Especially when they lack the ability to understand basic health concepts. Such as, Where is your heart located?
The 722 people who took part in the study were shown pictures of the human body (male or female) with certain areas shaded out and were asked which of the shaded areas was the location of a given organ. Although 85.9% of people could identify the location of the intestines and 80.7% knew where the bladder could be found, only 46.5% of people correctly identified the heart and 68.6% misidentified the position of the lungs.
Can you imagine trying to explain the pathophysiology of stable vs unstable angina vs NSTEMI vs STEMI to 75 year old retired lady who can't even tell you where the heart is located. In this day and age where conversation is uncompensated and technology is viewed as the savior of our health care needs, it's no wonder why it's just easier to talk fast, sound important and recommend "tests" that make loud beeps, take fancy pictures and cost a lot of money, paid for by the Medicare National Bank. Perception is 90% of reality. And who's going to question the doctor when you don't even know where the heart is?
via Booster Shots
18 Outbursts:
Gee, Nurse K. 100% of all patients always understand 100% of the time by the time you've explained? Does this mean no one leaves AMA?
And of course, if you can't talk because you're in resus you can't refuse (or understand possibly, if english isn't your first language).
"And who's going to question the doctor when you don't even know where the heart is?"
Her DAUGHTER will, and will remember your brush off pomposity for months AND go back to school at age 37 to become a nurse...precisely to be the patient advocate for all the dear elderly ladies like the one mentioned above.
"Can you imagine trying to explain the pathophysiology of stable vs unstable angina vs NSTEMI vs STEMI to 75 year old retired lady who can't even tell you where the heart is located"
Yes, draw pictures, start simple, use analogies. Just because they don't originally understand it, doesn't mean they're incapable of learning.
Most people don't know much about diabetes past "you can't have sugar and aunt jo lost her foot from it" when they're diagnosed, but within weeks, even days, they manage to learn about carb counting and basal and bolus insulin and calculate bolus doses and hypoglycemia symptoms and treatment and injecting insulin and dka, and blood glucose testing and glucagon kits, and effects of exercise on blood sugar and even islets of langerhans. Diabetes, after maybe 2-3 days, is managed outpatient. So, people go from knowing nothing to knowing what they need to know to manage their disease completely independently in 90% of cases in a few days.
Diabetes wouldn't be able to be managed outpatient, nor would asthma, arthritis, CF,post BMT patients, or, yes, even CAD and post MI patients, if people really were incapable of being involved in their care.
Generally people who feel their life is at risk are a captive audience.
My grandpa got dx'ed with afib few years ago. He told me his doctor wanted him on Coumadin, but he doesn't like drugs so he's not going to take it. I spent 3 min talking to him about afib and he filled his Coumadin and hasn't missed a dose since. No one had ever explained to him why he needed it or what could happen if he didn't take it. They just sent him on his merry way and expected unquestioning compliance. My grandpa has no medical knowledge, but it wasn't difficult to involve him in his care and get much better outcomes as a result.
You can't leave patients in the hospital forever.
Can you imagine trying to explain the pathophysiology of stable vs unstable angina vs NSTEMI vs STEMI to 75 year old retired lady who can't even tell you where the heart is located.
Your heart has blood vessels which carry blood to the muscle of your heart. Sometimes these blood vessels get blocked up and make it hard for the blood to reach the muscles. Sometimes the blockage is SO BAD that it causes the heart muscle to die because it's not getting enough blood to keep it alive. Some people get pain when this happens and, believe it or not, some people don't! That's a heart attack. You can see if your heart muscle died by checking something called troponin in your blood. Your heart muscle releases this troponin when it dies. Your blood shows a troponin which is higher than normal and Dr. Happy says this means you had a heart attack even though that EKG we checked is normal now.
That wasn't so hard, was it?
We've talked about the uneducated and ignorant patients. What about the hyper intelligent?
HH: what would you do if you got Stephen Hawking as a patient? Severely disabled, but with a genius mind?
Would you assume that Dr. Hawking is severely brain damaged since he can't speak on his own? and "Shouldn't Be An Equal Partner In Health Care Decisions?"
I've run into this too many times (I have a similar disability as Hawking).
Nick
Nick, this post was presented as sarcasm in the setting of the stated research I linked to, as I stated above.
Sorry Happy, I can't side with you on this one.
I'm a PhD student in Health Sciences (so, fairly health literate). Today I met with my physician to talk about a thyroid disorder. He assumed I had some knowledge, but took the time to ask me if I would like a brief overview. I said yes and he proceeded to draw me a quick diagram to illustrate the disease. I'm sure anyone could have understood it, as he used no jargon or $10 words.
My physician respected that I am an educated person, he did not talk down to me, nor did he expect that I had any prior knowledge of endocrinology.
I understand how frustrating it can be to communicate with people who have less knowledge than you have. Perhaps you could ask the patient how THEY understand their illness and work from there?
Bottom line - of course patients should be equal in the decisions about their health care. They bring the expertise of their body, their symptoms, their health goals, their life goals - you bring the facts and your recommendations to help them achieve their goals. It should be a partnership in my opinion.
Um, I guess I don't have much trouble explaining those things. You have to dumb it down and leave time for questions, but dumbing it down doesn't mean the patient doesn't UNDERSTAND what we're doing. I think most people understand that there are blood vessels in the heart (most people know it's somewhere in the chest at least!) and troponin can easily be explained.
