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Protect Yourself In The Hospital – "What We Have Here Is A Failure To Communicate"
Two cases of accidental drug overdose as a result of miscommunication
The Institute of Medicine identifies “health illiteracy” as a leading cause of medical error
The Institute of Medicine (IOM) issued a report on April 8, 2004 [IOM Health Literacy: A Prescription to End Confusion] stating that up to 90 million American adults lack the reading and math skills needed to understand basic health information and navigate the US health care system. IOM identified a conceptual entity with its new title called “Health Literacy: A Prescription to End the Confusion”.
The IOM report specified that the list of skills necessary for a US citizen to be health literate are reading, writing, listening, speaking, arithmetic and conceptual knowledge. The IOM defined health literacy as “the degree to which people have the ability to obtain, process and understand the basic information and services needed to make appropriate decisions about their health”. At some point, most people, even well-educated people with strong reading and writing skills, encounter health information about forms, medications, or procedures that they do not understand. In addition to calling for the health system to address the problem through improved health education, IOM had doctors and other health care providers listen to their patients to discern whether they understood what they needed to know to participate in his illness. manage and/or improve your health status with preventive measures.
In my professional experience I have encountered thousands of patients in the home environment over two decades. Most of the people I interviewed who were taking medication did not know the name of their medication or the possible side effects. All they knew for the most part was the color, shape and what disease it was for (ie high blood pressure, diabetes, nervousness or infection)
There are two basic areas of concern in the IOM report. The first is public awareness of where to go for which problems. This is a matter of public education and deals with the population before they enter the system and meet with a health care provider. The second area of concern is the information provided by the doctor or other health professional. This applies to people who are under the care of the particular health care provider, whether it’s a doctor, nurse, chiropractor, HMO, home infusion company, etc. The IOM attributes failure to ensure that patients understand enough to participate in their own care as a leading cause of medical errors.
Therefore, part of the duty owed by a licensed health care professional is to ensure that the patient or responsible party understands the information to be provided to the extent that the patient or significant other can participate in the management of the disease and take preventive measures.
Case of point 1:
In the first case, a man living in the US who was not fluent in English was given a prescription for Tylenol with codeine. The label said, “1 or 2 tablets every 3 hours as needed for pain.” The patient understood this to mean that he could take two tablets every 3 hours or more often as needed. He ended up taking two pills every hour until he collapsed from a narcotic overdose. He survived with a mild degree of anoxic encephalopathy (brain damage from lack of oxygen). The patient sued, arguing that it would have been a simple matter to ask the patient, “What is your understanding of the instruction on your pain pills?” and not to do so was unreasonable.
While many would argue that people must take responsibility for not understanding simple instructions, the IOM notes that approximately ninety million people in the United States cannot understand medical directions as provided on labels, instructions, and verbally On the other hand, it can also be argued that people know whether they understand something or not, and if they don’t, they still have a responsibility to ask for further explanations. However, the core of the problem of miscommunication is not lack of understanding, but misunderstanding. Health illiterate patients often leave a consultation without realizing that they have a set of erroneous instructions in mind that differ from what the doctor said.
Therefore, it is incumbent on the health care provider to take reasonable steps to ensure that the patient received and correctly understood the medical advice. Also, we need to take a look at the standard instructions like “take one or two pills every three hours as needed for pain” and maybe change that to “take one or two pills every three hours or less often as needed for pain.”
Case of point 2
The second case involves a 63-year-old man who was sent home from the hospital with intravenous morphine delivered via patient-controlled analgesia (PCA). The man died of an overdose on the second day of the infusion despite his wife checking on him frequently throughout. In the investigation that followed, it was evident from the records that the home infusion nurse did not provide sufficient teaching to the patient’s wife. The wife just looked at her husband, who was sleeping most of the time, and thought he was fine because he was breathing and sleeping peacefully. He obviously didn’t have enough health knowledge to check for narcotic stupor by waking him up and seeing if he was hard to wake. He needed to find out if he could respond to the voice, or if he needed tactile or even painful stimulation to wake up. The nurse needed to make sure the woman understood how to assess the level of consciousness. It is likely that with a few extra moments of effective communication, the woman could have known her husband was in trouble and called 911 sooner to save his life.
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