Saba Shahab is a third year medical student at Western University.

 

How many patients remember every advice shared by their physician at a clinic visit? How often do patients know exactly what disease they take each medication for? As a medical student, I have had the unique opportunity of following a few patients through their encounter with several health care providers. During my physical medicine and rehabilitation rotation, I saw an 86 year old man who had suffered a stroke and had come in for a follow up visit after receiving rehabilitation therapy at the hospital. At the end of the visit, the doctor had multiple recommendations for the patient that included another follow up visit, medication changes, continued therapy at the outpatient rehab unit, community resources for stroke patients, a referral to another specialist for an unrelated problem, and counselling for prevention of future strokes.

Three days later, I was following an occupational therapist at the outpatient rehab unit and saw the same patient come in for their first day of therapy. The patient asked the therapist why the physician recommended that he seek therapy in the community instead of outpatient rehab at the hospital. The occupational therapist was confused as he felt that the program at the hospital was ideal for this patient at this time. I remembered the doctor’s recommendations and clarified that the physician wanted the patient to seek resources in the community after completing the outpatient rehab program if he needed more therapy.

This instance made me wonder how often patients are able to accurately remember physician recommendations. I have come across several patients who don’t clearly remember the medical advice they receive from their physicians. Many patients don’t know what pills they are taking and don’t know why they are taking the pills they have. This may be partly explained by a lack of clear communication between the physician and the patient and a result of patients relying on memory alone. Humans have a limited capacity for storing information in short term memory with research showing that we can store four chunks of information at a time. Additionally, people see physicians during stressful periods of their life and life stressors seem to worsen working memory capacity.

A possible solution to this problem would be for physicians to provide patients with written instructions. Of course, if the instructions are simple and few, this step may be unnecessary. Physicians could take out a few extra seconds to write down a list of recommendations and names of new medications with the reason for taking those medications. This will reduce instances of miscommunication and ensure that patients know what their physician recommended for them. During my emergency medicine rotation, I saw a patient who brought a sheet of paper with him with three columns: name of medication, reason why medication is taken, and additional notes. This patient knew his medications very well and undoubtedly was compliant with all his medications.

CMPA encourages physicians to provide patients with written instructions to supplement personal interaction during informed discharge of admitted patients. Adopting this practice not only at discharge but also during clinic visits will result in more patient compliance and better communication as the written instructions will help patients remember the information provided to them. A research study showed that written instructions provided to parents of children being discharged from acute care resulted in improved satisfaction and knowledge. This approach could be applied to adult populations as well. Providing written instructions has shown to result in improved recall of medical advice.

Of course, written instructions will not solve the problem fully. Some patients may lose the paper handed to them or may forget to bring it at their next appointment. As medical students, we learn about the importance of CanMEDS roles, qualities that physicians should acquire to be able to meet the needs of our patients. Communication is one of those CanMEDS roles. Providing written instructions is one way for us to become better at communicating with our patients.