A shared responsibility
Your body is yours alone, but if you become ill, you doctor certainly shoulders the major responsibility for establishing a diagnosis and planning a treatment. For the treatment to work properly, the patient must understand his illness and follow the treatment plan responsibly.Communication is the answer. Patients must convey their symptoms and concerns, and doctors must explain their diagnoses and treatment. It sounds simple, but a study shows that the chain of communication can have some mighty weak links.
The numbers speak
To find out how well people understand their diagnoses and treatments, doctors in New York surveyed patients when they were discharged from the medical service of a teaching hospital. To be eligible for the study, the patients had to have a good command of English and be alert, oriented, and able to understand the researcher's questions. They were allowed to supplement their memories by referring to their notes or other written material.
Although the New York State Patients' Bill of Rights specifies that all patients should "receive complete information about their diagnosis, treatment, and prognosis" and that they should be able to "participate in all decisions about [their] treatment and discharge from the hospital," only 42% of the patients were able to state their correct diagnosis in medical or everyday language. Only 28% could list their medications by trade or generic name. Whether or not they knew the names of their medications, 37% of patients did know their general purpose, but only 14% could state the common side effects of their pills.
Just as health is a shared responsibility, improving communication and understanding is also a task to be shared by doctors and patients.
What doctors can do
Today's physicians should be educators, teaching patients about their bodies, their illnesses, and tests and treatments. That means spending time with patients, having staff members assist in patient education, or both. It means using clear, straightforward language suited to each patient's educational and cultural background.
Clear words are necessary, but they may not be enough. Whenever possible, doctors should offer patients written information or referrals to appropriate print or Internet resources. And simply reciting a drug's possible side effects without indicating which are rare or reversible is likely to scare a patient away from even filling his prescription. Above all, perhaps, a doctor should encourage his patients to ask questions and should ask them to repeat essential instructions and precautions.
What you can do
The more you know about your body, the better you'll understand your doctor's explanations and instructions. Be an informed health consumer.
Before your appointment, make a list of your concerns so you'll be sure to mention them. And pull out a pencil with your list so you can jot down important facts and instructions.
Don't be afraid to ask your doctor to rephrase or repeat anything that isn't clear the first time. Ask for pamphlets or other instructional material. And if you anticipate a discussion of important issues, consider taking along a relative or friend for support as well as an extra set of ears.
When you are discharged from a hospital, you will usually receive instructions from a nurse as well as a doctor. Be sure your providers all agree, and ask for clarification if they seem to be in conflict.
Keep your own medical history. Include major illnesses in your family, major events in your health, a list of your medications (past and present), and a list of any bad drug reactions.
September 2007 update