Patient Education Miscommunications: Part III

A Long List of Instructions Hurts Recall—But Not for Everyone Equally:

Research confirms a commonsense idea: the total number of recommendations and decisions made in a single visit is a significant predictor of poorer recall. On average, each visit contains 4.9 medical "resolutions" (decisions or recommendations, like a new prescription) and 2.7 behavioral resolutions (like a dietary or activity change), which can be a lot to remember.

However, studies have shown a crucial and concerning nuance. This negative effect was particularly impactful for behavioral recommendations (like diet or exercise), for patients with less than a high school education but not necessarily for more educated patients. The disparity in recall ability was significant:

• Patients with less than a high school education: recalled only 38% of items freely and accurately.

• Patients with a college degree: recalled 65% of items freely and accurately.

This gap in recall highlights a serious issue of health equity: The standard format of a healthcare providers visit, which can involve a long list of instructions, may be systematically failing patients who have less formal education, putting them at a greater disadvantage in managing their health. All patients should have the capability to learn and understand what their provider is sharing with them, so they can make the appropriate changes to their lifestyle, and are able to learn alternatives to their needs. In example, a patient who loves pre-made foods that is now on a sodium restrictive diet will need to have some written information on how to check for sodium levels in food, how much is OK, and what are alternatives they can include in their diet. Being able to fully understand our clients concerns and needs, allows providers to actually meet their needs and support their health journey.