Factsheets for Patients

What type of information needs a factsheet?

Musculoskeletal Conditions

Factsheets provide information about a recommended treatment. This article focuses on musculoskeletal (MSK) conditions, particularly those related to foot surgery. You will find some useful links in this article and general comments about the factsheets. The most important information that a factsheet should convey is risks from treatment and choices.

The internet these days offers much of the information we need, but many articles are sponsored or promote a product. There are three principles to observe.

• Is the information current and recognised?

• Who produced the information?

• Does it contain what happens if things don’t work out?

The information in this advisory article does not imply that the person treating you is not the right person, but it will assist you in your need for the right type of information. Regulators and professional health bodies advocate providing patient information in an accessible format.

Is your information sheet current?

There is nothing worse than having a bleached photocopy conveying hard-to-read information. Ask for a better copy. Professionally printed copies are better, but if a sponsor produces them, the data is likely written generically. This means it is not specific to the practitioner you are consulting. 

Treatment should be recognised by a body of professional peers, and if it is experimental—i.e., not currently used in mainstream practice— then be cautious.

Fat Atrophy in the foot one of my recent articles covers the use of experimental treatment.

At the bottom of an information sheet, you should see when the material was first published and often a second date when the review is expected. This is helpful as it informs you if the information is up to date.

I began writing consultingfootpain articles in 2014, using my own data to show patients the successes and problems I had audited. If the national data suggests an infection rate of 0.2%, but the surgeon has an infection rate of 0.7%, does this matter? In reality, infection rates for bunion surgery, for example, are 5-7%. No, as long as the data does not show a considerable variation, even clinicians are reluctant to admit failures.

When an orthopaedic surgeon was asked about the risk of complex regional pain syndrome, I was awaiting knee surgery. He mentioned he had never encountered such a case, but I was able to read his paper on knee surgery. There, in black and white, he recorded one such case. Of course, this was an oversight, and how easy it is to forget unless one focuses on such a condition.

Where to Go for Information?

Does it matter who produces information? No, not really. The most important matter is that the information is current, appropriate and recognised by a group of peers within the same speciality. Of course, each clinician may have a slightly different approach, and it is helpful to embrace those personal aspects of care. Here are a few thoughts on where to find some national-based information.

PLEASE READ MY SHORT ARTICLE ON WHERE TO GO. USEFUL LINKS TO FOOTHEALTH INFORMATION & TREATMENT

Few organisations provide dedicated information just about feet unless, as in the case of diabetes, feet play a significant role in the disease and loss of limb. ConsultingFootPain tries to bridge the gaps. 

Doubtless, with social media, everyone has something to say, and there are many unregulated sites. Making sense of what is true, accurate and reliable is a problem facing many patients.

What happens if things don’t work out?

Fact sheets provide data and hard statistics about conditions that can be treated. It isn’t easy to write about every procedure affecting the foot. We strive to provide the most accurate impression of expectations.

As clinicians, we must avoid being overly persuasive. The bulk of information should be provided before any treatment starts. It is important for all of us, patients and clinicians, to ensure those risks, no matter how small, are included in the discussion.

Fact Sheets versus Generic Information

I would make a distinction between factsheets and general information. Here is my take:

You want to travel from Birmingham to London. Facts about that journey include the time it takes, cost, services available en route, the speed you might travel, and options for first and second class. These are all fixed and known, although they might have variables or ranges: 95 – 120 minutes.

General information will provide you with how you might get there. This could include some options together with the dos and don’ts associated with travel. It may consist of instructions on how to connect to the internet while on the train.  What about the type of food and drink available? Choices might include road travel, flight, and train.  

Specific information about clinical treatment might be used to distinguish the fact that one person might use a different type of treatment from another. Information is governed by the limitations of an individual’s practice experience.

My current guidebook on bunions goes beyond fact sheets and delves behind the scenes, offering many answers to questions often forgotten.

Dialogue is Important

An introduction to fact sheets is important at every consultation these days. Factsheets do not and cannot tell the whole story, but they do provide a flavour and cover essential points, often curated for common risks and outcomes. Fact sheets do not always tell you about alternative treatments. Should you proceed with treatment (especially surgery)? That is the measure of a good factsheet.

In accordance with current legal views, it is important to have dialogue. The patient should try to ask as many questions as possible. Reading the information and then returning to a clinical office to discuss those points is more effective than relying on written information alone. A patient should be encouraged to return to the clinic before interventions to ensure all is understood. I have always encouraged my patients to write down their queries to avoid forgetfulness, or, of course, contact me.

Minor interventions do not always require much preamble.  In this case, choices would be limited, the risks and impact minimal, and the overall understanding would be less complex. Examples might include injections to dull pain or simple remedial toenail management. There again, if one searches, one can die from an untreated ingrowing toenail!

Nowadays, most clinical services will provide either a stock fact sheet printed by a professional body or one printed in-house. Always ask for written information, as this is now standard practice in all professional fields of medicine.

Thanks for reading 'Factsheets for Patients' by David R. Tollafield.

ConsultingFootPain is part of Busypencilcase Communications & Publishing.