'Patients must not be afraid to question GP'

In this week's Scrubbing Up Dr John Holden says patients should not be afraid to ask their GP to clarify instructions on medication or treatment.

Doctors often wonder why their patients sometimes struggle to follow basic medical advice or fail to take prescriptions as instructed.

Sometimes they suspect non-compliant patients are acting irrationally or being wilfully disobedient, but often there are other factors at work.

One element that could play a significant part is simple communication failure - where doctors issue unclear or ambiguous instructions that risk being misunderstood or misinterpreted. There's no denying that patients must sometimes feel like their doctor is speaking an entirely different language.

Professor Theo Raynor and his colleagues at Leeds-based Luto Research have recently looked at this issue in relation to the wording of medicine labels. When drug information leaflets are misplaced, Professor Raynor says, the label on a particular medicine "plays a very important part in guiding people's behaviour".

His team's research found that the word "drowsiness", for example, was not always readily understood and should be replaced with the phrase: "This medicine makes you sleepy."

He found similar results for the instruction: "Avoid alcoholic drink" - where some people thought it only meant they should limit their alcohol intake - and suggested it be replaced with: "Do not drink alcohol while taking this medicine."

In light of this research, the British National Formulary announced that it is recommending medicine labels should be improved "to ensure the wording is better understood by patients". Terminology should be simpler and more precise and changes are likely to come into force within six months.

Cause for complaint

These recommendations can be applied to more than just medicine labels. It is crucial that doctors are clear and precise when issuing any written or verbal patient instructions - particularly when giving telephone advice.

We know of a number of cases where unclear or ambiguous patient instructions have led to negative outcomes and given rise to a patient complaint.

One significant risk area relates to advice about medication.

Some patients may be given medication and told to take it "at meal times", but ideally this should be narrowed down to a more specific time frame, such as "take one tablet within two hours of eating a meal".

It can be easy for doctors, with their years of medical training, to lose sight of the fact that patients are not as familiar as they are with medical instructions.

Some patients who fail to take their medicine may simply not understand how or when to take it or, indeed, why they should take it.

There can also be problems if doctors are unclear about when patients should return for further treatment.

In one case a patient with gastrointestinal problems was told by his GP to "come back if the symptoms get worse". His symptoms persisted over several days but, because they had not worsened, he didn't return to his GP. This resulted in a prolonged illness and the patient went on to complain about the GP.

Crystal clear

In this case, it would have been clearer if the doctor had advised the patient to come back within a given time frame if the symptoms continued or worsened. It's a simple misunderstanding but with unpleasant consequences.

The need for clarity is heightened in phone consultations, which are becoming increasingly common. The lack of face-to-face contact can make it difficult for doctors to establish if advice has been listened to and understood. Whatever the circumstances, doctors have to make sure the patient is clear about what they should do if things either do not improve or deteriorate.

Equally, patients should not be afraid to speak up more often and ask the doctor to explain anything they have not fully understood. Some patients may be reluctant to question their doctor for fear of appearing rude or perhaps because they are embarrassed to admit they are unsure of something.

But doctors have a duty to discuss their patient's condition and treatment options in a way that's easily understandable so that both parties can make decisions together. The doctor-patient relationship should be a partnership, not one-sided, and patients are perfectly entitled to ask their doctor questions or raise concerns.

Good communication between doctors and patients is a fundamental step in reducing the problem of patient non-compliance.