Emergency-medicine experts are sounding an alarm that people who visit hospital ERs often go home without understanding the medical instructions doctors give them.
In an article in the January issue of the Annals of Emergency Medicine, which reviewed more than 50 previous studies, researchers recommended that doctors provide instructions verbally, in writing and include visual demonstrations when possible, The Canadian Press reported.
“It doesn’t happen as systematically as I would want it to,” said co-author Dr. Stephen Porter of the Hospital for Sick Children in Toronto.
“One of the big lessons for a lot of institutions is that simply giving written instructions, especially if it’s not at a reading level that is appropriate for a given patient, doesn’t really help.
“Because there’s not going to be much on that piece of paper that’s going to be a real reference for people if they either don’t understand what’s written or if they don’t have somebody else who can work with the document and understand what the plan is.”
The researchers’ review cited an example from pediatric medicine, where drugs often come in liquid form. Many parents can’t figure out the correct dose without help but doctors don’t necessarily show them exactly what dose is required.
Physicians give the dose in milligrams, said Porter, but once home, parents have to translate that dose into the volume marking on the syringe.
One of the studies the authors reviewed found 21 per cent of elderly patients did not understand their diagnosis when discharged from the ER.
Another study done in a pediatric ER found that while most instructions given at discharge required college-level reading skills, almost half the parents of children being treated had a high school education or less. Only 30 per cent of parents were able to demonstrate both an accurately measured and correct dose of acetaminophen, another study found.
Porter said the message parents should take from the review is that they should not be afraid to ask questions “and ask for people to show them.”
“Discharge communication is an opportunity to recap the visit, teach patients and families how to safely care for themselves or their loved ones at home, and address any remaining questions,” Porter said on the web site Medicalxpress.com.
“Failure to understand important elements of care can result in medical error at home and safety risks, including incorrect medication use, inappropriate home care and failure to follow-up on concerning symptoms.”
Misunderstanding discharge instructions also increases the likelihood of patients revisiting busy emergency rooms, Porter added.
“It’s a two-way conversation that has often been overlooked.”