Your Checkup: Health Conversations for Motivated Patients
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Your Checkup: Health Conversations for Motivated Patients
Medical Mishaps: When Patient Education Falls Short
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We discuss an important patient education story about medication misunderstandings that could have led to serious harm, highlighting the gaps in healthcare instruction.
• Nicole shares her experience with a broken toe and visit to urgent care
• The hosts discuss their current reality TV favorites including Love Island and Dallas Cowboys Cheerleaders
• A patient was discovered not removing the needle cap when trying to administer insulin
• Another patient only took blood pressure medication once weekly during readings instead of daily
• The importance of "teach back" methodology where patients demonstrate understanding
• Different approaches needed for teaching children versus adults about medical care
• Medical literacy varies greatly and providers shouldn't make assumptions about patient knowledge
Stay healthy, and follow the podcast for more patient stories and healthcare insights that might help you, a loved one, or a neighbor.
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
Hi, welcome to your checkup. We are the patient education podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Dolesky, a family medicine doctor in the Philadelphia area.
Speaker 2:And I'm Nicola Ruffo. I'm a nurse.
Speaker 1:And we are so excited you were able to join us here again today. We could probably do a whole episode on the things that have happened to you recently. Can you set the scene for us?
Speaker 2:It was traumatic. I am injured.
Speaker 1:It was a simple thing, turned so sideways.
Speaker 2:Oh my gosh. I know the couch came out of nowhere. I stubbed my toe, but I actually broke. My toe Blew up like a grape Heard the crack.
Speaker 1:Yeah.
Speaker 2:Eddie made me go to a beach urgent care to get an x-ray and I felt kind of silly being there, but then she told me it was broken so I felt kind of better you were like in the moment.
Speaker 1:You were like rocking in the fetal position on the exam table, being like I'm gonna feel so dumb if I, if this isn't real I was like the, the MA came in Maria she was nice.
Speaker 2:I told her all about it and then the PA came in and she's like so you stubbed your toe. I'm like, yeah, yeah, I did, but it cracked and it had stuff throbbing.
Speaker 1:Right. Normally you stub your toe, you're in a couple moments of agony and then it goes away. It becomes a thing that happened, that you're like, you're resilient, you bounce back. No, your bone crumbles. Oh my god, it was so dramatic my first broken bone I know. I was so sad about that, like my nicky and like your bone, no like.
Speaker 2:If we want to talk about dramatic, okay, it is not lost on me that this is fine. It will get better. It could could be worse, right. However, I cannot get over the bruising on my foot. Every toe is bruised. Like half of my foot is bruised. I can't put on a sneaker. I'm walking in this stupid post-op shoe, probably for a couple of weeks.
Speaker 1:Yeah. It's so dramatic for no reason and it really takes you down too Like can't. Like I mean you're being really creative with like exercising too, but like we were running girlies I know I don't want you to think, I don't want you to think about that too much my first wedding dress fitting in like three weeks let's not go down that path right now. Um, all together, getting the x-ray was nice. She definitely was like so when we go to an urgent care, we go to like a hospital. We usually operate in disguise.
Speaker 2:Um, this has happened twice I mean yeah, we're not like being those people no, we don't, we were there for the x-ray. Like we're not there for stellar medical advice or care. Like we need the image and we'll go from there right.
Speaker 1:But then when, like she came in and she was like all right, I have good news and bad news. The bad news is it's broken and she never got to. What she interpreted was the good news she didn't. No, she didn't, she just stopped there and she's like the bad news is it's broken and I feel like her good news was like but the good news is here's a referral to sports medicine, which is totally the reasonable thing to do To ortho.
Speaker 2:yeah yeah, thankfully we have an ortho bestie, so Eddie sent my x-rays to him.
Speaker 1:I was like hey, can you-, so got to dodge that doctor's visit and co-pay? Double-check the work of a simple country doctor with what I'm thinking here.
Speaker 2:You know we do need to talk about something, though let's dive in. What do you want to talk about, though? Oh, let's, let's dive in. What do you want to talk about? Because I'm injured and I'm sitting here working. No, because hr refused to give me fmla and I feel like I should be going to the department of labor after this maybe you have to of labor after this.
Speaker 1:Maybe you have to to file a complaint. Yeah, maybe I don't like hr. I'll say that out loud. Um, not the people. The people are great, but you know, um, I got nothing to say. You and I both know how this is actually going today and the function of, uh, what we're talking about up front here. Yeah, she never did get to the good news which I was shocked.
Speaker 2:I have nothing to say on denying my FMLA.
