Analysis: We need a prescription to end the confusion of patients leaving hospitals, pharmacies and GP surgeries with more questions than answers
Some years ago, I was at the bedside of a relative in the intensive care unit. When the doctor came to talk to the next of kin, I was beside him. After going through the diagnosis, plan for treatment, prognosis, and next stage of care, the doctor asked whether there were any questions. "No doctor" came the immediate response. The doctor nodded and departed.
"Do you really not have any questions?", I asked my relative in the bed. He replied "No, of course not, I haven't the first clue what he said, and I’m just glad you’re here to translate it for me". This sentence stuck with me.
Full disclosure, I am a pharmacist by training so the medical terms used were quite familiar to me, but the word "translate" gives the distinct impression of a person speaking a foreign language and medical jargon, to all intents and purposes, can be a foreign language to many. I thought of the many times through ignorance or insecurity that I had managed to cut off any further communication with a patient, due to the terms I used (and expected them to understand).
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From RTÉ Radio 1's Today With Sean O'Rourke Show in 2015, Inez Bailey from the National Adult Literacy Agency and Dr. Michael Wolf from Northwestern University, Chicago discuss medical jargon
Thankfully in this example, no adverse effects were experienced by the patient, but contrast this with the parent who misunderstands the instructions on their child’s medication, and the outcome may be quite different. According to a 2015 survey by the National Adult Literacy Agency, two in five people are calling for doctors, nurses and pharmacists to use less medical jargon and give information in plain language.
This brings me to the term "health literacy". Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health‐related decisions and actions. Low health literacy levels can lead to poor medication adherence and worse health outcomes. The latest European health literacy survey (2019-2021) found that over a quarter (28.4%) of Irish citizens had limited health literacy and a further report found that 17% of people surveyed said they had taken the wrong amount of medication on at least one occasion.
I believe that the onus should be on the healthcare provider, rather than the healthcare recipient, to make sure that they are communicating in a clear manner and that their information is not lost in translation. This is especially crucial for those in our society who may have further obstacles to overcome in the (Irish) healthcare system; for example those who do not have English as a first language.
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From RTÉ Brainstorm, what was it like to go to the doctor in medieval Ireland?
It can be daunting for anyone going to a hospital, doctor’s appointment or receiving new medicine to know what questions to ask, and this has led to the development of the Ask Me 3® programme. This programme was developed by health literacy experts and aims to help patients by providing these three questions as a starting point to improve conversations between patients, caregivers and healthcare providers. The three specific questions to ask to better understand their health conditions and what they need to do to stay healthy are:
- What is my main problem?
- What do I need to do?
- Why is it important for me to do this?
When a patient receives a new medicine, there may be a lot of instructions in the form of counselling or advice provided by the pharmacist. This is to ensure that the treatment is a success. This information should be given in a way that is easily understandable and follows best practice in terms of the phrasing.
In my work as an educator, I try to help students learn using the "teach back" or "talk back" method. When you have given a lot of information to the patient (e.g. how much medicine to take, when to take it, whether with food or on an empty stomach etc), you need to check for understanding using this method.
These three questions are a starting point to improve conversations between patients, caregivers and healthcare providers
You say to the person "I have given you a lot of information about your medicine, and just to check that I have explained this correctly, can you tell me , in your own words, how you are going to take this medicine?" This makes it evident that the burden of clear communication lies with the healthcare provider, while allowing the patient to express what they have understood, and also allowing a dialogue between the patient and the pharmacist in case of any confusion.
For those who are already qualified and working in a healthcare environment, there is the option of acquiring a Digital Badge. My UCC colleague Dr Michelle O'Driscoll and myself along with the National Adult Literacy Agency and have developed a new course called An introduction to Health Literacy for Health and Social Care Professionals.
Our aim is to bring awareness to health literacy and give examples of meaningful ways professionals can adapt their practice to optimise communication. So, the next time you come out of a doctor’s office, hospital appointment or pharmacy with more questions than answers, please send them our way...
The views expressed here are those of the author and do not represent or reflect the views of RTÉ
