Do patients truly understand?
The question is not meant to be rhetorical. I have many conversations throughout the day with patients across all socioeconomic backgrounds and with varying levels of education.
The discussions include details surrounding their disease-specific particulars, treatment options, and surgical protocols. Patients digest my thoughts and then respond with specific questions of their own. They ask for instructions as well as the nuances of the healing process.
I confess that it’s not always easy to tell how much a patient comprehends when I’m discussing their diagnosis. I watch their body language and see how they react. I observe their facial expressions when I provide facts about their diagnosis. I listen to their follow-up questions because that’s one way to judge if they understand. The good news? At times their questioning is spot on. That’s a good sign.
Sometimes, however, there is a major disconnect. This can be risky because an inability to remain on the same page between doctor and patient may lead to disastrous consequences.
Many studies have been published highlighting the difficulty of communicating with patients; significant challenges exist. Some hurdles that need to be overcome include those in lower socioeconomic backgrounds. These studies emphasize the importance of being able to relate to your patient when providing an educational dialogue. Furthermore, written materials should be designed for a 6th-grade reading level.
Why is this important? Providing patients with the material they can understand and appreciate is not as straightforward as it may seem on the surface. Whether in person, over the phone, in print, or drawn out, information must be passed along to the patient in an easily understood format. It must be legible and easily digested. Poor compliance with this unwritten rule may lead to the further dissolution of the physician-patient relationship.
One technique frequently recommended to ensure information is well-received is the use of repetition. Explaining material in various ways and repeating it several times may ensure improved comprehension. Asking patients to repeat the statements or instructions will allow the practitioner to have confidence regarding their understanding. This enables the physician to identify gaps in the patient’s understanding and provide corrective measures if needed. By doing this, both the physician and patient can be confident that they are on the same page and that the patient understands their health condition and recommended course of action.
One of the key questions surrounding patient comprehension is what patients need to understand better. Does a close relationship with their health care provider help patients better identify with the information being presented? While it is true that some physicians may be skilled at providing ‘everyday’ types of analogies to facilitate a patient’s understanding, it can still be challenging to gauge a patient’s true comprehension. The act of signing an informed consent form and moving forward with a recommended process does not necessarily indicate that the patient fully understands the information presented to them.
Another area of interest is the influence of the white coat worn by physicians. Some theories suggest that the white coat can play a role in helping to convince a patient to proceed with a recommendation. Do patients become intimidated when receiving suggested treatment options and thus choose the one they feel their doctor believes to be most convenient?
However, due to the significant diversity among patient populations, there is no universal approach to providing information. Materials must be produced to accommodate all backgrounds and education levels, and there is no one size fits all method.
In conclusion, patient comprehension is a critical aspect of health care that requires the efforts of both the physician and the patient. Medical professionals must use language and communication methods that are easily understood by their patients, regardless of their background and education. By using simple analogies, avoiding medical jargon, and presenting information clearly and concisely, patients are more likely to retain and understand important information about their health. Additionally, patients can also take an active role in their understanding by asking questions and repeating information back to their health care provider. The end goal is to ensure that both the physician and patient are on the same page, which can lead to better health outcomes and satisfaction for the patient.
Adam Bitterman is an orthopedic surgeon.