If your goal is to make yourself look like the smartest mofo on the planet who knows big words, yeah, YOUR patients won't know wtf you're talking about. That's why you have nurses around to translate.
Gee, Nurse K. 100% of all patients always understand 100% of the time by the time you've explained? Does this mean no one leaves AMA?
Most of my AMA patients are those who were just told they ain't getting narcotics unless the work-up shows something. I can't say I've really ever had a patient who was truly sick go AMA. If it's truly a life or death situation, I'll bust out the, "If it's a money issue (which it usually is), we have payment programs here...you can bargain with the hospital much easier than with Grim Reaper if ya know what I mean..."
Oh, okay, nurse, I'll stay, sheesh.
Sure, but tell me what I just said first, Madam. This is important.
"You said I had a heart attack because there was that stuff in my blood, but I'm okay for now." Patients always hear the words "heart attack".
Right. "You need to tell me if you feel [insert ACS symptoms here]. That's really important." We'll get you some stuff that is good for your heart to eat now!
No, patients shouldn't equal partners. They should be making the decisions exclusively. All you can do is make your recommendations. They have to, and get to, decide what they do for themselves. Patients Bill of Rights, anyone?
The sicker you are, the less autonomy you're entitled to.
Outpatient visit for heartburn = discussion about pros and cons of medication
ER visit for hematemesis = this is what we're doing to save your life, hope it works. You don't want an NG tube, the discuussion is - you're putting your life and your ability to live independently at risk; if you're OK with this, I'm OK with it.
"Can you imagine trying to explain the pathophysiology of stable vs unstable angina vs NSTEMI vs STEMI to 75 year old retired lady who can't even tell you where the heart is located.
Your heart has blood vessels which carry blood to the muscle of your heart. Sometimes these blood vessels get blocked up and make it hard for the blood to reach the muscles. Sometimes the blockage is SO BAD that it causes the heart muscle to die because it's not getting enough blood to keep it alive. Some people get pain when this happens and, believe it or not, some people don't! That's a heart attack. You can see if your heart muscle died by checking something called troponin in your blood. Your heart muscle releases this troponin when it dies. Your blood shows a troponin which is higher than normal and Dr. Happy says this means you had a heart attack even though that EKG we checked is normal now.
That wasn't so hard, was it?",
Patient's response: Can I get something to eat?
Nurse K -
I sure hope you're not offering food when the patient's on their way to a stress test or cath!
Interesting research + sarcasm = angry self indulged readers.
If you have problems reading my style and get all flustered about it, I would kindly ask you stop coming by and go do something fun with your family. It's not worth the stress I seem to have on your life. I'm not changing my style to please anyone.
I've seen it all. Educated. Ignorant. Educated and ignorant. Ignorant but educated. Some people won't get it if you brought out Sesame Street and picture pages. That's the nature of complicated illness.
"What ever you say doc" is quite common in my parts. Even if you have a PhD or a really really smart daughter.
I once took care of a woman on our oncology floor who was refusing surgery after a severe episode of vaginal hemmoraging....cancer was suspected and emergency surgery was the recommended course, they brought her to the floor to await an open OR. It is still amazing to me how ignorant this 45 y.o. woman was of western medicine. I spent an inordinant amount of time with her trying to explain the rationale for the recommended surgery...hours at her bedside that I could not really spare. My other patients saw very little of me that day. She did not appear to be incapable of understanding, but she had followed alternative medicine her entire life and had not educated herself at all about the western medical approach to health care. I "dumbed it down" as best I could, over and over. She never did agree to surgery at that time. She never appeared to grasp the gravity of her situation, either. Of course, I don't know whether she had any follow up care outside of the alternative mode she had always followed.
In truth, people have a right to refuse medical care even if we don't agree with them. We can only do our best to educate them. If they can't/won't understand, it is still wrong to go after them with knives and poisons. The woman who refused exploratory surgery (with probably TAH) had very advanced symptoms and in truth the probability of a cure appeared to be low.
Despite all our efforts, many people are either incapable of or unwilling to truly comprehend the science of their own bodies. Denial is also such a strong force that folks can and do ignore the best medical advice.
Regardless of whether people accept good medical advice, they still have a right to decide who and what touches their bodies....even if they could die. The only exception I feel is appropriate to this is in the case of minor children who are not able to decide their own healthcare and whose parents are woefully ignorant. Still, I think it's a grave step to override parent's rights and this should only occur after extreme efforts are made to educate and work with the parents.
I know many may not agree with me. But it is not wrong to die. It may be tragic, and it may be "too soon" but it is not immoral except in cases of murder or suicide (as I believe).
The only conclusion that can be drawn from this research is that there are those who cannot accurately label the location of their organs on a picture (a picture with shaded areas representing said organs). You cannot conclude that these same people would not be able to point to the correct location on their own bodies. Even if they can't, you definitely can't conclude that they wouldn't understand a basic explanation of the pathophys of their disease.
An auto mechanic could talk about the technical workings of your vehicle that would leave you scratching your head. Should you be involved in making the decision about whether it should be repaired? I suspect that you would expect the mechanic to explain the problem to you in terms you understand so that you are able to make an informed decision.
It has been my experience that the vast majority of patients are extremely grateful when you take the time to explain treatment to them. They don't want a dissertation, just a basic explanation (like the example Nurse K gave). Here was the reaction of one patient when I took time to talk to her: http://medsurgzone.blogspot.com/2009/06/goodbye-i-love-you.html
8.3% of people in the study couldn't tell their arse from their elbow....this group was known as "middle management"
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