other things? There's a music trivia set of slides, there's a visual maze, there's a little word find game, these are what we call "boredom busters" and they're distracters that kind of help people forget that they're in pain. There's also a video about relaxation exercises and pain management techniques that are non-pharmacological and we have some videos of just soothing music and imagery, or bird sounds, or wave sounds. So it's a really an interesting, unique, and different way for using the system but it's still educational for the patient and might help reduce the number of call lights because, "I need my pain pill," "Oh, I need my pain pill, you haven't brought me my pain pill yet."

Interviewer: Sounds like there's a whole wide array of content on the channels. It sounds really kind of cool.

Doman: Yeah, I think it's a great resource and I'd love to see it get used more often. My mantra as of late has been, "Tune in, watch, repeat."

Interviewer: Okay. So yourself use it, if you're a health care provider and tell your co-workers as well about this great resource.

Doman: I like it.

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