It was reading a paper describing how sociologists were working with clinical trialists testing a microbiocidal pessary to reduce HIV transmission that got me thinking, again, about how we can lose ourselves in language. The example that stuck with me in the paper was of the understood meanings of the words ‘day’ and ‘month’. When does the day start? (When you get up? After the chimes of midnight begin? End?) What is this last month – a period of 28 days, tracking back, or the dates that all have the same month-name?
And that then came into focus again with a paper on medicines reconciliation in four children’s hospitals – looking at the discrepancies between what patients who had long-term medications had been prescribed, what they brought to hospital and what the admitting doctors wrote on the chart. 45% of patients had unintentional discrepancies; in 9% of cases that probably helped the patient, but 28% of patients may have suffered significant harm/deterioration of their condition if it had gone unchecked.
I imagine the docs who wrote up the charts were not thinking “1 in 10’s OK to cock up …”
I imagine they asked something like “And what medicines is he on?”
But do we know what people understand by the question? When we ask ‘medicines in he on’ or ‘taking’ or ‘uses’, what does that mean to the parent or young person? Do puffers count? Do creams for every now & then? What about the three-weekly infusions? We are aware that adherence to the regimes we prescribe is difficult and complex and full of guilt and challenge. Is that an issue when it comes to describing the meds being used?
I’m unaware of research in this area – but would be delighted to find some – so please, use the comments / FaceBook and Twitter threads to explore & expand our knowledge in this everyday and critically important area of practice.
- Bob Phillips