Saturday, February 13, 2016

Following doctor’s orders can be tough even for a doctor


(MCT) Six months before my children had wisdom teeth surgery, I met with their surgeon and was given verbal and written instructions as well as a video on pre-operative preparations. It included necessary information for administration of the children’s sedation and antibiotics on the day of surgery.

We arrived early the day of surgery, and my breakfast-deprived children were ready for their operation as I proudly displayed the surgeon’s instruction folder on my lap. Then I was asked: “Dr. Sadler, have they have had their pre-operative medications?”

Oh, no! I shrunk back in my chair like the retracting garden hose. That she called me “Dr. Sadler” in front of the other patients was salt in the wound. Dr. Mom had failed, and it showed clearly in my children’s horrified faces.

There are no excuses for my mishap, and I am more than capable of understanding medical instructions. But at least I know that, as a patient, I am not the only one who has had problems.

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  • Early studies reported in Canadian Family Physician first recognized the problem in the 1970s. At that time less than half of patients given instructions followed them completely, and almost a quarter deviated from the instructions.

    Patients receiving information both verbally and in writing were more likely to comply with physician directions. Still, according to a 2013 article in Medscape, nearly 50 percent of adult patients still had difficulty understanding and therefore complying with medical instructions.

    Not understanding instructions leads to poor medical compliance and may lead to costly hospitalizations and readmissions. Studies released in “The Revolving Door: A Report on Hospital Readmissions 2012” demonstrated that 1 in 8 Medicare patients required readmission after surgical procedures, as did 1 in 6 after receiving nonsurgical medical care.

    “Every patient’s story about his or her hospital readmission is complicated, unique and hard to characterize. Yet there are common traits across the stories,” according to the hospital report.

    For example, one patient left the hospital with a diagnosis of smoking-related lung disease, but he had no understanding of how to use his prescription inhaler properly, and he continued to smoke. Due to his inability to manage the disease at home, his condition quickly deteriorated and he required readmission. After his second hospital discharge, a health care team intervened to more closely monitor his breathing and had him enrolled in a smoking-cessation class.

    Another example from the study describes a diabetic patient admitted to the hospital for dangerously elevated blood sugars. She was discharged without clear instructions on the use of her insulin. Her primary care doctor was not offering diabetes care. Shortly afterward, she required readmission, but this time she met with a dietician. Together they developed a clear understanding on adjusting insulin doses. Understandably, she fared much better.

    Patients and their families can be overwhelmed by the diagnosis of a new disease and may feel that the health care system rushes them too soon to discharge. Sometimes in the clinic, the doctor has to move on to the next patient. Both of these situations can make patients feel unprepared and left on their own. Neither of these situations is beneficial to the patient or the hospital system. This is why more attention is being given to follow-up care than in prior years.

    Before you leave a medical provider’s office, be certain to review their instructions and always leave with your own written notes or directions provided by the clinician. Never feel silly about repeating the instructions aloud to get confirmation of mutual understanding. Don’t expect to remember everything that was said because I can assure you that your memory bank is already quite full.

    What’s my excuse for failing to follow excellent instruction? I have none. I should have been prepared. I assumed I knew what to do on the day of surgery. After all, I am a doctor! Well, this Dr. Mom re-learned a valuable and very humbling lesson.

    No longer will I leave a medical provider’s office without a calendar reminder set into the computer with all instructions needed prior to future appointments.

    Thankfully, I had a forgiving surgeon who informed me that he would “probably have made the same assumption,” which is doctor-speak for a gentle hand-slap.


    Dr. Jane Sadler is a family medicine physician on staff at Baylor Medical Center at Garland, Tex.. She blogs at


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