Broken Bones and Fractures – An Audit of Patients' Perceptions

Abstract

INTRODUCTION ‘Have I got a fracture or a break doctor?’ remains a commonly posed question in fracture clinics, suggesting that patients frequently feel a ‘fracture’ and a ‘break’ are two separate entities. This apparent misconception amongst fracture clinic patients may result in confusion and occasionally anger that doctors appear to have inconsistent views on the severity of their injury. Compliance and outcome of patient care can also be affected by poor communication. PATIENTS AND METHODS Our questionnaire-based study was conducted in two stages. The initial objective was to establish whether this misconception surrounding the words ‘fracture’ and ‘break’ is commonly held amongst our out-patient trauma patients. The second stage of the audit was to determine whether a patient information leaflet on fractures/broken bones could help reduce this misconception. RESULTS The preliminary audit involving 50 new patients attending our fracture clinic showed that 84% thought there was a difference between a ‘fracture’ and a ‘break’, with 68% believing a ‘break’ to be worse than a ‘fracture’. Following the introduction of an information leaflet, a re-audit of 61 new patients took place. This time 67% felt there was a difference between a ‘fracture’ and a ‘break’, with 65% believing a ‘break’ to be worse than a ‘fracture’. Only 21% had read the supplied information leaflet, and 69% of those still believed there was a difference between a ‘fracture’ and a ‘break’. CONCLUSIONS The majority of patients believed that there was a difference between a ‘fracture’ and a ‘break’. Access to information leaflets did not appear to alter this misconception. Verbal communication and explanation may be more beneficial and practical than visual aids and leaflets in overcoming this problem.

Patient Comprehension of Common Orthopedic Terminology

“…Patients in both the emergency department cohort and the orthopedic inpatient cohort had a mean score of less than 50% on the questionnaire, with emergency department patients demonstrating worse comprehension than orthopedic inpatients. Previous literature has demonstrated similar shortcomings in patient comprehension in both emergency department and orthopedic settings (Azam & Harrison, 2011; Bagley et al, 2011; Hadlow & Pitts, 1991; Kampa et al, 2006; Lerner et al, 2000; Peckham, 1994). In the emergency department setting, patients have been shown to have poor understanding of medical terminology with better comprehension of lay terminology (Lerner et al, 2000).…”

“…In the emergency department setting, patients have been shown to have poor understanding of medical terminology with better comprehension of lay terminology (Lerner et al, 2000). Similarly, in the orthopedic setting, patients frequently misunderstand common orthopedic terminology and are more familiar with lay terminology (Azam & Harrison, 2011; Bagley et al, 2011; Hadlow & Pitts, 1991; Kampa et al, 2006; Peckham, 1994). Of note, fracture and broken bone are confusing terms for patients, with most patients not able to identify that they are synonymous terms.…”

“…Health care professionals often use terminology that is unfamiliar to patients and assume the patient has understood, and doctors frequently overestimate patient literacy, which may increase the likelihood that patients will misunderstand the terminology used (Kelly & Haidet, 2007). In the orthopedic setting there are many medical terms used commonly; however, these terms may not necessarily be familiar to nonmedical lay people and thus can be confusing for patients (Azam & Harrison, 2011; Bagley, Hunter, & Bacarese-Hamilton, 2011; Kampa, Pang, & Gleeson, 2006; Lerner, Jehle, Janicke, & Moscati, 2000). Furthermore, there is a growing understanding that there are large groups of patients that have poor health literacy, particularly those from lower socioeconomic and educational backgrounds (Cosic, Kimmel, & Edwards, 2017; Paasche-Orlow, Parker, Gazmararian, Nielsen-Bohlman, & Rudd, 2005).…”

“…These patients may need information to be more carefully delivered to ensure patient comprehension. However, even carefully delivered information can be misunderstood if common medical terminology is not familiar, particularly in orthopedics, where analogous terms used commonly by health care professionals have different meanings to patients (Bagley et al, 2011; Kampa et al, 2006).…”

The construction and implementation of a clinical decision-making algorithm reduces the cost of adult fracture clinic visits by up to £104,800 per year: a quality improvement study

“…3 Inefficiency in the service through unnecessary attendances is therefore a waste of both department time and resources, and patient's time and clinical experience. 4 Up to 50% of emergency department attendances are related to musculoskeletal pain or trauma. 5 The majority of Chronic non-traumatic injuries -to be referred via general practitioner to appropriate elective orthopaedic clinic.…”