What should you ask from a fact sheet?
The question is fairly simple. What should you ask from a fact sheet? The answer must be equally simple. 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. You can also read my introduction to factsheets article.
Here’s Your Basic Toolkit
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’re 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 instill confidence. Assuming the consultation or if you like the precious time-period shared with your healthcare professional was 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 it 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 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 that not all treatment pathways as we call the journey are garnered with smooth travel.
While I am a great fan of fact sheets 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.
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 the patient and his/herspecialist 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 published (PASCOM-10). 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. The modern use of hyperlinking is wonderful but cannot work with a typed sheet or if a portable digital file (PDF) has been used this may knock out the links.
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 your 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?
The foot is part of the skeleton also known as the musculoskeletal system (bones and joints, muscles and ligaments). Do you need an investigation? x-ray, blood examination, urine and so forth. An x-ray won’t tell us about skin and soft tissue only about the hard stuff and joints.
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 and might mean surgery. We also have the usual types of treatment or therapy.
Do you have a choice? If I have to pay, or want to pay, how much is it? That bit won’t be in a fact sheet 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 on the importance of each element.
What form can information take?
There are several ways you may be given a fact sheet 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 ‘YouTube’. 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. Having said that I have made some YouTube films for a little longer than 5 minutes here is an example bunion pad.
- 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 ‘YouTube’ where appropriate. One of my recent finds was a website published by an American-Canadian source, although this tends to be biased toward surgery FootEducation.com
Information check list
ALWAYS read information through before a new consultation.
Make your own notes if a return appointment is indicated. If you receive the information in the post it is for you NOT YOUR MEDICAL DOCTOR. One patient received such information after a consultation and failed to read it because it had her doctor’s name on the letter.
Read the information through as 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.
As podiatrists our AIM is
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’ written by a patient and David Tollafield.
This article has now been incorporated in my latest publication Selling Foot Health as Podiatry.
Published by Busypencilcase Reflective Communications Est. 2015
Updated July 2020. First published April 2019.