The vast majority of patients don't fully understand the
instructions they
receive from doctors when they leave the emergency department,
according to
a new report.
Further, the vast majority of those patients weren't aware that
they didn't
understand.
The study, published online this month in the Annals of
Emergency Medicine,
followed 140 patients or their primary caregivers at two hospitals
in
southeastern Michigan. Researchers asked patients to recall what
their
doctors told them about their diagnosis and cause, emergency
department
care, post-emergency department care, and return instructions.
Researchers
then compared their responses with their actual charts, and asked
whether
the patients thought they had fully understood the instructions.
The biggest source of confusion: what they were supposed to do
when they
left the hospital.
That is "at minimal, distressing," said Dr. Kirsten G. Engel,
the study's
lead author and a clinical instructor of emergency medicine at
Northwestern
University's Feinberg School of Medicine. "If there's one aspect
of a
patient's care and instructions that I would hope they'd leave the
emergency department with, it's ... what they should be doing when
they get
home.
"This means that those people are likely to have difficulty
following the
directions," Engel said.
It's a problem Dr. Richard Wolfe, chief of emergency medicine at
Beth
Israel Deaconess Medical Center, is familiar with - but he said the
article
gave doctors their first hard data.
"This confirms what we've been suspecting for a while," he
said. In
response to those concerns, the hospital is now rewriting discharge
instructions and uses nurses - instead of doctors - to slowly and
carefully
walk patients through what they should do when they get home.
Another important aspect of the paper was the degree to which
patients
either weren't aware - or weren't willing to admit - that they
didn't
understand instructions from doctors, Engel said.
"If they have a deficit, the vast majority - four out of five -
of these
people are not going to tell us they have a problem," she said.
"They
won't even say ((their comprehension is)) only very good - they'll
say it's
excellent."
While the study's design is sound, its small size and limited
area - two
hospitals within 15 minutes of each other - makes it hard to
generalize to
patients throughout the country, said Dr. Richard Bachur, chief of
emergency services at Children's Hospital Boston.
"The design was very nice, and the journal that it's in is, to
me, the
premiere journal in emergency medicine," he said. But because of
its size,
"it's almost like a pilot study."
The fact that patients were given handwritten discharge notes,
instead of
the printed, bullet-point style fact sheets that have become
standard, he
said, was also problematic.
Still, the study exposes a vulnerability in a field that is
constantly
stretched because of pressure to see patients rapidly, he said.
"Whatever strategy people develop for a discharge procedure
should be sure
it includes real-time communication and an opportunity to ask
questions,"
Bachur said, particularly in emergency departments. "That could
make some
of the concerns in this article obsolete."
Tips for emergency department patients
Always ask for printed discharge information - and be certain
you
understand what it says. "Making sure you really get what you're
supposed
to do when you go home is important," said Dr. Kirsten G. Engel, a
clinical instructor of emergency medicine at Northwestern
University's
Feinberg School of Medicine.
Bring a friend or family member. "Patients are sick, they're
anxious,
tired, frustrated," Engel said. "It's hard to absorb information
when
you're like that."
Understand that healthcare providers are there to help you, and
that you
can trust them. "The issue of trust between patient and physician
.. has
eroded over time," said Dr. Richard Wolfe, chief of emergency
medicine at
Beth Israel Deaconess Medical Center. "And that's really where the
whole
secret to successful medical care lies."
Ask questions. "If you don't know or are uncomfortable, ask or
tell,"
Wolfe said. "There's no symptom or issue that's too small to
communicate -
it's more the unanswered questions that can create problems."
Get your provider's name and phone number in case you have any
follow-up
questions.
Pick up any documentation related to your care and read it
thoroughly.
NEIL MUNSHI
c.2008 The Boston Globe