Doctors' orders lost in translation

Jul 17, 2008

When patients are discharged from the emergency department, their recovery depends on carefully following the doctors' instructions for their post care at home. Yet a vast majority of patients don't fully understand what they are supposed to do, and most are not even aware of the chasm in their understanding.

A researcher at Northwestern University's Feinberg School of Medicine found more than three-quarters of patients (78 percent) do not fully understand the care and discharge instructions they receive in the emergency department. In addition, 80 percent of the time, patients weren't aware they didn't get it.

"It's distressing," said Kirsten Engel, M.D., a clinical instructor of emergency medicine at the Feinberg School and lead author of the paper, which was published online in the Annals of Emergency Medicine. "Patients who fail to follow discharge instructions may have a greater likelihood of complications after leaving the emergency department."

"It is critical that emergency patients understand their diagnosis, their care, and perhaps most important, their discharge instructions," said Engel, who also is a physician in the emergency medicine department at Northwestern Memorial Hospital. "It is disturbing that so many patients do not understand their post-emergency department care, and that they do not even recognize where the gaps in understanding are.

Researchers assessed 138 patients and 2 caretakers from Ann Arbor, Michigan in four categories of comprehension: diagnosis and cause, emergency department care, post-emergency department care and return instructions. About half (51 percent) did not understand fully 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, while 15 percent involved diagnosis and cause. Of those patients with comprehension difficulties, only 20 percent realized that their understanding was incomplete or inaccurate.

"The bottom line is that we need better strategies for identifying patients who are having difficulty understanding their care and instructions in the emergency department," Engel said. "The chaotic nature of the emergency department environment poses significant challenges to communication. We can, however, strive to minimize communication failures by determining why they occur and how we may intervene to reduce or prevent them. This will be critical to improving patient care in the emergency department."

Patients can help themselves by asking emergency department staff to repeat or clarify points that remain unclear. When possible, patients may benefit by bringing a family member or friend with them to the emergency department who can ask questions and help remember the patient's post emergency department care instructions.

"When you are in the emergency department, be honest and don't be afraid to ask questions," Engel advised. "If you don't understand what the doctor has told you, keep asking questions until you do. That's what we're there for."

Source: Northwestern University

Explore further: Experts call for higher exam pass marks to close performance gap between international and UK medical graduates

add to favorites email to friend print save as pdf

Related Stories

Ethnically diverse neighbourhoods 'safer'

Apr 10, 2014

Residents of ethnically diverse neighbourhoods can expect to experience fewer assaults than residents of neighbourhoods with little or no ethnic diversity, according to a new way of measuring violence.

Recommended for you

Obese British man in court fight for surgery

Jul 11, 2011

A British man weighing 22 stone (139 kilograms, 306 pounds) launched a court appeal Monday against a decision to refuse him state-funded obesity surgery because he is not fat enough.

2008 crisis spurred rise in suicides in Europe

Jul 08, 2011

The financial crisis that began to hit Europe in mid-2008 reversed a steady, years-long fall in suicides among people of working age, according to a letter published on Friday by The Lancet.

New food labels dished up to keep Europe healthy

Jul 06, 2011

A groundbreaking deal on compulsory new food labels Wednesday is set to give Europeans clear information on the nutritional and energy content of products, as well as country of origin.

Overweight men have poorer sperm count

Jul 04, 2011

Overweight or obese men, like their female counterparts, have a lower chance of becoming a parent, according to a comparison of sperm quality presented at a European fertility meeting Monday.

User comments : 0

More news stories

Less-schooled whites lose longevity, study finds

Barbara Gentry slowly shifts her heavy frame out of a chair and uses a walker to move the dozen feet to a chair not far from the pool table at the Buford Senior Center. Her hair is white and a cough sometimes interrupts her ...

Cancer stem cells linked to drug resistance

Most drugs used to treat lung, breast and pancreatic cancers also promote drug-resistance and ultimately spur tumor growth. Researchers at the University of California, San Diego School of Medicine have discovered ...

Making graphene in your kitchen

Graphene has been touted as a wonder material—the world's thinnest substance, but super-strong. Now scientists say it is so easy to make you could produce some in your kitchen.