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 childrenís
sedation and antibiotics on the day of surgery.
arrived early the day of surgery, and my breakfast-deprived
children were ready for their operation as I proudly displayed
the surgeonís instruction folder on my lap. Then I was
asked: "Dr. Sadler, have they have had their
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 childrenís horrified faces.
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.
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.
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.
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
patientís 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
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.
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.
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.
you leave a medical providerís 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. Donít expect to
remember everything that was said because I can assure you
that your memory bank is already quite full.
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.
longer will I leave a medical providerís office without a
calendar reminder set into the computer with all instructions
needed prior to future appointments.
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.