September 6th, 2018

How much medicine can you actually remember

I’ve gotten very used to Nodding.

People nod all the time when you talk to them about Medicine and it came as a great surprise to read how little knowledge retention and understanding came with all that nodding.

Although the earliest research papers looking at this go back as far as 1979 (Ley) we have not changed anything since. In 2010 a systematic review (very strong evidence type) combined 34 research papers on the failure of patients to retain medical information. The retention was clearly shown to be higher with written information but we still don’t see this in general medicine. Medics simply don’t have time.

In any medical setting monitors beep constantly. There is noise. There is movement. In the place where you most need to concentrate and understand the information critical to your health there is very little chance of hearing every word, let alone acquiring any great clarity around it.

While understanding and general clarity is not something that you can measure, you can test the actual knowledge retention in the same way as you would do a school test. Worryingly, it’s very little. A 2016 study showed patients recalled just 43% of the alcohol advice and 52% of diet advice.

This is why we started Full Health Medical, writing simple explanations about Blood Pressure , Cholesterol, Heart Attacks and cancers in a spare copybook and photocopying it to allow people take home a proper explanation with pictures.

Almost a decade later, there are thousands of algorithms, written by specialist medical consultants, clear explanatory graphics and a team of software developers to give patients what they actually need... Personal, written clear explanations and medical advice about what was tested, why it was tested and what they need to do now.

The written word is underestimated. If you think back to your school maths tests and remember how you studied for an exam you’ll recall that you read, re-read, thought about, digested the information over time, and then went back to it again to fully understand the information.

The same principle needs to apply to medicine if we are to achieve any real change in population health. We live in an era where 80% of chronic diseases like cardiovascular disease and cancers are preventable and yet emergency departments are full to capacity with all of these cases.

Looking forward we don’t have the financial planning or resources in Medicine to deal with the huge looming epidemic of Diabetes, and the large proportion of the population who are living longer with a higher prevalence of chronic disease.

It’s sometimes hard to understand why people are not compliant with medication, how they have not noticed that they haven’t physically moved in 3 weeks, or why they don’t make any attempt to improve diets. After almost 20 years in Emergency Departments I realise that it’s because they don’t understand cause and effect.

It’s not their fault. We have not, in Medicine, made an enough of an effort to educate and empower the patient to fully understand their lifestyle choices, the medical conditions, and any medicine that is necessary.

That said, we haven’t had time to sit down for five minutes on a shift and have a think. Healthcare resources are so stretched already that any new ideas or clarity of thought is difficult.

Change takes time, and it’s time that we don’t have, however it’s come to the point that medicine is running out of resources unless we use a scalable solution to explain medical tests, measurements, lifestyle choices and let the patient take real ownership of their health.

Unless we embrace IT in the world of medicine, and place a greater value on empowering the patient with a clear understanding of the condition and what they need to do about it we are running out of road very fast.

Dr. Ann Short is an A&E Consultant and co-founder of Full Health Medical. Contact Dr Shortt