Health Care Literacy in ED

According to a recent report in Annals of EM, our patient population in the ED is such that 40% have below an 8th grade level of health care knowledge. The article goes on to state that much of our patient oriented literature is focused towards at least a 9th grade level of health literacy. We should remember this carefully when constructing discharge instructions and we as physicians as well as the nurses should work to ensure the patient understands. It is so easy for us to regress to words and phrases and trains of thought that we take for granted, that the average ER patient may not understand. Nobody likes to feel like you are talking down to a pt, and we will run the risk of doing that to some patients, but we have to work to catch that bottom 40% and make sure all of our patients understand. It is easy to start out very slow and judge from the patients reactions how well they are in fact understanding and adjust from there (however, be aware that often a pt will lead you to believe they understand, simply to be amicable, when maybe they actually don't)

The lounge

I did forget to mention the one improvement I have contributed to the lounge. I stuck a random picture of bisphosphonate related osteonecrosis similar to this on the bulletin board right above the lunch table. This is a totally rare and irrelevant disorder as EM is concerned, but the pic is so nasty I had to hang it.

The ICU

Rotating in the ICU and, like roy basch, it is about to become the breaking point for me. Our patients die every day. From the 47 year old breast cancer, to the 34 yr old lung cancer patient, yes 34. The asphyxiated elderly man who layed two weeks brain dead because the family was too guilty to pull the plug, they all die. It is one big swarm of death. The only thing I haven't seen kill anybody yet in our ICU is the swine flu. Cade is taking it the hardest. I think he really thinks ghosts are following him around the hospital. He talks about them all the time. which ones might be present, and why. In the elevator he tries to decide if all the people he has killled can fit in there with him. He says they follow him down the halls at night, and bang on the door of his call room. He sees glimpses of them from the corners of his eyes. He is crazy. But......I would be scared too if I had stolen the big screen from the hospice house!

The Resident Lounge Revisited

Who Are the suspects in the residency lounge vandalisms? First, lets consider the possibility; could it all be a series of accidents? The beds are the cheapest of cheap, maybe somebody just sat on them to heavily. But twice? Maybe the hair in the drain is just old, built up over tim. But why was it all long and one color? The busted mirror? Maybe bad luck. Who knows. And who attempted to Jimmy the lock? Wouldn't the perpetrator know the code? But, who are the suspects? Cade? Probably number one in some minds. He did "steal" the flat screen TV from the hospice lounge. Who could be more heartless and lawless? Does that man know no limits or have no morals? Me? I am certainly not above suspicion. I have never been known as the strictest rule abider. There are some in the hospital who probably think I am capable of this. What about the EM / IM resident who I will refer to as our own version of "The Fat Man", except she is "The Fat Woman" And the name is well earned. While she lacks the flare and intelligence of the original, she at least lives up to the name. Maybe she sat too hard on the super cheap beds, and they went down. She has to sleep somewhere, after all. What about the aforementioned Peds resident. With the drug habit and the paranoid schizophrenia, I still put her at the top of the list, and she has the long hair. The butch fat woman does not. What about Lyle? The freaky resident with the wife in the GI fellowship? Did they practice colonoscopies on each other in the sleeping area and get too frisky on the beds? Is that all ass hair in those pipes? Who knows. I am certain the investigation continues, and I will be sure to keep you posted.