How to Get A Clear Answer From Your Doctor

A vast majority of patients leave their doctors' offices or the emergency room without understanding the treatment they received, or how to care for themselves once they get home. This can lead to medication errors and serious complications that can send them right back to the hospital.

In a recent study, pateitns discharged from emergency departments were asked for their understanding in four areas: their diagnosis, their ER treatment, instructions for their in-home care, and warning signs of when to return to the hospital.

The study, published online 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. "Patient Comprehension of Emergency Department Care and Instructions: Are Patients Aware of When They Do Not Understand?" Annals of Emergency Medicine. 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 researchers described a woman in her twenties who went to the emergency room with abdominal paid. After extensive testing, doctors there diagnosed pelvic inflammatory disease, a sexually transmitted infection. But when interviewed by a researcher, the woman said that she was not aware of any diagnosis, that she did not realize that she had been sent home with an antibiotic (she inly took the pain medication she was given), and that she did not know she should abstain from sex, tell her partner, or have follow-up care.

Similar results have been found for patients leavivng hospitals, not just emergency rooms. Everything is exaggerated in the emergency department. Doctors are busy, they have little time to go over complicated information and not likely to be thinking clearly. This is not the best environment for someone to remember information.

The problem is particularly acute when it comes to drugs. A patient-education program used in 130 health delivery systems across the country found that about 40 percent of patients 65 or older have a medication error after they leave the hospital. A 2006 report by the Institute of Medicine found that doctors and nurses were contributing to these errors by not providing information in an effective way.

Patients who did noto follow discharge instructions were often labeled as "non-compliant." However, doctors are notoriously inept at communicating to patients. The new study found that people were not aware of what they did not understand, suggesting that simply asking a patient if he understands is not enough. Older patients are particularly vulnerable with communication barriers, such as vision and heaering problems.

Experts in doctor-patient communication recommend a "teach back" approach, in which the patient, preferably accompanied by a relative, friend, or caregiver, has to repear the instructions back to the doctor.

When talking with your doctor, always ask if you do not understand specific words the doctor is using or what your doctor is recommending is not clear. Make sure you leave your doctor's office with a clear understanding of: (a) your diagnosis, (b) your treatment, (c) at-home care, and (d) warning signs of when to return to the hospital or doctor's office.

For example, you should ask your doctor and insist on answers to the following questions:

What is my diagnosis?

If your diagnosis is unknown, ask: What is the differential diagnosis? Among the possible diagnoses, which is most likely and why?

Have you dealt with patients with problems like mine before?

What is the usual course of treatment for my condition?

What can I do to get better?

How room can I expect to feel well again?

All patients in New York State hospitals must receive a written discharge plan and a written discharge notice before they leave the hospital. This plan shoudl describe the arrangements for any health care services you may need after you leave the hospital. Patients must be provided with the opportunity to sign the discharge documents and receive a copy of the signed documents. 10 N.Y.C.R.R. section 405.9(g)(1), 405(g)(3)(i).

It's up to the patients to get the information they need. Do not be afraid to ask questions, call, or return if you do not understand something.