Did You Understand What the ED Doctor Told You?

Most people didn’t, apparently. University of Michigan physicians conducted interviews to see just how many of the patients discharged from the Emergency Department (ED) understood the care they had received and the instructions they were given. They reported the results of their survey at the recent Society of Academic Emergency Medicine meeting.

The structured interviews examined how well patients understood four areas of their ED care: diagnosis and cause, care given in their ED, instructions about continuing care, and return instructions. These were done in 140 English-speaking patients or their primary caregivers, which were conducted after discharge from the ED. Patient comprehension was assessed by comparing their answers to questions with entries in their medical charts. Unless there was full agreement, comprehension was rated as “deficient”.

Overall, comprehension was deficient in at least one of the 4 areas listed above in 78% of the patients; 51% had deficient comprehension in two or more areas. The most common area for deficiency was continuing care, at 34% of all deficiencies. Next came the actual ED care received (29%), followed by instructions regarding return to the ED (22%) and diagnosis/cause (15%). What was most disturbing, over 75% of patients said they were confident that they understood their care and the instructions they were given.

The University of Michigan has implemented a program to address this discrepancy. It includes follow-up phone calls within 24 hours after ED discharge to discuss the need for a return visit or referral to a specialist. Many EDs already provide instruction sheets covering continuing care and possible return instructions, but it’s likely that much more could be done. In particular, the communication between patient and doctor could be improved enormously if the both speak the same language fluently . . .