I really do love my doctors and surgeons and anaethetists. However I have noticed over the years some of the post-operative instructions given to patients could be improved. I’m going to cite a couple of recent examples and why they could be misleading to patients. If you are one of my surgeons reading this and recognise your own paperwork, trust me, I’ve already highlighted these items to your staff!
I want to make clear the responsibility here goes both ways. I am NOT blaming the medical profession. I’m just trying to help both patients and the profession be in synch! Patients can be lax about reading the documentation they are given. I think the medical profession therefore tries to make the documentation as short as possible, e.g one page of the important things the patient needs to follow or do. Unfortunately sometimes this can lead to misleading or unclear instructions. While drafting this article I spoke to two professionals, one medical, one allied health. The allied health professional wanted to put more responsibility on the patients, while the medical professional agreed with my observations. So I do not expect everyone to agree with me here! Please just think about it!
Patients: if in doubt, ask! Seek clarification.
Regular readers will remember me writing about this conversation with a surgeon of mine (who is wonderful, I let him operate on me three times).
Funny conversation with surgeon at the 12 week post-op.
Me: “So I have no restrictions now?”
Surgeon: “No, you’re fine!”
M: “So I can do the leg press?”
S: “Sure!”
M: “So what weight can I start at?” (Thinking to myself 50 kgs seemed reasonable to start)
S: “Oh, just the plate, no weights!”
M: Thinking – that sounds like a restriction to me!It always pays to clarify. I think maybe he didn’t consider his nearly 70 year-old patient was going to be doing things like the leg press. Have I got news for him!
https://limberation.com/2024/03/24/tough-but-worth-it/
Sometimes written documents can also not quite say what they mean. Let’s look at some examples. These are just a few examples, I don’t want to turn this into a book!
Example 1
I have a piece of paper in front of me that says:
“Lead a normal life – but do not do very strenuous activities.”
What is strenuous in this context? Is 200 kg on the leg press strenuous or leading a normal life? For that matter, is sex strenuous or leading a normal life? Strenuous means different things to different people and this needs to be defined or quantified. What is considered strenuous by you may not be considered strenuous by me. Percentages of usual activity levels might work. Even walking, considered not strenuous by many, can be if your normal life involves walking REALLY fast to improve your VO2 Max rating – is getting my heart rate up to 150 strenuous?
Next is a dot point list of “You may…” statements. “You may shower or bathe” is one example. Item 7 on the list reads:
“You may use eye make-up and attend a hairdresser if you wish, one week after surgery.”
I can guarantee a lot of patients would read as far as “You may use eye make-up and attend a hairdresser if you wish” and completely miss the last few words. It is the first dot point in the list with a qualification, so by the time the reader gets to item 7, qualifications are not expected.
Imagine the patient, four days after surgery, is unexpectedly invited to dinner. “Oh, f*ck”, the patient thinks, “I’d better check my post-op instructions!” So they do – and read the first bit and skip the qualification entirely because they are in a hurry.
Simple to fix, just switch to “One week after surgery, you may use eye make-up and attend a hairdresser if you wish.”
Example 2
My second example is around headings. I have a document with the following headings relating to physical activity restrictions post-op:
During the first 72 hours:
During the first week:
During the first two weeks:
During the first four weeks:
I can see what happened here. The first heading was typed, then a copy & paste was done and the last few words changed on each heading.
The problem is that based on the headings, anything in the first four weeks section can also be done in the first 72 hours. This is NOT what is meant, of course.
The headings SHOULD read something along the lines of:
During the first 72 hours:
For the remainder of the first week:
During the second and third weeks:
During the fourth week:
During the fourth week it is stated you may now restart slowly all previous levels of physical activity (including sports). At least there is a degree of quantification here, slowly, but again slowly can mean different things to different people. Yes, I agree, if in doubt the patient should seek clarification, as I did in the conversation I cite above with one of my own surgeons. I suggest maybe a sentence along the lines of “seek clarification from your surgeon in relation to your specific activities” should be included.
Note to surgeons: don’t assume your definition of slowly is the same as the patient’s definition. Clear quantification is needed. Maybe an exercise physiologist may be a good recommendation.
Example 3
My third example is slightly different. This relates to being prescribed a medication. Last week I had a kidney stone issue/episode (a story for another time) and was prescribed a medication we will call MedT. I had never had this before so naturally my pharmacist gave me a print out of the CMI (Consumer Medicine Information) which naturally I read.
The first bit of information that struck me was “MedT is a medicine for use by MEN only.” Yes, the MEN was in caps! Now, the last time I looked, I’m pretty sure I don’t have the right anatomy to qualify. My daughter joked that perhaps I would now want Robyn spelt as Robin. No, I do not!
It was a bit scary. Had the doctor at the hospital prescribed the wrong medication by mistake? Would I be OK? Should I even take it? There are some rather scary side effects for men listed, such as “extremely rarely, medications similar to MedT have caused prolonged painful erection of the penis, which is unrelated to sexual activity.” Of course, there was no mention anywhere about any side effects for women, because only men are taking this medication….supposedly.
I rang the pharmacist! The use of this med in my case is an off-label use and only short-term so I will be fine and yes, women are prescribed the med in certain situations, kidney stones particularly. Well, SOMEONE might have told me this when either giving me the prescription, or fulfilling the prescription, or something!
In Closing
I am well aware it is very difficult to write instructions that will meet the needs of every patient. I spent years writing Information Technology (IT) user guides/manuals. Not exactly the same thing, but similar. Trying to put technical stuff in layman’s terms. The medical profession doing it for patients, IT people doing it for end users. It isn’t easy to get right or clear every time.
Limberation 
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