Prescription for Simple Language and Better Communication

It's clear that doctors and pharmacists need to improve their communication. Some headlines in the science press include Most Adults Misunderstand Standard Warnings on Prescriptions, Prescription Labels Geared Toward Pharmacies, Not Patients, Low Literacy Equals Early Death Sentence. Even with highly literate people, studies reveal that as many as 70% of patients do not correctly understand the instructions on their prescription medicines.
One study of less-educated patients, Low Literacy Impairs Comprehension of Prescription Drug Warning Labels, revealed the following shockingly common misinterpretations of the instructions on prescription drug labels:

1. Patients thought "Take with food" meant "Don't eat anything."
2. When the label said "Do not chew or crush, swallow whole", many thought it meant "Chew the pill and crush it before swallowing" or "Don't swallow it whole because you might choke."
3. A warning to "avoid exposure to direct sunlight while taking this medication" meant that they weren't supposed to leave the medicine in the sun.
4. "Do not drink alcoholic beverages when taking this medication" was seen as a warning about drinking and driving, or a warning not to drink alcohol at all, because it's poisonous and will kill you.
5. "Do not take dairy products within one hour of this medication" was interpreted either as "If allergic to dairy, don't take medicine" or the more general "Don't eat for 1 hour after taking medicine."
6. "Take medication with plenty of water" was misinterpreted as "Don't take pills when you are wet", " You don't need water with this medicine." or even "Don't drink hot water."
7. "For external use only" was interpreted as "Take this medicine when outside", "Use extreme caution in how you take it", or "Take only if you need it."

As with every other form of communication, simple language helps. And, as with every other form of communication, closing the loop with discussion and confirmation is invaluable. Findings from various studies all point to similar concepts for improving understanding, including:

Explain things clearly in plain, simple, everyday language, avoiding jargon

• Instead of adverse reaction, say side effect. Instead of hypoglycemia, say low sugar. Instead of topical, say on skin. Instead of suppository, say that the pill that goes up your bum.
• Slow down the pace of your speech.
• Pay attention to patient's own terms and use them back.
• Be specific, not vague. Say "Take this pill 1 hour before you eat breakfast" instead of "Take on an empty stomach"

Focus on Key Messages and Repeat

• Limit information. Focus on 1-3 key points.
• Develop short, simple explanations for common medical conditions and side effects.
• Discuss specific behaviors rather than general concepts. Focus on what the patient needs to do.
• Review each point at the end.

Use "Teach back" and "Show me" to Check Understanding

• I want to make sure I explained everything clearly. If you were trying to explain to your wife how to take this medicine, what would you say?
• Let's review the main side effects of this new medicine. What are the 2 things that I asked you to watch out for?
• Show me how you would use this inhaler.

Draw Out Questions

• Don't say, "Do you have any questions?" or "Any questions?" While these appear to invite discussion, their effect is to produce a quick, risk-free "No". There is an implied accusation of stupidity - I'm done explaining it so you should understand it now.
• Instead say, "What questions do you have?" This makes it clear that you expect questions, and makes it safer for people to ask. There is no implication of stupidity - I've explained it as best I can but I probably missed something; let's clear up any confusion I've created.

We look for grand technology solutions and system-wide initatives to improve our organizations. Those are great, but don't ignore such simple things as simple language, repeating yourself, getting people to teach back what they learned, and drawing out their questions. These simple ideas can dramatically improve understanding, and dramatically reduce mistakes.