What Patients "Know"
A set of three cautionary tales:
TALE THE FIRST
What the doctor says: Happy Hospitalist gives non-compliant diabetics his "lecture" on the dangers of not taking care of their disease, because the patient never heard it from the lazy-ass outpatient primary care doctor.
What the patient says to him: "No one ever told me that before."
What you can't possibly expect the patient to say: "I've heard all that stuff from my family doctor so many times before, I just tune it out. I wasn't really paying any attention to you either."
What the outpatient primary care doctor really said: Every visit for the last 10 years has included a documented discussion of the importance of managing diabetes, including lifestyle issues, medications, and complications.
TALE THE SECOND
What the patient says: Doctor, the surgeon says I need an operation, but he didn't tell me anything about it.
What I do: Spend forty-five (uncompensated) minutes having an extensive discussion about the need for the surgery, the possible ramifications of not having it, and so on.
What you can't possibly expect the patient to say: I was too nervous to pay attention to what the surgeon was telling me, so I have no idea what he said.
What the surgeon really said: Pretty much the same things I did.
TALE THE THIRD
What the surgeon says: The hospitalist sent you here for a surgical procedure that didn't need to be done while you were in the hospital, but can be done as an outpatient now that you've been discharged.
What the patient says: What?? Dr. Happy never said anything about an operation.
What you can't possibly expect the patient to say: That guy talked about all kinds of things, I couldn't make heads or tails out of most of it. I tuned him out after the first twenty-four hours.
What the hospitalist actually did: Reminded the patient every single day about the unrelated problem that wasn't keeping him in the hospital but would have to be dealt with once he was well enough to leave. Made a special point to discuss it in detail at the discharge visit, and carefully documented it both in the medical record and the patient's discharge instructions.
WHAT WE SHOULD LEARN FROM THESE TALES:
Assume that patients really have heard the basics already. Whether or not they understand what they've heard is of course a completely differently pigmented equine. But all of us -- and I do admit my own not inconsiderable guilt in this matter -- need to give our colleagues the benefit of the doubt in terms of what patients have been told. Remember that it's far easier for the patient to claim they've never heard what you're telling them (and oh-so-flattering for us as well) than to admit that they've either forgotten or ignored the same material in the past.