Speaker 1:No, I have absolutely nothing to say to that. I deny that, I denied.
Speaker 2:Your people can talk to my people.
Speaker 1:Your FMLA. But then when I asked her, I was like, oh, is it displaced? She gave me this look of like who taught you that trick? And we still remained in this guy's Google medical degree. Absolutely. She like totally thought that I like had looked up toe fracture and and, like you know, came up with that I mean yeah.
Speaker 2:I don't blame her.
Speaker 1:No, I would have thought the same thing. She wants to keep it moving. Well, yeah, but like, if that happens to me, I usually ask like, oh, like, are you in the medical field? Like a question like that comes out, then I usually lob up the like what do you really know? So, I'm not speaking to like giving, like the no jargon information. We can talk, like you know, compadres.
Speaker 2:Yeah.
Speaker 1:So what else has been going on? What else has been going on?
Speaker 2:there is no, no, there's nothing um well, we're deep into love island, such good rotting for someone who jumps in and like just listens to this episode.
Speaker 1:Can you tell them what love island is?
Speaker 2:yeah, love island is probably some of the best reality tv and we would know we watch a lot we watch a lot. Um, guys, girls, they're on an island, they're all coupled up together and then these bombshells come in. But the whole shtick of it is that it's pretty much edited and put out in real time, like what you're watching happened like two or three days ago because they're in Fiji. So then there's like live voting you can do. So that's been really fun. We've also been watching DCC.
Speaker 1:Oh right.
Speaker 2:Which something OK.
Speaker 1:Not to be forgotten c.
Speaker 2:Oh right, which something okay?
Speaker 1:not to be forgotten, we need to talk about what's going on in texas. Actually remember this is last year how most reality tv is produced I mean it's still going on, I'm sure well, now they're doing this go ahead sorry okay, the dallas cowboy cheerleaders these women are like beautiful, stunning flaws.
Speaker 2:They are tense across the board. And then they're all, for some reason, except for that girl, kelsey from last year, who got married, and he was like an actor or something like he's good looking. All these the men that they're with, are these like kind of baby face, a little portly, like, just like it's true men. I know and I'm like how did you get her?
Speaker 1:because, like, this is crazy I know a couple people and I might have to like be like you got to go to texas, like you might. That's, that's where you gotta go. I mean, it is, it is shot. They're great people. It's just like maybe one after the next. I know it's consistent.
Speaker 2:The third one we were like what is happening? How are these men who are like a three getting these like perfect looking girls?
Speaker 1:it's a pattern too it is.
Speaker 2:It's not just a one-off yeah, I don't know, maybe they have a lot of money that mike has never been the same since mike yeah, thanks mike really grabbed onto it.
Speaker 1:Um, yeah, that's a. That's a great point. I don't understand it. I see it too. I'm with you if you watch dcc for no other reason. Just like, check that out and let us know what you think. Maybe we're just being judgmental, but um, probably, but that's fine. This is a safe space as far as I'm concerned right, this isn't going to go out to be available to anyone who wants to listen at all.
Speaker 2:Um oh, we didn't talk about Jalen on Love Island.
Speaker 1:Oh sweet king.
Speaker 2:The sweet king. Do you know what's happening online with Jalen?
Speaker 1:No.
Speaker 2:Okay, so Jalen was one of the bombshells that came onto Love Island. He's this like sweet southern country boy. He was there for like two nights or something like that.
Speaker 1:It was not a long time.
Speaker 2:Ended up, like the other islanders voteders voted him off. But he's like so sweet he hangs out with his grandma in his free time. He got a passport like had never left the country, got a passport to go to fiji and then he got kicked off. So then he makes a tiktok yeah, it doesn't feel he made a tiktok like three or four days ago, he got got like 300,000 followers overnight. He has over a million followers now, really.
Speaker 2:And all of these brands and like airlines and stuff are commenting being like we want to fly you out, like get more use out of your passport, all this stuff. So like he's going to do great, wait, that's I know.
Speaker 1:Thanks for telling me.
Speaker 2:This is total news to me. Thanks for telling me.
Speaker 1:This is total news to me.
Speaker 2:And like people online Would be like. I can't stop thinking About Jalen smiling For his first ever Passport photo To go to Fiji, and then he has to Turn around and come home.
Speaker 1:Yeah, they, I. He should have stayed, he should have. I don't like what they did there, but yeah, I like taylor, I really do. I think it was a little bit of a taylor's so funny.
