Woundcare expert Paul Chadwick explains why understanding a patient's background is essential.
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Socio-economic factors can have a huge effect on the understanding, administration, and efficacy of healthcare. My experience comes from working with people in Salford, in the North West of England, who have diabetic foot disease. Salford has higher than average levels of deprivation and lower than average educational attainment. I have learnt how different levels of understanding can have a huge impact on the well-being of a patient.
From a sociological perspective, most of my patients have little understanding of foot disease and its treatment. At the most fundamental level, they don’t understand that foot disease can be preventable.
The most widely-held view is that foot disease inevitably leads to amputation. There is little appreciation that it is generally treatable, with very few people relating it to diabetes control, and even fewer relating it to any underlying pathology such as nerve damage or vascular disease.
Despite the great work of many charities in trying to empower and educate patients, there is still a significant disconnect. While it’s well known among every section of society that smoking causes cancer, the connection between smoking and peripheral arterial disease does not exist, despite its seriousness. Clearly, there is room for the healthcare community to paint a clearer picture in people’s minds.
Retention of information is another issue among foot disease patients. As a result, we have revolving door patients who aren’t particularly well-informed about something they’ve already had treated. Typically, they’ve had an ulcer, it’s healed, and they come back with another ulcer. But, importantly, they have no real understanding of how they got it and how they will go about treating it.
I’m optimistic this is changing. Practitioner-patient relationships are evolving and a shift towards patient empowerment is certainly helping. Increasingly, healthcare practitioners inform patients about their condition before they come to a consultation, with the aim of creating a two-way conversation rather than being purely didactic.
By updating patients with things like the status of their diabetes control, blood pressure, and their most recent foot screen, they can come better prepared to discuss the most relevant treatment options.
Despite this shift in approach, patients are still reluctant to rely on themselves. They are coming to see an expert, so what good can they do until then? More needs to be done to empower patients so they feel confident coming to experts armed with relevant, personalised knowledge and ready to ask educated questions and discuss treatment possibilities.
We must be more pragmatic and flexible in the way we communicate healthcare information, in my case to foot disease patients and those at risk of developing it. Understanding the sort of people likely to develop foot disease is a vital aspect of educating them about prevention and treatment.
We need to ask ourselves a series of questions. What is their demographic? What form of information does that demographic generally respond to? What is the best way to reach these people and are we leveraging that? The power of social media, for instance, cannot be underestimated.
The total reliance on expertise offered during face-to-face appointments is likely to lessen as the Google generation enters the patient group. Patients will come to the specialist armed with knowledge and questions gathered from the internet. But the importance of foot disease education will remain because patients’ knowledge is only useful for their treatment if it is relevant to their specific condition.
Paul Chadwick has been a Consultant Podiatrist at the Salford Royal Hospital NHS Foundation Trust for almost 20 years. He specialises in tissue viability, research, diabetic neuropathy and holds a PhD in the latter discipline.