By James Campbell

     Very intelligent and thoughtful clients frequently tell me the doctor never told them the things documented in the medical records.  For example, I have seen the records document the patient was told to follow up within a week, but the patient swears they never heard that.  Or, the record reflects the patient was told what to do in the event of drainage or swelling following a surgery, by the client recalls nothing of the sort.   Another frequent miscommunication is the patient is told to get a particular test, and then follow up with a particular specialist to review the test. 

My impression after hearing many of these disconnects over the years this information is often communicated in a rush as the patient is focused on leaving the facility.  The patient is anxious, thinking about the next step, and often does not feel well.   Frequently, after surgery, patients are still in an anesthesia induced fog.  

Moreover, health care workers are often rushed at this time as well.  Emergency Department physicians have very heavy caseloads.  They are focused on maximizing their time.  As a result, detailed instructions to the patient are often given short shrift. 

This problem is exacerbated when a third party, like a nurse or an MA, is included in the communication chain.  The doctor tells the nurse to tell the patient the discharge instructions.  Often, important information is lost in the game of medical telephone line. 

There are several things a patient can do to avoid these potentially dangerous miscommunications.  The first is have an advocate with you.  Everyone needs an extra set of eyes and ears at the hospital to help a patient to remember things told to them while  you were sick.

Also, here are a set of questions that may help you to respond to the doctor/nurse/MA when they ask you, “do you have any questions?”

Follow-up

• Who do I follow-up with and when?
• What am I following-up up for?
• What are the doctor's contact info and office address?
• Do I need to bring anything with me to the appointments?
• Are there any test results pending and how will I find the results out?

New diagnoses

• What are my new medical problems/diagnoses?
• What procedures did I have?
• How are these going to affect my life long-term?

Medications

• What are my new medications and what are they for?
• Are they scheduled or do I take them as needed?
• What are the side effects?
• What medications am I staying on?
• Are there any I am stopping?

Home care

• Incision or wound care?
• Special diet?
• Home health care, PT/OT?
• How do I get this home health care?
• Assistive devices?
• Bathing?
• Activity level?
• Return to work?

Warning signs

• What are the signs and symptoms I should watch for at home and what should I do if I get them?

Medical records

• How can I get copies of my medical records from this hospitalization?
• How can I request that the records get released to my primary care provider?

The bottom line is: we all want to go home and nobody likes the hospital.  But, take an extra second or two to make sure you or your loved one really knows and understands ALL the follow up instructions.