Sometimes we’re not as clear as we think … Introducing a new column by our editor-in-chief.
It was just a fairly routine telehealth consult.
Mick, who is 58, has had type 2 diabetes for a fair few years now. It’s been tricky to control and his endocrinologist has been tweaking his insulin regimen. Last week’s phone consult was simply to discuss the results of his latest blood tests, which were ok but not as good as Mick had hoped.
In the course of the conversation it became clear that something didn’t quite add up. He seemed to be getting hypos at odd times and not feeling all that great despite trying to eat well and exercise.
Turns out that instead of taking the biphasic insulin in the morning and two doses of the rapid acting insulin at lunch and dinner, he was doing it the other way around. No wonder things were a bit awry.
Mick is a smart man. It was just some very simple misunderstanding somewhere down the line that could have had some nasty consequences.
I picked this one up, but it always makes me think how many of these errors are happening with my other patients that I’m missing. It was only about a month ago, I discovered that a patient I had prescribed an oestrogen patch for was diligently using it twice a week – but only leaving the patch on for an hour each time! I was just about to increase the dose because the symptoms weren’t resolving. I obviously had explained that medication well. Not.
I really do try to be clear and comprehensive but this communication game is a little fraught. And it is not always things that you might anticipate could cause confusion that actually do.
Sometimes it is simply that our routine explanation about the disease, the test or the medication – the explanation that we’ve repeated a million times over – will for some often inexplicable reason be misinterpreted, misheard or misunderstood.
The best case of “what did I say?” that I’ve heard recently happened to female colleague. The patient was an older lady coming in for her long overdue Pap test. The patient was wearing a skirt, so the doctor (as she had done hundreds of times before) directed her to go behind the curtain, remove her underwear and lie up on the examination couch. She also handed her a small “modesty” sheet to put over herself when up on the couch. After a few minutes the doctor went behind the curtain to attend the woman – only to find the patient completely naked with the “modesty” sheet over her face! Ooops. To the doctor’s credit she never said a word – did the test very efficiently and the woman left without a hint of awkwardness. But you can bet your life that doctor thinks twice before repeating those instructions!!
I guess wherever there is the possibility for human error to occur, such misunderstandings and misinterpretations will always happen. I do know this – I should know this, but cases like Mick and my lady with the patches still act as a wake-up call.
It doesn’t hurt to have a reminder every now and then that there really shouldn’t be anything that is “assumed knowledge” especially with regard medications – and the onus is on us to ensure patients can and do understand what we are saying. We’ll never eliminate all the possible errors but hopefully we can minimise them – and maybe avoid some of those situations that are potentially dangerous, damaging or just simply awkward.
