The Reality of Discharge Information Comprehension & Retention

A recent study published in JAMA Internal Medicine, and reported on ChicagoTribune.com, will probably reinforce what many ER health care providers already know: just because discharge information is explained thoroughly, doesn’t mean that it is understood or that it will be retained.

The study interviewed 395 people age 65 and older after being discharged from Yale-New Haven Hospital May 2009-April 2010. One very interesting stat from the study was that 96 percent of patients reported knowing why they had been hospitalized, but only about 60 percent could appropriately describe their diagnoses. (That raised a question for me: Is it possible that the patients understood the information at the time, when it was explained, but were unable to retain it?)

Either way, not only does this increase the chances of a patient’s readmission, or of a poor outcome, it also increases a physician’s liability. No physician wants to be accused of not explaining a patient’s diagnosis appropriately or of inadequately explaining the necessary follow-up a patient should take –be it with medication, a follow-up appointment, etc.

Having been a patient myself, and the mother of a patient with a long medical history, this study hits home, all to well. Despite being someone who has worked in health care her entire professional life, and having more than the average layman’s understanding of medicine, and being comfortable in a hospital setting (and more than 2 decades younger that the study group), I, too, have had difficulty remembering information (or being able to explain information) that I had comprehended just hours before.

Quite simply, I don’t think it can be underestimated just how overwhelming and overstimulating for the average person the hospital can be. Add to that, the often scary situation many patients emotionally find themselves in at that time –where they are just trying to adjust, cope and process all that is happening. Never mind the obvious physical stress or stresses on the body that landed the patient in the hospital in the first place…and the possible sleep deprivation that may have occurred in the hospital on top of all of that.

Interestingly, the article suggests the use of the National Patient Safety Foundation’s “Ask Me 3” campaign. The campaign recommends that patients ask their doctors the following three questions:
1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?

I find this suggestion slightly odd given the results of the study. Clearly patients are not processing information well or retaining information in this setting. Does it make sense to try and get them to remember to ask 3 questions?! Why put the burden on patients? How about, instead, asking health care providers to make sure that they convey this information AND put it in writing –considering that we just learned that patients can’t remember information well in this situation. Just an idea.