How much do your patient's know after they are d/c'd from the ER?

[MrBling]

---

Members do not see this ad.

An interesting article from today's NYT.. ( i guess you can always go back to the source study in the annals)

..The study, published online in July by the Annals of Emergency Medicine, found that 78 percent of patients did not understand at least one area and about half did not understand two or more areas. The greatest confusion surrounded home care — instructions about things like medications, rest, wound care and when to have a follow-up visit with a doctor.

The study, published online in July by the Annals of Emergency Medicine, found that 78 percent of patients did not understand at least one area and about half did not understand two or more areas. The greatest confusion surrounded home care — instructions about things like medications, rest, wound care and when to have a follow-up visit with a doctor....

 

[spyderdoc]

We use a discharge instruction system that gives patients the standard info on most dischargable diagnoses (wound care, CP, bronchitis, etc), and then I hand type ant other specific instructions...I always make sure patient at least understands the need for follow up...

These instructions are in plain English, and relatively easy to understand....That being said, I think patients tend to not read them.

It is interesting that with our QI cases, one of the first places that we look at is the discharge instructions that were given to the patients...Was the patient given adequate instructions and a follow up plan.....

Many people write discharge instructions in medical jargon.....One of our guys routinely writes "take tylenol prn pain", amongst other things that you just know the patient will have no idea what they mean....So make sure that if you are hand writing the instructions to do it in plain English.

The other big factor is that the patient has to actually read them and follow them.....

 

[southerndoc]

Patients probably don't understand instructions given to them by their primary care physician. Case in point: the number of CHF'ers we see with acute overloads secondary to eating a bucket of fried chicken.

Anyone aware of any studies that have looked if patients understand instructions from clinic visits?

 

[docB]

The interesting thing about these studies is that when they ask the patients what they remember about their discharge instructions they get almost no respondants who say either "I'm too stupid to understand what I was told and/or I didn't read the written instructions (6th grade level at my house) and/or I just didn't pay attention." Nope. Seems everyone responds with "They didn't tell me nuthin'." Strange, huh?

 

[MrBling]

The interesting thing about these studies is that when they ask the patients what they remember about their discharge instructions they get almost no respondants who say either "I'm too stupid to understand what I was told and/or I didn't read the written instructions (6th grade level at my house) and/or I just didn't pay attention." Nope. Seems everyone responds with "They didn't tell me nuthin'." Strange, huh?

Agreed.. While I'm sure we are all proponents of patient advocation, I wonder when someone will hold the patient accountable for their own healthcare.. as in actively trying to understand their disease process and the appropriate care.

On a related note, I recently finished "Intern" by Sandeep Jauhar and there is a chapter on informed consent where he argues that consent has turned into a way for MDs to defer liability by forcing the patient to make decisions on their own care.. the crucial risk-benefit analysis of whether to undergo a risky procedure... I guess in an unexpected way, this is the other extreme of making sure the patient is involved with their care.

 

[docB]

Agreed.. While I'm sure we are all proponents of patient advocation, I wonder when someone will hold the patient accountable for their own healthcare.. as in actively trying to understand their disease process and the appropriate care.

On a related note, I recently finished "Intern" by Sandeep Jauhar and there is a chapter on informed consent where he argues that consent has turned into a way for MDs to defer liability by forcing the patient to make decisions on their own care.. the crucial risk-benefit analysis of whether to undergo a risky procedure... I guess in an unexpected way, this is the other extreme of making sure the patient is involved with their care.

Damn. Wanna make point. Gotta goto code. Later.

 

[leviathan]

Patients probably don't understand instructions given to them by their primary care physician. Case in point: the number of CHF'ers we see with acute overloads secondary to eating a bucket of fried chicken.

Very true...although I did see a 77 y/o male with acute exacerbation of CHF last night who was very adamant about restricting his salt intake, very compliant with his medications, and well informed about his disease. This species of patient is a rare sighting, indeed.

 

[EM2BE]

Very true...although I did see a 77 y/o male with acute exacerbation of CHF last night who was very adamant about restricting his salt intake, very compliant with his medications, and well informed about his disease. This species of patient is a rare sighting, indeed.

Is this the lying species (sarcasm rare sighting) or just a species that actually follows the rules (you weren't being sarcastic)?

 

[leviathan]

Is this the lying species (sarcasm rare sighting) or just a species that actually follows the rules (you weren't being sarcastic)?

The very-often-sarcastic Levi is not being sarcastic this time. This patient was a physician's dream.

 

[deleted109597]

My patients know at least as much as they did before coming. That is, unless they suffer anoxic brain injury. You never know with some of ours.
This sounds like another one of those "lets test the ER" schemes from the higher ups. Now we have to quantify what discharge instructions. What if they only speak spanish, but can't read it? Do we have spanish braille discharge instructions? Why not? Someone call the ADA lawyers!

 

[Apollyon]

One of our guys (a lifer) uses all sorts of jargon in his DC instructions (combined with horrible typing skills), such that they're literally illegible. One of my (NOT) favorites? "Push fluids" Huh? Like, off the table?

As Roja and I have exhorted for years, good discharge instructions are better than an accurate diagnosis (that specific verbiage from Slovis and Wrenn), and clear, simple DC instructions will save your ass, time and again.

I don't use bullet points - I write in prose, and the nurses read verbatim to the patients what I've written.

 

[leviathan]

I don't use bullet points - I write in prose, and the nurses read verbatim to the patients what I've written.