So what did the doctor say ?

Researchers conducted exit interviews of patients to measure the degree of comprehension that is retained and lost upon leaving the examination room. Results concluded many patients do not remember what the doctor just said.

I started using a new medicine that is a topical application to the underarms. I am very careful to always explain how to use the product and all the informatin that is required with a new prescription. The medicine requires one pump from the bottle onto an applicator cup. The cup is then positioned under the armpit to apply the medication. This past week, a patient didn't understand why the medication was flowing onto the floor- well, he filled the cup to the rim with the gel and, as he was applying it to this tender area of the body, it poured onto the floor. Today, another patient was complaining that this product leaks. He was squeezing the application bottle directly to his armpits. Gravity had the upperhand in this situation too. Not only did these patients get the instruction from me, I had sent them home with material to read.

What are the steps that we as physicians need to take to provide instructions that will enhance compliance and understanding ?

1. Simple medication dosing regimens (ie: once a day; small tablet sizes, easy to swallow or apply; convenient devices to remind dosing- med box, alarms)

2. Simple verbal instructions with written literature to review after the office visit; This should be given to both patient and an accompanying friend, family member, advocate (see my previous blog on advocates)

3. Ask for "teach/tell-back" so the patient can repeat back what was just explained

4. Assess patient beliefs, ethical issues, religious or other convictions that can bias a treatment plan. Some patients cannot understand nor read what is being explained due to literacy deficits. The medical team needs to be sensitive to these issues as they impact a patient's wellbeing

What are the steps a patient needs to take to insure that the information passed on from the physician is properly communicated and to make the office visit most effective ?

1. Prepare a list of questions and concerns  to discuss with the healthcare provider. This is a good way to also take notes as the issues are being addressed

2. Keep a current medication list including the name(s) of the doctor, pharmacy information and a list of allergies. This can serve as a safety measure with the office medical record

3. Ask questions pertaining to anything that is not clear- this is not a time to be uncomfortable about speaking up

4. Ask for a written copy of the explanations and instructions for reference

5. Bring an advocate with you for backup

The medical team consists of patient, patient advocate (as appropriate), and healthcare provider.

some interesting help in this topic

http://journals.cambridge.org/abstract_S0033291700048558

We all need advocates especially as we get older and medical issues become complex. There are many times we encounter complex diagnoses and evaluations. Family members can add information that helps clear the fog for the medical team.

I remember an older lady who had fallen and was complaining of neck pain. Her son insisted something was wrong with mom. At first glance, this was another case of an older adult who had fallen and tripped- not an unusual situation.  After performing a deeper investigation, we discovered that she suffered a stroke from a clot that came from her heart. She had a growth on the heart valve that created a traveling clot to the brain. We ultimately sent her for heart valve surgery and she is fine to this day.

I have to admit that the son's persistence advocating for mom helped us reach the ultimate diagnosis and formulate a successful treatment plan. These experiences keep us, as healthcare providers, humble (or at least should).

I recommend everyone have a spokesperson, especially as we get older. The advocate should be equipped with a current medication list, advanced directives/power of attorney for healthcare document, and have easy access should an emergency arise.." you never know"....

Introduction

This is our first blog entry. I would like to use this format to communicate with my patients and anyone else who is interested on relevant topics that I encounter in my daily work. The science of medicine changes all the time and this medium will enable a flow of information that I think will be valuable. More to come soon...