ER Patients Don't Understand Doc's Orders

July 7, 2008— -- More than three in four emergency room patients do not fully understand the instructions that doctors give them after their visits, new research suggests.

Even worse, not only do the patients not understand the care instructions from their doctors, but the vast majority are also unaware that they have not fully understood what the doctor has told them.

The findings were published Monday in the journal Annals of Emergency Medicine.

"It is critical that emergency patients understand their diagnosis, their care and, perhaps most important, their discharge instructions," Dr. Kirsten Engel, one of the study's authors, at Northwestern University said in a news release issued Monday by the American College of Emergency Physicians.

"It is disturbing that so many patients do not understand their post-emergency department care, and that they do not even recognize where the gaps in understanding are."

Other experts agreed that these numbers, while high, are not surprising.

"This report confirms what I have long suspected," said Dr. Richard O'Brien, spokesman at the American College of Emergency Physicians. "Our nation's emergency departments are overburdened and overcrowded, and one of the consequences is a significant amount of difficulty communicating effectively with our patients.

"It is like trying to teach in an overcrowded classroom, with many distractions," O'Brien said. "The message will sometimes get lost."

But other experts said the study, which looked at 138 patients and two caretakers, could have resulted in such high numbers because it may have been too narrow or not comprehensive enough.

"Things like the kind of instructions patients were given and how complicated the patient problems were will play a role," said Dr. Alfred Sacchetti, chief of emergency services at Our Lady of Lourdes Medical Center in Camden, N.J. "For example, some instructions are simply overly complete, making it impossible for anyone to understand them."