Emergency Department Patients Don't Understand Diagnosis and Care Instructions

A study published in the most recent issue of the Annals of Emergency Medicine concludes that more than 3 of 4 patients do not adequately understand what has taken place during an emergency visit. The study questioned patient comprehension in terms of understanding 1) diagnosis and cause, 2) emergency department care they received, 3) post emergency department care, and 4) instructions for return. Approximately half of the patients failed to comprehend directives of care in two or more of these areas.

Even more problematic was the fact that most patients do not seem to realize that they were leaving the emergency room with inadequate understanding or misinformation about their condition and care requirements.

There is a growing body of research that suggests patients typically remember and understand less than half of what their doctor discusses with them. It is not surprising that additional time constraints and increased levels of stress and fear from an emergency room visit compound the issue. Health literacy is defined as a patient's ability to read, comprehend and act on medical instructions. A patient's level of health literacy is not always apparent, especially when physicians and healthcare workers are busy and overburdened with multiple patients needing care.

"It is critical that emergency patients understand their diagnosis, their care and, perhaps most important, their discharge instructions," said Dr. Kirsten Engel, one of the study's authors.

One helpful strategy is for physicians and their support staff, in the emergency room and all areas of healthcare, to institute communication strategies to improve health literacy. By asking patients to repeat instructions, or explain in their own words what they've just heard, they are increasing the ability of the patient to recall the information, as well as making sure comprehension is complete. This "teach back" method of communication gives patients a chance to digest the information while the physician or healthcare worker is still there to provide feedback and answer questions.

Skin Cancer Rates Rising in Young Women

More than half of all cancers in the United States are skin cancers. More than one million cases of non-melanoma skin cancer (skin cancers found on the outer layers of skins, primarily due to sun exposure), and nearly 60,000 new melanoma skin cancers (which originate deeper in the skin) will be diagnosed this year.

Despite increased education programs about the dangers of sun exposure and improved sun protection products, an analysis of cancer statistics from 1973-2004 shows that the rate of melanoma tumors increased in populations of young women. Though the reasons for the trends were not analyzed, Mark Purdue, a research fellow at the National Cancer Institute, suggested "One possible explanation is increases among young women of recreational sun exposure or tanning bed use. Both of these things have been identified as risk factors."

When melanoma is caught in the early stages, it is curable. When it is not caught, it will spread to other areas of the body, making it more serious than skin cancers that begin in the surface cells. The American Cancer Society estimates that more than 8,000 people will die of melanoma cancer in 2008. Risk factors include overexposure to UV light (including tanning beds and lamps), moles, fair skin, and a family history of melanoma.

As with all skin cancers, people should reduce their risk by limiting their time in the sun, avoiding tanning beds, wearing properly applied sunscreens and protective hats and clothing, and reporting any changes in moles or other skin appearances immediately to their physicians.

I welcome your questions, comments and feedback relating to these issue; please do so by emailing me at baileyriskmanagement@medicusins.com.