Patients enter the medical world as visitors.
They don’t know the rules of the house. They don’t speak the language. They don’t know why we do what we do or why something that seems small may matter much more than they realize.
Think about what it’s like to enter a world you’ve never experienced before. For a few hours or a few days, you follow everyone else’s lead. You try to be on your best behavior. You trust that the people who belong there will tell you what you need to know.
For nurses, the hospital is different.
Before we ever became comfortable walking through those doors, we spent years in school, clinicals, labs, exams, orientations, and training. Then we began spending eight or twelve hours at a time inside this world, several days a week.
Eventually, the unfamiliar became ordinary.
We say a patient is “NPO” without thinking twice. We talk about ambulation, blocks, PRN medications, Foley catheters, incentive spirometers, and weight-bearing restrictions as though these are normal parts of everyone’s vocabulary.
They aren’t.
There was a time when we didn’t know what any of those things meant either.
And when we forget that, we can hurt people.
“But I Told Them”
One of the things I’ve learned as a nurse is that giving someone information and making sure they understand it are not necessarily the same thing.
This becomes especially important at discharge.
Sometimes I spend longer discharging a patient than someone might expect. But I keep coming back to one thought:
They don’t know, so I should tell them.
Take something as ordinary as Tylenol.
Most people don’t think of Tylenol as a particularly dangerous medication. You can walk into almost any pharmacy or grocery store, pick it up from a shelf, pay for it, and go home. You don’t need a prescription.
Now imagine that same patient has surgery and receives a prescription for pain medication. Some prescription pain medications contain acetaminophen, the same active ingredient found in Tylenol.
The patient may know exactly what both medications are supposed to do.
One is the pain medication the doctor prescribed after surgery.
The other is Tylenol, something they’ve probably taken many times before.
They follow the directions on the prescription bottle. Later, they take Tylenol according to the directions on that bottle.
From their perspective, they may be doing everything correctly.
But if nobody explained that their prescription medication already contains acetaminophen, they may unknowingly take more acetaminophen than intended, increasing their risk of serious liver injury.
It is easy for those of us in healthcare to look at a situation like that afterward and ask:
Why would you take both?
My question is different.
Did anybody make sure they knew?
Familiarity Can Become an Assumption
Healthcare professionals have knowledge that patients simply have no reason to possess.
That doesn’t make patients stupid.
It makes them patients.
Someone can be highly educated, successful, intelligent, and capable and still know absolutely nothing about postoperative pain management. Another person may have limited health literacy. Someone may be frightened, exhausted, medicated, overwhelmed, or trying to remember ten different instructions while thinking about how they’re going to get home.
Yet sometimes healthcare treats lack of medical knowledge as though it were a failure on the patient’s part.
We shouldn’t.
We were taught this information.
We had professors, textbooks, clinical instructors, preceptors, competencies, examinations, and years of repetition. Then we practiced until things that once required conscious thought became second nature.
Our patients didn’t get any of that.
They walked into our world because they needed help.
Discharge Is More Than Paperwork
When a patient’s immediate medical problem has been treated, our responsibility doesn’t suddenly disappear.
In some ways, discharge is when the patient’s responsibility becomes greatest.
Inside the hospital, we know what medication they received and when they received it. We know what symptoms concern us. We know what their incision should look like. We know their restrictions. We know when something warrants a phone call and when something warrants immediate medical attention.
Then we send them home.
Now they have to know.
A stack of discharge papers doesn’t automatically accomplish that.
Neither does saying the information aloud.
Patient education isn’t simply about being able to document, “Discharge instructions reviewed. Patient verbalized understanding.”
The real question is what happens after that patient gets home and we’re no longer standing beside them.
Do they understand what they’re supposed to do?
Do they know why they’re doing it?
Do they know what could go wrong?
And, most importantly, do they know what to do if it does?
They Are Visitors in Our House
Patients enter a world that is normal to us and unfamiliar to them.
They don’t know all the rules of the house.
And they shouldn’t be expected to.
Our responsibility isn’t only to treat the problem that brought them through the door. We also have to consider the problems that could come from the treatment we’re sending them home with.
Sometimes that means taking a few extra minutes.
Sometimes it means explaining something that feels painfully obvious to us.
Sometimes it means asking a patient to explain something back rather than simply asking, “Do you understand?”
And sometimes it means remembering that what has become ordinary to us may be completely foreign to the person sitting in front of us.
Because eventually, that patient is going to leave our world and return to theirs.
Before they leave our house, we should make sure they understand what they’re taking home with them.
Disclaimer: Clarity & Case is intended for general educational and informational purposes only. The content shared here reflects personal perspectives and experiences and should not be considered medical advice, diagnosis or treatment. Individual health needs and circumstances vary. Always consult an appropriate healthcare professional regarding questions or concerns about your health, medications, or treatments.
Any clinical examples discussed are generalized, hypothetical, or modified to protect patient privacy and are not intended to identify any individual patient or healthcare organization
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