Good fact sheets follow good consultations

If you have read my short article Getting the best from clinical information here is the follow-up article offering a little more meat. What should you ask from a fact sheet?  The answer must be equally simple. Factsheets should be well written, have few spelling mistakes and be easy to read. They should be laid out well and ideally not photocopied to death. Well, presented factsheets show the clinician cares as much about you as the information that is offered. 

The 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. You do indeed have a choice. Having been a patient as well as a consultant, 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! 

There is a balance between using complex words i.e bunion is simple. Hallux valgus may be harder and hallux abducto-valgus takes us to Wonderland! A bunion is a bump and is often thought of as part of the bent big toe. However many do not mind the more complex term hallux valgus. When we call it hallux abducto-valgus all we mean is that the toe rotates and bends together. This might be too much information as we need to know (1) that this is a deformity and (2) can it be fixed? (3) how easy is the treatment and how will it affect me and (4) what do I need to know about the process.

Avoid what patients say

“I’ll leave it to you as you’re the expert”, the patient says, adding naively – “You are the expert.”  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. 

“I am your last resort! I’ve been everywhere and hope you can make me better?” You are now creating high expectations when you need to ask, “is my foot fixable and if not is there anything that will help?”

Now a good clinician will tell you what is possible, what is definitely not possible and maybe advise someone else if he or she feels you might be placed in a better hand.

I had a patient referred to me who had absent circulation. Now I could fix joints and deformities, limit the pain and protect vital tissues, but I could not make his circulation better. I found out she had a blockage at the knee and he needed a vascular surgeon. What had just happened was that I could figure out the problem but fixing the problem was outside my skill set. However, I knew someone who could help. This is what being a specialist is – NOT necessarily fixing everything. We work as teams in modern medicine to offer a broad package of care to patients. GP to podiatrists, podiatrist to specialist.

Enter the fact sheet. 

  • 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 of any conversation but covers the most important parts that you MUST know
  • it should help you consider your priority. When to have something done.

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 that have a deep interest in foot surgery are the Royal College of Podiatry and the 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.

Drifting 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 US English translate to British English and in reverse? There is no one reliable system so this is why I wrote a book, Morton’s neuroma and Bunion Behind the Scenes to fill in the gaps. Given so many conditions even for the foot, it would be difficult to cover everything but my website offers a reasonable range.

The Patient Journey

The Patient Journey is unique and some patients write about their own experiences in 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 suggesting where everything went well is not as helpful as one might think. We know that treatment pathways, as we call the journey, are not garnered by 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.

Fact sheet example

Here is an example of a Factsheet about surgery on a rigid toe joint. Note that it was published in 2018 and it was designed to be printed off or read on a laptop rather than a Smartphone or tablet. It provides some key information, but there are some areas left out that the patient and his/her specialist need to fill in. The next example covers bunion surgery as an article which will open up on SmartPhone and tablets: What you really need to know after bunion surgery?

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 published data called PASCOM-10 which is specific for feet. The system is owned by the Royal College of Podiatry.

The other problem with factsheets is that once material runs to many pages of typed lines it is easy to put this 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 a portable digital file (PDF).

Good factsheets follow good consultations

A good factsheet tells you something about the condition and how it occurred. I will call this knowledge you desire; what, why, how…? You may have been born with a hammer toe or it may have occurred during your life. An infection may have come from outside or inside your body. How does it impact you? Well, treatment may cure you in 90% of cases. This percentage is not a guarantee but shows that there is a good chance of success. 

The next thing you are going to want to know is will it impact 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 your life so prior knowledge is important before embarking on a treatment plan that is likely to affect you.

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 – a different shoe, stick, dressing, or removable appliance? Self-help is desirable but may not fix the problem but only minimise the effect. If treatment cannot wholly remove pain, deformity or allow complete restoration to normal, you should know this and how to cope with some kind of disability.

Investigations

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. Why not read – Does it matter which foot bone you break?

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 to mean surgery. Modern clinical practice now discussed treatment plans and pathways with patients eg digital neuroma– in this article, there is an example of a clinical algorithm to treat a nerve.

Planning your treatment is a process that requires your permission, your wishes and your understanding which we call consent. Your written information will add to the confidence but don’t forget that it must be read and understood and that you are free to ask questions. If the podiatrist is busy ask if you can send an email or simply leave a message for the clinician to get back to you. 

Not included on clinical factsheet

The following information should be available. If I have to pay or want to pay, how much is it? This 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 does require any direct payment for treatment. Additional information that might follow includes what to know about admission, going home, physiotherapy, and 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 will list your choices and highlight any 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 information on the internet
  • In my series of electronic factsheets launched from my website, I have used the 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 your 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 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 Royal 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 CHECKLIST

  • 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 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 BLUE to help you with consent).

OUR AIM 

To provide reassurance, choice, knowledge, understanding of the consequences and the ability to act upon the decisions made confidently.

We call this informed consent.

Thanks for reading ‘What should you ask from a Fact sheet’ by David RTollafield.

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Published by Busypencilcase Communications. Est. 2015 for ConsultingFootPain

The article on factsheets has been incorporated in Selling Foot Health as Podiatry written for clinicians (2020) and available on Amazon books

More information about foot health can be found  in this 2021 publication. Foot Health Myths, Facts &Fables. Available from Amazon books


Published by Busypencilcase Reflective Communications Est. 2015

First published April 2019. Reviewed 28 March 2021