Takeaway
Always use simple language with patients when giving directions about how to take medication, and check for understanding.
Lifelong Learning in Clinical Excellence | September 27, 2021 | 2 min read
By Jeffrey Millstein, MD, Penn Medicine
“The single biggest problem in communication is the illusion that it has taken place.”-George Bernard Shaw
Recently I listened in on an executive leadership course my wife was facilitating. A speaker was presenting a PowerPoint and one of the attendees requested a copy of the slide deck. The speaker replied, “I’ll send it right away.” For some in the group this meant in one hour or less, whereas others expected it by the end of the week. The lesson—while it’s tempting to blame the attendees for not requesting clarification, the responsible leader must own this communication failure. This exercise brought to mind a few memorable scenarios when my medication prescribing instructions weren’t as clear as they could have been, which resulted in adherence challenges.
In one example, I explained to my patient that her thyroid medication was best taken in the morning on an empty stomach. Later, when her blood levels failed to improve with dosage titrations, she told me that she was skipping her dose whenever she had a few bites to eat before remembering her medication. I clarified that it is always better to take the medicine with food than not at all.
Another patient completed a 30-day bottle of blood pressure medication a week or so before her appointment. She didn’t realize that I assumed she would renew it, and thought that after a month of daily medication, her blood pressure problem would be cured.
A third patient was given a medicine with dose titration instructions, “Take half a tablet daily for one week, and then increase to one full tab daily.” She glanced at the directions and thought she only needed to take the medicine for one week and missed the second instruction to continue thereafter at the higher dose.
In each example, I could have communicated my prescribing instructions more clearly. A “teach-back,” which is asking the patient to repeat the instructions back to me as if our roles were reversed, may have picked up any misunderstandings and created opportunities to correct them.
I learned that when communicating with patients about medication directions:
1. Use simple language without jargon.
2. Be aware of instructions that may be misinterpreted and lead to poor adherence.
3. Keep in mind that patients may not read long instructions carefully.
4. Always perform a “teach-back” to ensure that your patient understands their medication instructions, and allow time for clarification.
This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.