Patient compliance is one of our greatest challenges in treating patients with wounds—ie, convincing patients to follow our treatment instructions. Studies have shown that less than 50% of patients follow medical instructions, including filling and regularly taking prescriptions, even though they have been told these treatments are for their benefit.1,2 Could part of the problem be that patients do not understand what they are being told? Many times, we may contribute to this problem by the way we impart information to our patients. Unfortunately, this provider-to-patient discussion is something that has to be done and done in a timely manner so the next patient can be seen. Oftentimes, the information is provided in medical jargon, which the patient may have difficulty comprehending, if at all. It takes thought and effort on the provider’s part to translate their fluent medical language into layman’s terms. In today’s world, providers spend time on a computer recording data in the electronic medical record during the patient’s visit. The provider may not thoroughly evaluate or even look at the patient, much less notice if they understand the treatment instructions. Rarely, if ever, does the practitioner ask the patient to repeat the instructions to ensure the patient understands and has the chance to ask questions regarding their care plan. This is important because many of our patients will say they understand (perhaps to be polite) despite not comprehending what the practitioner said. Many patients have told me that they do not know enough about what was said to ask questions. In these cases, I feel it is our duty to propose answers to the more common questions that might be asked so the patients truly understand what is being asked of them. For those who have English as a second language, it is obviously difficult to provide information to these patients due to the lack of fluency and translation problems. Most hospitals have translation services that can help if the practitioner takes the time to use the service.
Many facilities use preprinted brochures and other literature. However, there are many potential problems with these; as a result, we do not use them in our wound care center. In the event that they are used, be sure that someone in the facility has read them to double check that the information is in line with the recommendations and policies of the facility. Many times, the information is rather generic and does not match what the patients have been told. When using brochures, it is important to print them in fonts large enough for elderly patients to easily read. Another issue is that many brochures may be written at an 11th grade reading level, while the majority (56%) of adult Americans read at a 6th grade level3 and 21% are either illiterate or functionally illiterate.4 How can we expect understanding and full adherence if patients cannot read and understand our instructions?
Imparting medical information to patients can be a challenge and should not be the lowest priority task in importance in managing our patients. Remember, we should think ahead of time to plan what we will tell the patient and provide that information using terms the patient can understand. We must then use some method to ensure they have understood what they have been told other than a polite “yes” or a nod of the head. As we have discussed in times past, it is critical that we do all that we can to help patients help us take care of their wounds.
“The key to good decision making is not knowledge. It is understanding.”
Content adapted from Karen Everitt, Medical Risk Management Advisor, 2004;12(1):3.