NEW YORK (Reuters Health) -
Patients often fail to fully
comprehend the treatment they receive during an emergency
department visit or recall instructions for their care after
they leave, new research suggests.

More often than not, these patients aren't even aware that
they have not understood what transpired or remembered what
they were told, the investigators note in their study,
published in the Annals of Emergency Medicine.

To shed more light on the communication process that occurs
in this setting, Dr. Kirsten G. Engel at Northwestern
University in Chicago and colleagues interviewed 140 adult
English-speaking patients or their primary caregivers after
discharge from emergency departments at two teaching hospitals.

The subjects were asked questions about their diagnosis and
the cause of their symptoms; the care they received, discharge
recommendations and return instructions.

The results showed that 78 percent of patients or their
caregivers had a deficient comprehension in at least one of the
above areas and 51 percent had deficits in two or more areas.

At 34 percent, the highest rate of mistakes involved
after-care, which raises significant concerns about patients'
ability to adhere to discharge instructions and recommendations
after leaving the ED,” the investigators note.

“Moreover,” they add, “our study suggests that we cannot
simply ask patients to identify their comprehension
deficiencies because the majority did not report difficulties
in areas in which deficits were objectively demonstrated.”

Specifically, subjects were unaware of their comprehension
deficits 80 percent of the time.

Engel's group recommends that clinicians test their
patients' understanding by asking them to repeat information in
their own words. Improving the content and organization of
written discharge instructions may also be of benefit.

SOURCE: Annals of Emergency Medicine, July 7, 2008 online.