Thursday, December 4, 2008

Most Patients Don't Know That They Don't Know

Not long ago, a study published on the online version of the Annals of Emergency Medicine concluded that more than three-fourths of patients in emergency rooms don’t understand what staff nurses and doctors tell them about their conditions or the take-home directions they receive.

Worse yet, a whole lot of these patients don’t know that they don’t know.

It also might be that nurses and doctors fail to give the needed information. Obviously this is not a good thing and can lead to problems later on, as illustrated by this story I heard recently from a friend:

Her elderly mother was taken to an emergency room by her elderly father because the mother had fallen and broken her tibia. The bone was set and, according to my friend, who is a nurse, her parents were sent on their way with no instructions about home care, nor how to help her mother manage with a broken leg. The result was predictable; a couple of days later, her father dropped her mother on the floor while trying to help her transfer. The elderly lady was back in the ER with a broken elbow.

I was furious when I heard this story. I couldn’t imagine sending away an elderly couple with obvious needs without so much as an instruction sheet or a list of resources where they could get assistance. I know that nurses and doctors often give instructions, but between the patients’ distress and the chaos of the ER, it might be that they can’t remember and/or don’t understand.

But apparently there is little checking to see if patients really do get it, according to the study out of Northwestern University called “Patient Comprehension of Emergency Department Care and Instructions: Are Patients Aware of When They Don’t Understand?”

The investigators interviewed and assessed 138 patients and two caretakers. They checked patients in four areas of comprehension: diagnosis and cause; emergency department care; post-emergency department care; and return instructions. Researchers found that:
• More than half of the patients (51 percent) didn’t understand what they were told in two or more categories.
• More than one-third (34 percent) of the “comprehension deficiencies” involved patients’ understanding of post-emergency department care.
• Fifteen percent of the comprehension problems involved diagnosis and cause.
• Of all the patients who had problems with comprehension, a whopping 80 percent didn’t realize that their understanding was incomplete or inaccurate.

What problems do you have getting patients to understand?

Do you think the information gap is the fault of patients or health care professionals?

What do you think are the barriers to better understanding?

Do you have any tricks to share that might help patients understand their medical problems and instructions?

Tell us what you think.

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