Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

Understanding Instructions

When a healthcare provider takes care of a patient, he or she usually completes the episode by explaining something to the patient. For instance, if I treat a wound, before I leave the patient, I explain how to change the dressing, take care of the wounds, signs and symptoms of infection, how to take any suggested medications, when to return for a recheck, etc. But in thinking about how I make the communication, I don’t always write everything down for the patient, or even quiz the patient to determine if they comprehend what I have told them. Undoubtedly, some do not.

A recent study performed in the emergency department setting indicates that at least three quarters of patients do not fully understand the care that they have been given, or even comprehend when they do not understand their discharge instructions. Dr. Kirsten Engel and colleagues (Annals of Emergency Medicine 2009; 53:454-461) found that, “not only do the patients not understand the care instructions from their doctors, but the vast majority are also unaware that they have not fully understood what the doctor has told them.” One can always be critical of any study’s methodology – in this case it might have been more effective to include more patients and caregivers in the analysis – but even if the findings were not so dramatic, there is an important message in the results.

There are many reasons why a patient might not understand what has been accomplished for him. These include lack of an explanation, an explanation that exceeds the patient’s educational level (comprehension), language barrier, and distraction of the patient (by being ill, in pain, having altered consciousness, or other medical/social situation). Doctors are sometimes poor communicators, and are even caricatured as such. During a rescue situation, or when there are multiple victims, there may not be time to be a superb communicator. However, whenever possible, at least the basics should be covered, and this certainly applies to situations of medicine in the outdoors.

If the situation allows, take the time to explain what you are doing for/to your patient while you are doing it. This begins with preparing him or her for the event, particularly if it will be painful, like wound cleansing, manipulating an injured body part, realigning and splinting a broken bone, etc. After you have accomplished your medical intervention, if you need for the patient or anyone else to be responsible for assessing/monitoring the patient, then be very precise about what it is that is to be observed, how frequently to check on the patient, and whom to tell if there is a problem. Explain all medications, including purpose, doses, frequency of administration, and common side effects. To the extent possible, write everything down, so that the patient and other caregivers have a record of what they are supposed to do. If time allows and you have the patience for it, ask the patient and caregivers if they understand what you have told them, and ask them to repeat your advice and instructions. Do not assume that because you have told someone something one time in an awkward and rushed moment, that they heard and understood everything you said. “Medical speak” can be complicated or confusing, and what seems simple and logical to you may require more than a quick run-through. The time that you take to be clear, straightforward, and understood will pay large rewards later in terms of better patient outcomes and fewer problems down the road.

Preview the Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 24-29, 2009.

Join me from January 24 to February 2, 2010 for an exciting dive and wilderness medicine CME adventure aboard the Nautilus Explorer to Socorro Island, Mexico to benefit the Wilderness Medical Society.

This post, Understanding Instructions, was originally published on by Paul Auerbach, M.D..

You may also like these posts

    None Found

Read comments »

Comments are closed.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »

Commented - Most Popular Articles