Why Some Patients Aren't Following Your Instructions

Neil Chesanow


May 29, 2013

In This Article

Be Alert for Red Flags

Despite patients' adroitness at hiding their inability to read or understand, doctors and staff should be alert for red flags that may indicate a problem. Such "tells" include patient registration forms that are incomplete or inaccurate, frequently missed appointments, nonadherence with medication regimens, and lack of follow-through with laboratory or imaging tests or consultant referrals.

Test results that leave you bewildered, even though a patient says she is taking her medication, should raise your index of suspicion, as should a patient who tells you that he left his glasses at home when you give him something to read, Osborne says.

To learn what your patients really understand about following their regimens, schedule a "brown bag review." In this, your scheduler asks the patient to put all of his medications into a bag and bring it to his visit, Osborne explains. You then remove the medications one by one. Can the patient name each of them? Does he know why he's taking it? Can he explain when he takes it?

If the patient gives general answers -- for example, "3 times a day" -- probe for specifics. Does this means morning, noon, and night, which is what you'd hope? Or does it mean 7 AM, 7:15 AM, and 7:30 AM, which is how some patients interpret it?

Some doctors find it helpful to add a question on literacy skills to the patient's social history, Osborne says. "After asking about occupation and education, they add, 'How happy are you with the way you read?'" Or, "'What is the best way for you to learn new things?'" Insights into how a patient best takes in information can improve your communication with this individual -- and the care you deliver.

How to Make Patients Understand

Health literacy, as the Institute of Medicine defines, it is "the ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions and follow instructions for treatment."[1] What can your practice do to foster this communication?

Everyone in the practice should welcome patients with a general attitude of helpfulness, Osborne says. When scheduling appointments, have a person answer the phone, and save voicemail for after-hours. Give directions to the office. Ask patients to bring all their medications with them to the visit and write down any questions they may have. Use clear, easy-to-follow signage.

The person at the front desk who hands patients forms to fill out at check-in should ask whether they require assistance and arrange for it if they do. Many forms are just too long. They overwhelm patients with unnecessary information requests. Less is more: Collect only essential information. If you have multilingual patients, provide forms in the relevant languages. And make sure the forms are easy to read.

Handouts and other documents should also strive to be patient-friendly. Use short words, with only 1 or 2 syllables. Keep sentences short. Paragraphs should be no more than 2-3 sentences long. Large fonts (12-point type) and serif fonts (letters that have little curlicues at the end) are easiest for patients to read.

Use simple illustrations, graphs, and tables, with simple, adjacent captions, Osborne advises. Bulleted lists are easier to understand than blocks of text, particularly when indicating steps in a process or making a series of key points. Use headings and subheadings to break up text. Each page should have ample white space. Pages that are black with text are forbidding to read.


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