Patient Perspective

Today's Writing prompt: In your own words, explain why or why not the perspective of the patient is the most important determinant as to whether an adverse event has occurred


Ever since I was little I have had an issue with authority. Most people wouldn't guess that- I have never been grounded or punished by my parents, gotten detention at school; actually I had never even been tardy to class until I went away to college and learned the joys of the snooze button.  My issue with authority wasn't an unruly teenager flipping the bird at her parents behind their backs- it was a mischievous little girl quietly flouting authority in small unnoticeable ways yet significant (at least to her).   I don't have an issue with authority itself or the idea of obedience, I simply take issue with the idea of following an order that may not be the best thing for me.  I have always been of the opinion that I know  me  best.  Notice I did not say I know what's best for me, but that I know myself better than anyone else. Some may say that's a semantics argument. I disagree- I think there is an important difference between the two.

This is something I think people lose sight of, and especially in healthcare. Patients' complaints about their doctors not listening to them or taking them seriously are a dime a dozen, and are often ignored because of the idea that doctors clearly know more about medicine than the people paying them do.  I wouldn't argue that fact- surely the people who went to medical school for eight or so years are more knowledgeable about medicine than the person wearing the hospital gown; yet could the patients have a point?   The person wearing the hospital gown has had a pretty close relationship with themselves for years- maybe decades; the doctor probably just met them five minutes ago.   There is a legitimate argument to be had that sometimes doctors lose sight of this fact when they are working with patients and making diagnoses. 

When it comes to an adverse health event- which is more important, the patient's perspective, or the doctors?  There can be arguments made for both sides; the patient is the one experiencing the effects and having to tolerate the symptoms, yet the doctor is the one knowledgeable in all of the effects as well as likely why the event occurred, and if  it might happen again or trigger another adverse health event. 

Let's say for example that a patient experiences an adverse health event. The doctor is concerned about this event that has occurred and recommends to the patient that he seek such and such a treatment in order to prevent this from occurring again. However, let's say in this situation that the patient has been experiencing these ongoing symptoms for some time, but is not bothered by them or the fact that they happen, and does not want to follow the treatment plan the doctor has provided. Who is right?   On the one hand, the patient knows their own body better than the doctor does- and is the one experiencing everything firsthand; however, the doctor is the one with the training and may know that if the patient does not seek treatment conditions may worsen and danger may be present.

I think when it comes to adverse health events, neither the patient perspective or the doctor perspective is the most important in deciding whether an event has occurred.  Patient perspective is absolutely important, and should not be disregarded.  Who hasn't suffered the unpleasant experience of being questioned endlessly about how you are feeling, when you continuously repeat that you are feeling fine?  Nobody knows you better than you do after all. However, someone with eight years of medical training can undoubtedly identify a medical issue better than someone without years of medical training. Is it not possible for someone to be suffering an affliction of some sort yet present no symptoms currently? As healthcare professionals we know all too well that someone can feel fine one minute and be barely alive the next.  For this reason, I would have to say the patient perspective is not the most important determinant when decided whether an adverse health event has occurred- because both perspectives are important. There is no "most important"  perspective or person, rather both patient and provider should work together.

Health Literacy- fact or fiction?

Lately I've been hearing a lot of people talk about not understanding what is actually wrong with them after going to the doctor. I know the feeling- a lot of times I leave the office in a literally fog (flu season gets me every year!)  and I barely remember the directions he or she has given me to follow, let alone the scientific terms and proper names for all of the parts of my body that were identified.    However, you have to wonder whether or not this is really significant to people getting better  and whether it affects the quality of our healthcare.

Kaiser Health News did an article on this titled Health Care Quality Issues: the Disconnect Between Patients and Experts (which can be found here )  They defined "health literacy" as follows:

This literacy is "the limited ability to understand the technical jargon, the orders, the prescriptions and the forms coming from doctors, nurses, pharmacists and insurance companies. This failure to communicate leads to missed doctor appointments, medications taken incorrectly, instructions ignored — all contributing to worsening health."

Now obviously, this is a real and observable fact. For example- let's say you visit the doctor because you are sick and are coughing up mucus, and the doctor says you have bronchitis. The anatomy of the lung as explained by PubMed Health states that

"When air is inhaled through the nose or mouth, it travels down the trachea to the bronchus, where it first enters the lung. From the bronchus, air goes through the bronchi, into the even smaller bronchioles and lastly into the alveoli."

 Now let's be honest- your doctor will very likely mention at least one of these scientific terms when explaining bronchitis to you, however, how many of us would raise our hands in a classroom if we could point out where in our bodies the bronchioles are?  Probably not many. And at that moment in time when your head is in a fog and you feel like death, understanding the advanced explanation of what is causing your body to feel the way it does at that moment is not high on your list of things to worry about.  All you care about in that moment, is what you are going to do to feel better, and what the doctor can give to you.  

It is for this reason that I always, always, always have a notepad with me when I go to the doctors, to write down what he or she is saying, because I know (and you know)  that once I leave that office, the details are slowly going to leak out of my head while I wander up and down the aisles of Walgreens miserably waiting for my Z-pack prescription to be filled. Completely human- however, this is an issue that is affecting healthcare quality.   There are several issues at play- one issue is that if the patient doesn't fully understand their prognosis, they may later on down the line make mistakes with following the directions on their medication, or follow up treatments.   Even further than this issue, is an overall literacy issue period, with patients being unable to read and understand the directions printed on the medications they are taking.  

Estimates from the article report that this issue could cost up to $7.5  billion dollars annually- no small chunk of change.   But what can be done to insure that this issue is resolved?   speaking from personal experience, I am seeing an increase in the amount of informational pamphlets being handed out after visiting a healthcare facility. In the past three years, I have noticed that I am given handouts when leaving the healthcenter on campus, explaining  details of what I may have visited for (and this is at a college campus, where you would expect those visiting to have reached a certain level of literacy!)   However, the health center is making an important observation: You just can't assume people understand; as a health provider, it is our responsibility to make sure the patients receives and understands all pertinent information given to them.

In a world where everyone thinks they're a doctor courtesy of WebMD, it's easy to forget that not every patient who walks through the doors of a health facility has already been on line and diagnosed themselves, and is only their for a script.  In order to ensure healthcare quality continues to improve and that all patients receive the highest level of care available, healthcare providers will have to continue to keep health literacy in mind when delivering care.