To the Editor: With the increased importance of improving both quality of care and patient satisfaction, providing patients with information about health, illness, and treatment is an important issue in health care. Psychiatric patients in particular need such information because improved outcomes depend on medication compliance, which, in turn, is related to patient satisfaction. Patient satisfaction has come to be regarded as a prerequisite of high-quality care (1).
Although educational materials such as pamphlets and posters are standard fare in most physicians' waiting rooms, the effectiveness of this form of "environmental patient education" (2) is still relatively unknown. A review of the literature found only two studies that investigated the effectiveness of this type of educational approach (3,4). Both studies were conducted with a general-practice patient population, and both used self-report questionnaires; however, the results of the studies differed. Ward and Hawthorne (3) reported that patients aged 50 and older were more likely to read the posters. Waiting time was also found to influence poster reading: patients who waited longer were more likely to read the poster and remember the subject of the poster. On the other hand, Wicke and colleagues (4) found that patients aged 61 and older were less likely to recall poster topics and that waiting time was not associated with recollection. Unfortunately, these findings shed little light on patients' behavior in this setting and provide no information about patients treated in a psychiatric setting.
In 2002 I conducted five thorough observation sessions in the waiting room of a community mental health center that serves patients with schizophrenia and related disorders. I observed that the vast majority of patients appeared not to be reading or taking the educational materials provided. Of more than 20 patients observed, one woman picked up a pamphlet; however, she did not read the material but placed it in her handbag.
Is placement of educational materials in waiting rooms an effective form of patient education? More important, is this use of passive education replacing or diminishing a more clinician-initiated or active educational approach? Specifically, are clinicians assuming, and perhaps wrongly so, that patients are obtaining information in the waiting room and thus not providing patients with information that they otherwise would?
In attempting to answer these questions, it is important to determine the factors that influence patients' likeliness to read or take such educational materials. These factors might include the nature of the clinical visit, the type of clinical environment, or how the presence of others affects a patient's behavior in the waiting room. Until more is known about the "culture of the waiting room," perhaps the best advice for clinicians is the following: If a pamphlet is important or relevant enough to be put on display in the waiting room, the clinician should give it to the patient directly. In addition, clinicians should always read this material themselves.
Mr. McGrath is a graduate student and Dr. Tempier is an associate professor in the department of psychiatry at McGill University in Montreal. Dr. Tempier is also chief of continuing care at McGill University Health Centre.