What should you ask from a factsheet?

A Feature Article

Factsheets should be well written, have few spelling mistakes, be easy to read, laid out well and ideally not photocopied to death. Well presented factsheets mean the clinician cares as much about you as he/she does about the information they offer.

Here’s a basic tool kit for the factsheet experience.

This should help drive your understanding of the consultation better. The factsheet will offer information about your care to help you make a choice. Having lived on both sides of the consultant’s desk i.e been a patient as well, I understand what I want and need. Don’t be under any illusion I am any more likely to be a worse patient than you will be!

As education has played an important role in extending our understanding of sciences, television has played host to horror stories and unsavoury conditions, and so we expect more for our investment.“I’ll leave it to you as you are the expert” is no longer acceptable, the patient says, adding naively – “You are the expert.”

As a former consultant I used to cringe at this inaccurately held belief of me being an expert, not least because I was often the last resort for foot pain and many good people had already tried their best. But, as a professional I had to instil confidence. Assuming the consultation or if you like the precious time-period shared with your healthcare professional is helpful, you will need an aid-memoire to take away so you can tell those nearest and dearest what was said and what was expected. Enter the factsheet.

  • So its acts as an aid to cover those parts of the consultation that need highlighting, things you need to know.
  • It provides useful data that  can be used to make a decision
  • It fills in gaps
  • it should help you consider your priority

What a fact sheet does not do

It does not answer all of your questions. This is simply because everyone has different views and a small percentage of patients decline detail. The two main professional bodies who have a deep interest in foot surgery are the College of Podiatry and British Orthopaedic Association. Both offer valuable information but of course like any information, and those published by private (independent) hospitals, the information is often simplified. There is nothing wrong with this until you need to make a surgical decision. Drift to the internet and ‘search’ for information and you will find plenty. I did this when I had back surgery and ‘ping’ it was North American / USA sources. Again, nothing wrong with this as there is plenty of material but does it translate? There is no one reliable system so this is why I wrote a book, Morton’s neuroma to fill in the gaps. Given so many conditions even for the foot it would be a difficult to cover all so I have focused on the top five initially.

The Patient Journey

The Patient Journey is unique and some patients write about their own experience with considerable detail.The day to day, even hour to hour, step by step description of human routine brings life into full colour expanding on the shades of those realities that can fill many  with dread. Harnessing a story with the facts and analysing the stages is important. In some ways publishing a diary where everything went so well is not as helpful as one might think. We know from our considerable database (College of Podiatry) that not all treatment pathways as we call the journey are garnered with smooth travel. 

While I am a great fan of factsheets we have to rely on the specialist’s advice and any other information offered. If you are like me I devour information with relish but there comes a point when only you as the patient can make your mind up.

Factsheet example

Here is an example of a Factsheet about surgery on a replaceable toe joint. It provides some key information, but there are some areas left out which patient and specialist can easily fill in. The reason that factsheets cannot provide all information is that for the most part they cover information from many sources. My factsheets are pooled from over 100 centres and in this case cover several thousand  patient feedback reports based on the data held by the College of Podiatry. The other problem with factsheets is that once material runs to many pages of typed lines it is easy to put aside for another day. Headings help guide you to the right place. Multiple sheets (probably more than 5) require an index to guide the reader.

Good factsheets follow good consultations

A good factsheet tells you something about the condition and how it arrived, that is unless you fell over and that swollen foot is now the obvious result of you acting less sincerely toward your own safety. I will call this knowledge; what, why, how… ?

The next thing you are going to want to know is will it impact on my life, for how long, can I go to work – or even should I go to work?  And can I go on holiday, go dancing, go to the theatre and can I cope, and will it get worse? If you are an adult you have responsibilities if you have a family, or you are needed as a core member of the household as a carer. These factors may impact on your life so that prior knowledge is important before embarking on a treatment plan.

Is there something I can do to help myself? Is it practical to fix the problem myself. Do I take medication or have something provided to help me get around – different shoe, stick, dressing, removable appliance?

Tests

The foot is part of the skeleton also known as the musculoskeletal system (bones and joints, muscles and ligaments). It is fixed several ways after the diagnosis is confirmed. Do you need tests? x-ray, bloods, urine and so forth. An x-ray won’t tell us about skin and soft tissue only about the hard stuff and joints.

Treatment

Do nothing, do something, rest. Use medication (pain and anti-inflammatories), sort out an infection, apply dressings or splinting, buzzy electronic treatments (ultrasound or extracorporeal treatment), add heat or cold, perform an injection (sometimes steroids) or carry out some type of procedure we call invasive which might mean surgery, then we have the usual types of treatment or therapy.

Not included

Do you have a choice and if I have to pay, or want to pay how much? That bit won’t be in a factsheet but it should be available as it is now a condition of independent health provision that no patient should enter into any contract to investigate or have treatment without knowing the cost. The NHS of course in the UK does require any direct payment for treatment. Additional information that might follow on includes what to know about admission, going home, physiotherapy, emergency call numbers, all of which are provided outside the factsheet. In some ways this information should be kept separate so you can focus in the importance of each element.. 

What forms can information take?

There are several ways you may be given a factsheet or information about your care.

  • This might comprise a drawing with key facts labelled. This lists choices and highlights risks
  • A leaflet will have a list of information offering a concise summary of key elements you need to know
  • A dedicated A4/A5 sheet may be produced that comes off the internet, or produced as a word document printed with or without diagrams
  • Some organised specialties have booklets, others may even have published books or recommend such a resource available from the internet
  • In my series of electronic factsheets launched from my website, I have used video film ‘You Tube’. The material is often American (US) and so I have selected quality narration, avoided music, only considered clear images, material that is not overly gory and should ideally run for no more than 4-5 minutes. 
  • Using an e-format allows a large amount of information to fit into a smaller space and remain obscured until required.
  • Casting you eye down the sheet you really want to know what effect any treatment decision might have. You must appreciate that all surgery carries risks and you need to place this in the correct perspective. Is a risk high but has a low effect and easily resolved, or is the risk low, but if it arises becomes a permanent part of your life? 

Your clinician may suggest you Google the information but having a website or link provided is better. Many electronic documents  as found on this website are linked to organisations such as NICE, that is the National Institute for Health and Care Excellence, NHS Choices or The College of Podiatry or even ‘You Tube’ where  appropriate.

What do you do with the information?

ALWAYS read information through. Make your own notes if a return appointment is indicated. This saves time, keeps you focused and prevents rambling or anxiety about missing anything out. You want the time spent with your healthcare professional be it GP, Podiatrist or Surgeon to be profitable. Make sure you ask is there a non surgical approach. Surgery carries risks but can be beneficial for many foot conditions some of which I will cover under Factsheets. Read the risks and impact factsheet (click on the coloured text) to help you with consent. 

Our AIM?

Reassurance, choice, knowledge, understanding the consequences and ability to act upon the decisions made confidently. We call this informed consent.

Thanks for reading ‘What should you ask from a Factsheet’ this article was written by patient and podiatric consultant David Tollafield. Let me know how close we are to getting it right? Use the reply box below.