Speaker 1:He's so funny. But I also think that all of that was for, like, protecting him and his relationship with alandria, and it should have I don't know they should have given them another chance. It was so obvious that it's hood is time to go, and like they should have given jalen another chance and it's it warms my heart to hear that he's getting this opportunity. That's actually really cool and like who knows what comes after that.
Speaker 2:But you know, like a million followers hopefully he has like three tiktoks when I was talking about it the other night. So he has three tiktoks and like over a million followers that's awesome and all these brands, like all of his comments, are just like brands wanting to like send him stuff, fly him places, do all this stuff.
Speaker 1:That's crazy. Maybe we need to have some sob story.
Speaker 2:Let's put your toe out there.
Speaker 1:And then maybe we put a um like those AS ASPCA.
Speaker 2:Oh my God.
Speaker 1:Commercial like those as as pca um oh my god commercial in the arms of the angels, and then it's your x-ray with like a very subtle fracture, you really zoom in to really zoom in and maybe that will get us where we want to go yeah, maybe.
Speaker 2:No, like don't you feel like my foot? Like I feel like that was someone else's x-ray, like my foot how it looks does not know I'm what the x-ray was giving a little, a little curious to see what the um, the repeat x-ray shows.
Speaker 1:Yeah, because you have like tenderness, like in a lot of places, more than just where you stubbed your pinky toe, I actually shattered my foot.
Speaker 1:So I'm glad you're in the boot. We'll get you another x-ray soon enough, and probably next week, and we'll see what happens. Oh my goodness. All right, what are we going to talk about today? Nick, we're trying to diversify our content and we see a lot of important things throughout our days and some powerful stories, and every once in a while, we want to include those stories in a HIPAA compliant way and share what we've learned from witnessing all of the things that we see. And so today is one of those episodes and we're going to hear a story that is very important. So here we go.
Speaker 2:I mean, it's not like, it's just like a little tidbit, yeah, but I think it's good for patient education, great. So we discharged this patient recently and then the nurse practitioner I work with was telling me that she last week got a message from home needle off the pen, I guess to inject herself with insulin. So it was just like I don't know where it was going, in the cap, I guess.
Speaker 1:Oh, my God.
Speaker 2:But I thought that was a good. So then I think the home care nurse was like show me how you give your insulin.
Speaker 1:And then she didn't.
Speaker 2:She wasn't taking the cap off, but that's a good um, like education absolutely just think like how, because like we do she wasn't a new. I don't know if she was a new diabetic actually. Whatever, it doesn't matter, but we do like insulin teaching before someone leaves and there is a nurse who's like, dedicated to do, like all the education for everyone, who's wonderful, and I don't think she, you know, didn't tell her to not take the cap off yeah but it's just one of those especially.
Speaker 2:I don't know what she went home on. I don't think it was a pen, but even like sometimes you can't because even like the if it was a pen, kind of like the safety sleeve over the needle, it's hard to tell if there's a needle there one would think that that's like the cap yeah right, because it's like oh, here's this big honking thing at the end.
Speaker 2:Let me take this off yeah and I'm good to go. So I mean whenever, like I would be doing education, like teach back, is so important. So I guess, really like if you're, you know, like at the doctor's office or in the hospital and someone's teaching you how to do something, I think pretty widely you know like teach back and like demonstration is pretty, very common. But if someone's not asking you to show like you know, show me back how you would do this at home.
Speaker 2:Yep, you should do it. You'll probably be asked to do that. I can't imagine a situation where you aren't but oh, I can think of so many, I guess, I don't know.
Speaker 2:Yeah, I can think of a lot and like where, because I think hearing it and then actually doing it are two totally different things I think there was another guy he I can't remember exactly, but he had like very uncontrolled blood pressure, had a stroke because of it, and then I think it was the resident that was like or someone was talking about, about like medicine and his I guess like primary care doctor told him to like check his blood pressure at home weekly okay and then you know, so they could figure out meds and whatever.
Speaker 2:So he was checking his blood pressure once a week and only taking his medicine when his blood pressure was high. So he was only taking it once a week there you go, not every day, right?
Speaker 1:yeah, these are like such common misunderstandings that it's very.
Speaker 2:What am I trying to say? I mean, all those little like nuances are really difficult, especially if you have zero experience. Right, right, like if you or I had an injection of some sort that we had to do at home, like, yeah, that's fine, where do I pick it up? At the pharmacy, like whatever. But not everyone knows how to do every single little step. It's kind of like when you were in school I forget what, like the term for this is but did your teachers ever do anything where, like you had to write down instructions for something and like the one that, like I've seen and I've been told like from my teachers, was like write down the instructions for how to make a peanut butter and jelly sandwich?
