Give Written Instructions

Enhancing Patients’ Treatment Adherence

When we give patients complicated treatment regimens to follow, it makes sense to give the information in writing.  Writing out instructions can be time consuming, but we can’t expect patients to remember important nuances of complicated instructions.

We also can’t expect patient to remember simple instructions.  I well remember a young child who came to see me for eczema that was resistant to treatment offered by another dermatologist.  The child’s skin was very dry.  I asked the mother what soap she used to bathe the child.  She reported, “Ivory.”   “Ivory,” I replied.  “Is that what the previous dermatologist recommended?” “Yes,” she said. “The previous dermatologist recommended I use Dove or Ivory.”

In dermatology circles, Dove is considered a mild, moisturizing cleanser, while Ivory is considered harsh and drying, not something that would be recommended for a child with eczema.  I am quite sure the previous dermatologist who cared for this child had recommended “Dove, not Ivory,” but by the time mom had gotten to the store to buy it, “Dove, not Ivory” became “Dove or Ivory.”

Patients cannot be expected to remember even the simplest instructions.  We prescribe many of the same things, day after day, and to us, the information about those treatments may be second nature.  Even if we remember to explain to patients all the necessary particulars that patients need to know to use their medication effectively and safely, if we don’t give them that information in writing, it may well be forgotten, or worse, misremembered.  All treatment regimens and instructions are novel and complex from the patient’s perspective.  Don’t underestimate the ability of patients to forget what we tell them.  If it is important enough to tell the patient, it is important enough to give it in writing.

–Steven R. Feldman, MD, PhD