Health Literacy PIM 'Teaching Back' to Doctors

Dr. Cesar Arias has spent his career treating children in inner city neighborhoods in the Bronx, N.Y. and now in Baltimore, MD. He works in an urgent care clinic, and in the emergency room at St. Agnes Hospital.

Drs Arias & Noja

“We get some of the neediest children, many of whom don’t have (an ongoing relationship with) a pediatrician,” he said. “A lot of times, they come in really sick, but they bounce back quickly. They are so resilient. It’s rewarding when you can help them feel better quickly.”

Like many other physicians, especially with inner-city practices, Dr. Arias has seen an increasing number of asthma cases. Controlling asthma often requires complicated treatments with multiple medicines.

“I didn’t realize how many parents didn’t understand what I was telling them about their child’s asthma treatments,” he said. “When you’re prescribing corticosteroids and albuterol, and trying to explain which one to use once a day, and which one to use if the child has an attack – it really is complicated.”

He found the Health Literacy PIM very useful, he said, especially the “teach back” method, where the physician asks the parent or caregiver to repeat the instructions as if they were giving instructions to a parent.

“The ‘teach back’ method is really effective,” he said. “It helped me communicate better with parents, and make sure they understood what I was telling them about their child’s health and how to follow the prescription instructions. The treatment (for asthma) is very complicated, especially for parents without any medical education.”

Dr. Arias’ wife is also a physician. Dr. Corina Joje is a pediatrician in the intensive care unit at Johns Hopkins Hospital in Baltimore and an assistant professor of anesthesiology and critical care medicine in Johns Hopkins Medical School. Certified in general pediatrics in 2009, she said the preparation she received during her residency at St. Barnabas Hospital in the Bronx and her fellowship at Johns Hopkins (the In-Training Exams and activities) prepared her well for her initial board certification exam.

“I know from Cesar’s experience with the PIMs that the concept is the same as what we do every day in the ICU, which is to find ways to improve our practice,” she said. “Quality improvement is an ongoing process in the ICU, and that’s what the PIMs are based on.”

Two pediatricians working different schedules at different institutions don’t have a lot of free time together, they said.

“We take advantage of the few days we have off together,” Dr. Arias said with a laugh. “But we love the children, and being able to help them – that’s the great reward.”