When your doctor discharges you from the hospital, the last thing you want is to end up back in the hospital. It makes sense that for the best outcome and to reduce your chances of a readmission, you need to follow your doctor’s instructions. But the majority of patients don’t understand discharge instructions. What happens if you can’t understand your discharge papers?
What if you think you understand, but really you don’t? Odds are, you don’t understand the directions as well as you thought you did!
A recent study published in The American Journal of Surgery found that 65% of patients had functional reading skills that were at a grade level lower than the reading level of their discharge papers. Only 24% of the group had the reading skills necessary to fully understand the doctor’s summary and instructions.
The study also found that of the 40 people readmitted to the hospital within 30 days, 65% of them could not read at the required level to understand the doctor’s discharge papers.
Why do patients and families struggle to understand discharge instructions?
Almost 1/2 of the U.S. population is marginally literate; they can only read and understand material that is at an elementary or grade school level. As you read this post, you may think although this is unfortunate, it doesn’t apply to you. You are confident that you read and comprehend at a high level. Although having strong reading and comprehension skills improves your chances of comprehending discharge instructions, it might not be enough to help you. Doctors write these notes for other doctors, not just for patients and families. These notes are full of medical jargon that is hard to understand in the best of circumstances, but even harder to understand when you are feeling sick as a patient or worried and exhausted as a family member.
Need more proof that this is an issue that may affect you?
A 2009 study published in Annals of Emergency Medicine evaluated patients’ understanding of 4 key issues as they were being discharged from the emergency department: diagnosis and cause; ED care; post-ED care; and return instructions. It turns out comprehension was low:
- 78% of the patients were not correct in at least one of these areas.
- 51% were incorrect in 2 or more areas.
Surprisingly, researchers found that only 20% of the patients who they identified as confused about their instructions reported that they weren’t sure of how much they understood. The other 80% were inappropriately confident in their incorrect understanding.
What are the consequences?
The consequences of limited health literacy can be severe. This lack of understanding can lead to:
- Medication errors (2 possible consequences: taking the wrong medication or taking a medication incorrectly).
- Lack of follow-through on tests.
- Higher mortality rates for patients with acute heart failure.
How can you make sure you understand discharge instructions?
I recommend you consider the following when the medical team is discharging you, or a loved one, from the hospital, emergency room, day surgery. These tips are even helpful when finishing a doctor’s appointment:
- Don’t do this alone! If possible, have another responsible adult with you to go over discharge papers and instructions. This is particularly important if you are weak, exhausted or recovering from anesthesia.**
- Ask as many questions as you need until you are sure you understand what the doctor, nurse and/or discharge papers are stating.
- Write down every detail, no matter how small. There is a lot of information to process and it is easy to forget or get confused.
- Make sure you understand what symptoms and side effects warrant a phone call to the doctor or a trip to the emergency room. For example, ask about fevers, bleeding, signs of infections, etc.
- Make sure you know who to call, day or night, if something arises.
** I recently heard from a colleague who’s doctor gave him discharge instructions after surgery, while he was still under the influence of anesthesia. Staff would not allow his family to see him until they put him in the car to go home; therefore, it was impossible for the family to ask questions about discharge instructions. Needless to say, the patient had no recollection of the conversations he had with the doctor and nurse. When the bleeding wouldn’t stop, the wife called the doctor who reassured her that this amount of bleeding was normal. If the doctor wrote the instructions more clearly, and/or the family had participated in the discharge conversation, the family would not have worried unnecessarily and they would not have interrupted the doctor during a busy work day.
Want to learn more?
For information on reducing the risk of complications after discharge, read my post Tips for Hospital Discharges.