Abstract
Providing thorough responses to patient questions is an important part of the provider–patient relationship and key to good communication. Failure to do so puts patients at risk of looking for alternative and possibly harmful answers. Mindfulness is a popular topic, but due to its vague definition and variable outcomes, it may be difficult for health care providers to know how to answer patient questions or to identify patient needs. Using the One-Minute Preceptor model as a template provides health care providers a thorough yet organized and time-efficient method while also giving patients answers to their questions.
‘. . . increased access to health care information also presents challenges for health care providers.’
While disparities continue to exist in access to health care–related information, overall medical information is more accessible to patients via the Internet than ever before. Greater ease of access to medical information has many benefits including better informed patients, the ability of patients to take a more active role in the decision-making process regarding their care, increased efficiency in clinical visits, and greater access to personal health care information. 1 However, increased access to health care information also presents challenges for health care providers (HCPs). For example, the Internet allows patients to become pseudo-experts in aspects of their medical care, tipping the traditional balance of the HCP relationship. 1 Additionally, because the general public is not trained to evaluate the quality of a body of scientific evidence, patients can develop beliefs in the potential of a certain type of treatment when the evidence supporting this particular treatment may be lacking or the outcomes are potentially harmful. This presents further complications for HCPs in trying to provide optimal care to patients.
As discussed by Victorson and colleagues 2 and Rajguru and colleagues 3 in this issue, mindfulness may be appealing to many individuals who learn about this technique, yet the evidence supporting the effectiveness of this technique is lacking. The broad scope and, at times, ill-defined topics in behavioral medicine such as mindfulness, present unique challenges for HCPs to address in an office visit. 4 Because the concepts are often not well defined, it may be especially difficult for HCPs to fully comprehend what the patient believes mindfulness entails. Also, mindfulness does not fit into the pathophysiological part of medicine in disease and management with clear medical goals or purposes. 5 This creates barriers for HCPs to guide patients in reaching a goal through mindfulness.
Fad diets and popular weight loss interventions are another common area in which patients may present with strongly held beliefs in the effectiveness of a particular strategy that may be lacking scientific support or scientific basis and may even cause harm.1,6 While HCPs typically look at evidence-based medicine and epidemiological outcomes to make recommendations, patients often look at advertisements, diet Web pages, or personal testimonies of the diet. Though patients do ask for their HCP’s advice, inadequate guidance may result in patients trying practices on their own. As Internet use continues to expand worldwide, patients will continue to seek answers from HCPs in these and other behavioral medicine topics. Thus, knowing that patient questions will likely only increase, HCPs need to be equipped to address these questions in a time-efficient yet comprehensive manner. Being able to effectively respond to the triangulation of the patient, Internet, and HCP within the clinic visit has important implications for the provider–patient relationship.
The One-Minute Preceptor Model
One model that has already shown much promise in the clinical setting is the One-Minute Preceptor. This model was first introduced in 1992 as a method to teach medical trainees in clinical situations. 7 Since then, it has been used by numerous studies,8-11 and it continues to be used in current medical teaching practices. Reviews note that it is a thorough yet time-efficient and effective model in clinical practice.12-14 The model consists of 5 objectives or microskills for the preceptor to address with the trainee in review of a patient’s care. It is estimated that the 5 objectives will take 3 minutes and the discussion will take 1 minute; hence, it received the name One-Minute Preceptor.
Get a commitment: Assess the individual’s ability to define the problem: Ask what is the problem?
Probe for supporting evidence: Ask what reasons make this problem likely?
Reinforce what was done well: Provide the individual with positive feedback, creating a supportive environment in which constructive feedback can be provided.
Give guidance about errors and omissions: Provide constructive feedback and correction, especially for practices that may cause harm.
Teach a general principle: Provide the individual with a pearl of wisdom or take-home point.
In addition to a model for teaching trainees, the One-Minute Preceptor can be expanded to teach patients in the medical setting. For example, a patient presents to an office visit and states that he/she is interested in using mindfulness strategies. Since the concept of mindfulness is broad and patient understandings of the concept often vary, utilizing the One-Minute Preceptor may help clarify patient needs rather than potentially fluid ideas or beliefs. First, the HCP asks the patient to define the problem or explain the problem that he/she believes mindfulness strategies will be useful to address. The patient states a desire to include mindfulness strategies to lose weight in order to address his/her obesity. Therefore, a focused discussion on lifestyle modifications may be most appropriate. Next, the HCP probes for supporting evidence, for example, asks the patient, for what reasons do you think mindfulness will be helpful with weight loss. The patient explains that he/she desires to pursue mindfulness because he/she has read on the Internet or heard from the media that mindfulness strategies help with satiety. Thus, when discussing lifestyle modifications, including information on high-fiber foods and portion control could be beneficial to the patient. Then, the HCP reinforces concepts that are done well, such as encouraging the patient for expressing an interest in losing weight. Next, the HCP gives feedback to the patient about any misinformation or harmful practices, such as certain herbal supplements or laxative overuse for weight loss. Finally, the HCP finds ways to encourage the patient to initiate a weight loss attempt by leaving the patient with a pearl of wisdom, such as incorporating strategies that have demonstrated effectiveness to promote weight loss (eg, self-monitoring of food intake). Successful implementation of the One-Minute Preceptor with mindfulness identifies patient needs to encourage optimal patient care, avoid harmful practices, and increase confidence in the provider–patient relationship.
Specificity
One of the benefits of the One-Minute Preceptor model is that it encourages HCPs to be very specific with patients. Specificity is critical for behavioral change. Without it, plans are likely to become platitudes, and platitudes do not typically lead to long-term change. This is particularly important when addressing patients’ questions in session, to determine exactly what the patient is asking and also in giving recommendations for treatment. There are 4 dimensions of specificity: (1) action, what exactly does the patient intend to do; (2) target, what behaviors will be targeted; (3) context, what is the goal; and (4) time, what is the expected timeframe, duration, or frequency. 15 For example, in recommending self-monitoring, the HCP should first define that self-monitoring of dietary intake involves recording of all foods and liquids and their amounts consumed throughout the day. Decide with the patient if he/she will focus only on dietary intake or if other variables will be monitored such as satiety or physical activity. State that the goal is to increase awareness about food intake with the goal of promoting overall lower caloric intake. Finally, specify for how long the HCP would like the patient to keep these records and how often patients should monitor their intake. By addressing these 4 aspects of specificity, HCPs may have greater confidence in the ability of their patients to follow recommendations.
Summary
The One-Minute Preceptor, a model originally for trainees in medical settings, can be expanded for provider–patient interactions. It provides HCPs with a simple and organized yet thorough and time-efficient method to discuss topics with patients, especially for topics with vague definitions or variable outcomes. The model also allows HCPs to understand patient needs and the rationale for their needs while it also encourages positive practices, redirects misinformation, and gives patients a clear take-home point.
Conclusion
Provider–patient communication is crucial for patient care, mutual respect, and optimal patient outcomes. One area in behavioral medicine where miscommunication could easily occur includes topics such as mindfulness. Sometimes, patients come with ideas or beliefs that are not evidence-based and need guidance from their HCP. At other times, patients use a word or cliché that is interpreted in one way by the HCP but in another way by the patient. Using the One-Minute Preceptor for provider–patient communication in behavioral medicine topics is a promising model to address patient questions as well as provide a time-efficient, structured method for HCPs to answer these questions.
Footnotes
Acknowledgements
This work is a publication of the USDA (USDA/ARS) Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine (Houston, TX) and has been supported with federal funds from the USDA/ARS 3092-5-001.