From the Mayo Clinic: Many Discharged Patients Do Not Know Diagnoses, Medications, Side Effects.
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The authors report that 72 percent of the patients were not able to list the names of all of their medications, however, more could state the purpose of their medications. And about 58 percent of the patients were unable to recount their diagnosis or diagnoses."All methods that enhance the patient’s understanding of his or her discharge treatment plan focus on one central aspect — proper communication," says Dr. Friedman. "Although not all patients are noncompliant because of poor communication, this is probably the leading cause of noncompliance."
Dr. Friedman notes that communication involves many aspects, including language (speaking to the patient in terms the patient understands), practicality (giving the patient a regimen that can be followed without much disruption to daily life) and time (spending reasonable time counseling the patient and ensuring that the patient actually comprehends the instructions).
"Without willingness of the health care team to devote time to communication, the careful and effective treatment that was delivered in the hospital may not continue after discharge because of patient noncompliance," says Dr. Friedman.
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I have no doubt this is a universal problem. Patients recently discharged from my hospital who return frequently have their copy of their handwritten discharge instructions. They are variably legible, don’t have a diagnosis written anywhere un them, frequently use the medical abbreviations for medicines (T.I.D., etc), and the patients don’t remember even who their doctor is. There is certainly room for improvement.
The authors go on to recommend some ideas they hope would help, but I doubt the practicality of many of them.
I wonder how much some of the proposals for paperless documentation of patient records will change this? Will hospitals make patient records available with a simple login proceedure to facilitate ease of ordering medications, etc.? It seems like the eventual answer has to be something along the lines of modernizing medical recordkeeping.
Many doctors do not know the side effects of many medications. We seem to really brush over side effect profiles in meds. Doctors care about curing disease at all costs regardless of pesky side effects. This is probably why B-blockers are so over-prescribed. We want to lower your BP regardless of whether you can’t get an erection, get depressed, etc.
I’ve read that the average educational level in this country is somewher between 6th and 8th grade. For most docs (even most people who have had some college), it is nearly impossible to put yourself in the mindset needed to explain a complicated medical condition to an 8th grader. Maybe we can start using more cartoons and music videos in our discharge. Oh, and does anyone else notice that only about 1% of stated med allergies are actually anaphylactic reactions. Usually the medication “upsets my stomach” as in most antibiotics or “makes me feel weird” regarding antiemetics. So in the ideal ED, there are dispensers with amoxil and vicodin in the waiting room, everyone gets CT’d from head to toe as they walk through the door, and a PDR is handed to and understood by every patient. Maybe that’s what heaven’s like for EM docs.
That would be heaven for me.