Speaker 1:Oh, my God Wait yes.
Speaker 2:And then the first one that kids always write is like put the peanut butter on the bread. So then the teacher would take the jar of peanut butter, put it on the whole loaf of the bread in the bag.
Speaker 1:Yep.
Speaker 2:And it's like okay, I put the peanut butter on the bread. So I think that that's like the best comparison that I can think of.
Speaker 1:That's a great example For like patient education. This came up when I had a coding class in college and they were like you have to write all of the instructions for this device to be able to achieve what you want, and that the peanut butter and jelly thing came up. And they were like well, where do you?
Speaker 2:get the peanut butter and jelly thing came up and they were like well, where do you get the peanut butter?
Speaker 1:instead of writing like open the bag, take out a piece of bread, open the jar of peanut butter, get a knife. You know, which really just invites that all of us could be doing better when we are giving descriptions to people about how to do things. And you shouldn't take it for granted like, oh, this is your blood pressure medicine versus this is your blood pressure medicine that you should take one pill of every night for the rest of time or until something changes and you like, need to keep getting refills. If you don't get a refill or the medicine runs out, you need more of it. That's a very common one. Or people think, like if the medicine isn't there anymore, there's no refills on it. That like it's not and it's a chronic medicine that they just I'm done taking it I'm done taking it, which is very common, but it happens a lot.
Speaker 1:Yeah, and diabetes education in the hospital, I think, is so important because it's a more fluid open time than a finite like 20 minute visit outside the hospital. And so, like we've, we get plenty of people with new diabetes in the hospital and they're like, oh, they can teach it, they can teach them outside the hospital, they can teach them outside. And I'm like, no, please put that order in so the nurse can educate them, because one, the nurses are brilliant.
Speaker 2:They do this all the time. I actually love doing the diabetes education.
Speaker 1:I guess my question for you is at what age did the diabetes education go to the child versus the parent?
Speaker 2:Well, I think a lot of it is like developmentally.
Speaker 1:Okay.
Speaker 2:I don't know if there's like a specific age, but kids are also pretty. What's the word I want to use?
Speaker 2:Spongy Spongy yeah, they are pretty spongy and they're just like aware and I feel like they a lot of times kids kind of like want to be in control of, like not in control. What am I trying to say? Yeah, I guess like in control, or even just like checking a kid's blood sugar, like they want to use the lancet themselves and like prick their finger and like I think it kind of like gives them that sense of autonomy. Um, I mean, regardless it goes. You know, it's both the parent and the kid.
Speaker 1:Did you find it easier to teach?
Speaker 2:You can't be like, fully dependent on an eight year old to be counting his carbs.
Speaker 1:Right. Did you find it easier to teach the child or the parents?
Speaker 2:oh, that depends, okay. I mean, you know like literacy level, education level, all very important.
Speaker 1:Were there certain times when, like common hiccup points or frustrations that would come?
Speaker 2:I mean, yeah, there are, but I think I mean that's like a very overwhelming thing to be diagnosed with diabetes or have your kid diagnosed with diabetes, especially if you don't know anything about it and it is kind of, you know, just like wrapping your head around. It is a little bit difficult, I think, especially if you have like zero medical literacy.
Speaker 1:Right.
Speaker 2:That's really hard. But then, like sometimes, if it was I don't know, like whatever, like school-aged kid, like 10 or so, I think sometimes like the mom would be like really stressed out about like counting, because it's a little bit more detailed in peds versus adults, where you have to like do a couple like equations, counting carbs.
Speaker 1:You're dividing stuff they do tend to do that more in peds than adults.
Speaker 2:I still don't exactly know why, and then sometimes, like the kid will be like mom, it's like this number and like oh yeah. And they're like ready to go and like the mom will be like freaking out yeah.
Speaker 1:Yeah, because they're like in still like a learning and growth mode, because they're in school, they're like learning every day. But learning as you get older, I feel like tends to go by the wayside a lot and it's less invited in the adult world. Well, thank you for coming back to another episode of your Checkup. Hopefully you were able to learn something for yourself, a loved one or a neighbor.
Speaker 1:On this episode. We hope that this patient story was nice for you to hear and you can check out our website. Follow the podcast so that you can get updates about when new episodes come out. And, most importantly, stay healthy, my friends. Until next time. I'm Ed Dolesky.
Speaker 2:I'm Nicole Arrufo.
Speaker 1:Thank you and goodbye Bye. This information may provide a brief overview of diagnosis, treatment and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Thank you.
