About one-third of adults misunderstand medical directions. One question could change that

By Madeline Holcombe, CNN

(CNN) — Take twice daily.

Does that mean two pills in one sitting? Can you take once at breakfast and once at lunch? Should they be taken with food at all? Can you take them at the same time as your other medications?

The instructions on prescription medications may seem clear, but they can often lead people to different interpretations. New research suggests that misunderstandings and mistakes when it comes to health information and medication instructions are widespread.

Nearly one-third of middle-aged Americans struggle with personal health tasks, including recalling information from a doctor’s visit, reading standard health materials and properly dosing out medication, according to research published Wednesday in the Journal of Internal Medicine.

Many of the participants in the research were not new to the healthcare system –– some were managing multiple chronic conditions.

“Our study was able to really provide some validation to people,” said study coauthor Abigail Vogeley, a research fellow and doctoral student at Northwestern University’s Feinberg School of Medicine in Chicago. “They’re not alone in being confused by the healthcare system and by medications.

“It’s something that us, as the healthcare system, need to improve and help people with rather than just saying, ‘OK, good luck.’”

Nuanced language and short visits

The study asked 942 primary care patients with an average age of 52 to complete a series of tasks to test health literacy — meaning their ability to accurately interpret, understand and use the information given to them.

Those tasks included replicating a doctor visit in which the participants were given a new diagnosis and seeing what information they could remember and report back, and giving the participants a fake prescription bottle and seeing what information they could get from reading the label and directions.

Just 10 minutes later, it was difficult for people to remember all the specifics of the diagnosis they were given, Vogeley said. Also, problems with the prescriptions often came from nuanced language and the variation in labeling practices, she said.

“Some of the warnings are maybe written differently or in different places that patients don’t think to look,” she said. “It’s a uniformity problem.”

People wanted to get their prescription information right and do the best they could for their health, but fostering health literacy can be difficult when doctors’ visits are short and the information may not be written in a straightforward way, said senior study author Dr. Michael Wolf, professor of medicine and director of Northwestern’s Center for Applied Health Research on Aging.

Misunderstandings become mistakes

Medication generally works best when taken as instructed.

When you take a prescription, if you take it with food, how often and even what it is for can get lost in communication, particularly when patients don’t feel comfortable asking their healthcare providers questions, said Dr. Jan Carney, president of the American College of Physicians and professor of medicine at The Robert Larner College of Medicine at the University of Vermont.

Misunderstandings in instructions can lead to a patient taking too little or too much of a medication, taking it with another drug that it shouldn’t be combined with, or taking it in a way that might make one more prone to side effects, Vogeley said.

Someone may not know to take a diuretic in the morning, for example, so they take it with dinner and end up waking up in the night to use the bathroom, said Stefanie Ferreri, professor of pharmacy practice at University of North Carolina at Chapel Hill Eshelman School of Pharmacy.

The study also found that a lack of clarity can lead to people overcomplicating their medication dosing, such as waking themselves up in the middle of the night for a third dose unnecessarily or trying to space out their medications so much that much of their day is spent stopping to take a pill.

“How do you sustain that behavior if you’re literally having to take medications up to seven times a day, which, quite honestly, is what we see people doing,” Wolf said.

Although the study measured people’s ability to manage medications and healthcare, the results of the study are not an indictment on the individual, but rather a call to action for the health system to improve communication and collaboration with patients, Wolf said.

‘Do you have any questions?’

While waiting on the medical field to make changes toward better communication, there are things you can do to improve your health literacy.

“Do you have any questions?”

That query probably ends most of your doctors’ visits and prescription pickups, and for many people the answer is usually “no.” Start saying yes, Ferreri said.

Even if you don’t know specifically what information you might be missing, it is helpful to ask your doctor and pharmacist open-ended questions such as, “What do I need to know about this medication?” she added.

Don’t just ask it once, Ferreri said. Ask both your healthcare provider and your pharmacist the first few times you pick up your medication to make sure you are getting all the information you need.

Many people also don’t have a great working memory of what exactly they are taking and for what conditions. Ferreri recommends keeping a list so you can reference them when being prescribed anything new.

Visits to a doctor can be quick, but you as a patient can slow your healthcare provider down if you need to so they can more clearly explain your diagnoses and treatments, Wolf said. If allowed, it can even be helpful to bring a voice recorder in for the last few minutes of an appointment to have a record of the instructions and information so that you don’t forget the details once you get home, he added.

You also may find it helpful to carry a list of the medications you’re taking, so you can be sure any new medications can be taken along with them. That can be a written paper list or something you have on the notes app of your phone, Ferreri said.

You and your doctor are supposed to be partners in your healthcare, Carney pointed out, meaning that patients should feel comfortable asking for more information and clarification when they need it.

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