Doctors’ Instructions CanBe Confusing: Strategies toEnsure You’ve Got It RightBy Jan Tippett, RN, AE-C

Jan Tippett, RN, AE-C, is a certified asthma educa-tor and practices in Sacramento, Calif. She is amember of the American Academy of Allergy,Asthma, and Immunology.

Recently I was explaining a patient’s care planto her. The patient looked at me, smiled, and said,“Thank you for writing down my instructions.Now I can just listen and watch as you demon-strate my medications without being distractedtrying to remember everything you say.” She con-tinued: “You know, my body looks good for 75,but my mind can’t remember as well as it did.”

Such feelings, though seldom verbalized bypatients, are true regardless of a patient’s age. Studiesconducted among members of all age groups showthat only a small percentage of what is taught duringa training session is remembered over the long term.Asthma care plans can be complex, and somepatients have more than 1 disease, necessitatingseparate treatment plans from various health careproviders. Providers may also use medical languagethat is hard for a nonmedical person to understand.

Here are some strategies to help you get themost from your health care provider’s instructions:• When seeing your health care provider, bring a

written list of all current medications, includ-ing the dosages you take regularly or on an “as-needed” basis. Include all medications, evensuch things as eye drops, inhalers, and pre-scription skin creams. Also include all over-the-counter medications, supplements, vita-mins, and herbal products. This will help yourprovider make the best recommendations foryou. It will also help ensure that the medica-tions he or she prescribes do not cause adversereactions when taken with any of your othermedications. Update this list for each visit.

• Bring your asthma medications to yourappointment. This will be helpful if your asth-ma educator asks you to demonstrate yourinhaler technique.

• Provide a written list of any changes in yourhealth since your last visit.

• Memorize the names of your medications and

make sure you understand how each medicationworks. Ask your health care provider to writedown how each medication is to be used andhow it helps you. For example, inhaled cortico-steroids help reduce airway inflammation(swelling) and are called “long-term con-trollers.” They should be used daily, even if youare feeling well and have no symptoms.

• Ask your health care provider to demonstratethe use of a newly prescribed device andrequest a repeat self-demonstration under hisor her supervision.

• Let your health care provider know if you arehaving difficulty with your treatment regimen.For example, if it is difficult to manipulateyour inhaler on days when your arthritis flaresup, your provider might switch your medica-tion to a more user-friendly device.

• Learn how to tell when your inhaler is readyfor a refill. Does your prescribed device have acounter, or will you need to count doses to besure you have medication left in your inhaler?

• A chronic disease such as asthma requires fol-low-up care. Ask your health care providerwhen follow-up care should be scheduled.

• Ask your provider for a written emergency-careplan that tells you what to do in case of anacute asthma flare-up.

• If you do not understand your treatment plan,do not be afraid to ask for clarification.

• Let your health care provider know if you arehaving difficulty affording your medication.Perhaps the provider can supply medication sam-ples or prescribe a less expensive medication. Heor she may also be able to direct you to otherresources to help you pay for your prescriptions.

• Ask your health care provider for a writtencopy of your care plan and date it. Keep yourcare plans in order, in a central place such as anotebook, for easy access.

Reprint orders: Elsevier, Inc., 11830 Westline Industrial Dr.,St. Louis, MO 63146-3318; phone 314-453-4350.doi:10.1016/j.asthmamag.2004.06.003

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