Prescription instructions that seem straightforward to physicians may be misunderstood by patients, according to experts who recommend communication strategies to help physicians confirm patients’ understanding.

For example, in Brazil, prescriptions often list the medication name followed by the notation “8/8 h” to indicate that a medication should be taken every 8 hours. Although the instruction is clear to physicians, some patients interpret it as taking one tablet at 8 AM and another at 8 PM. Believing that they are following the prescription correctly, they skip one of the three daily doses, reducing the treatment’s effectiveness. The example illustrates how misunderstandings can undermine treatment and highlights physicians’ responsibility to ensure that patients understand prescription instructions.

Speaking with Medscape’s Portuguese edition, Aline Albuquerque, PhD, professor in the graduate program in bioethics at the University of Brasília, Brasília, Brazil, and director of the Brazilian Institute of Patient Rights, said, “It is the physician’s duty to ensure that the patient understands the information provided. It is a relational issue, and within this relationship, there is one aspect that pertains to the physician and another that pertains to the patient.”

Medical jargon is a part of this problem. “What seems obvious to us as physicians is often far from obvious to patients,” said João Carlos Resende Martins Medeiros da Trindade, MD, oncologist at Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil. He recalled the case of a grandmother who brought her grandson to a medical appointment. The child’s condition failed to improve because the prescription included the abbreviation “PO” (by mouth), and she believed the medication was intended for her. “These may sound like amusing anecdotes, but they occur far more often than we realize.”

Trindade recommends avoiding abbreviations such as PO, IV (often confused with the Roman numeral), QT, IO, and other prescribing abbreviations, including protocol acronyms, because they may be unfamiliar or confusing to patients.

The Plain Language guidance adopted by the US Centers for Disease Control and Prevention and the US Agency for Healthcare Research and Quality recommends using short sentences and vocabulary without abbreviations. The goal is not to oversimplify medical information but to present it in a language that patients can readily understand and act on.

Several communication strategies can help reduce misunderstandings. The most widely recommended internationally is teach-back, in which physicians ask patients to explain the instructions in their own words at the end of the consultation. In the case of the “8/8 h” prescription, this approach would likely have identified the misunderstanding before it affected the treatment.

Another strategy, chunk and check, applies the same principle throughout the consultation. Rather than providing all the information at once, physicians present one concept at a time, confirm the patient’s understanding, and proceed to the next.

The ask-tell-ask approach begins differently. Before offering any explanation, physicians ask what patients already know about their condition. They then provide information tailored to the patient’s existing knowledge and recheck their understanding. The principle is straightforward: Patients who already understand certain aspects of their condition do not need every concept to be explained from the beginning.

Decision aids, including videos, printed materials, and digital platforms, can also support shared decision-making by helping patients compare the benefits and risks of different treatment options.

“But how many physicians in Brazil are familiar with these techniques? Unfortunately, many have not yet been trained to use them,” said Albuquerque. Time constraints present another challenge.

“Some healthcare payers allow only 15-20 minutes for an oncology consultation,” said Trindade. “That may be enough for a routine follow-up visit, but not when test results are abnormal, the disease has recurred, or chemotherapy has not produced the desired response. These are difficult conversations to have in such a short time.”

Even so, he believes that physicians have a responsibility to devote adequate time to communicating with patients.

Empathy is the other side of the equation. In medicine, it means more than simply “putting yourself in someone else’s shoes.” Rather, it involves understanding the patient’s emotional and cognitive experiences.

“Patients tell us what is really happening only when they feel comfortable,” Albuquerque said.

The benefits are tangible and include better treatment adherence, greater patient satisfaction, and fewer diagnostic errors.

According to Heron Rached, MD, cardiologist and clinical director of CardialMed, physicians need to understand not only the disease but also the patient’s daily life and routine.

“Sometimes physicians explain everything clearly, but patients do not admit they do not understand because they are embarrassed or afraid of appearing uninformed,” he said. “Treatment adherence improves only when patients feel they are active participants in their care and genuinely believe they are being cared for.”

A UK study evaluating hospitals within the National Health Service found that organizations with higher scores on a measure of systemic empathy achieved better safety and effectiveness outcomes while reporting lower operating costs.

Albuquerque believes that training in empathetic communication should be incorporated into the Brazilian medical curriculum, following the example of countries such as Switzerland, where communication skills and empathy are considered essential components of undergraduate medical education.

“In Brazil, the biomedical model still predominates, based on the view that caring for patients means prescribing medication. Unlike acute illnesses, chronic noncommunicable diseases cannot be cured; they can only be managed, which is not possible without building a relationship with patients. How can we motivate a patient with obesity to change their lifestyle within this model? Brazilian medical education is outdated,” she said.

As populations age and chronic diseases become increasingly prevalent, the need for effective physician-patient communication continues to grow.

A study involving faculty members from the School of Medical Sciences at the State University of Campinas, Campinas, Brazil, examined whether empathy can be taught during medical training. The findings showed that opinions differed. Some participants believed empathy cannot be taught. “You can learn good manners, but I think empathy is deeply personal. Some people may go through life without ever developing it,” one participant said.

Albuquerque, the author of Empathy in Health Care, partly disagreed.

According to Albuquerque, empathy can be cultivated, but it requires a conscious decision. “It is difficult to be empathetic unless we choose to act from that perspective,” she said.

Washington Castilhos has been a science and health journalist for more than 20 years. He holds a master’s degree in science, health, and technology communication from the Oswaldo Cruz Foundation in Rio de Janeiro, Brazil, and a doctorate in education and biosciences communication from the Federal University of Rio de Janeiro, which included a doctoral internship at Paris 8 University, Saint-Denis, France.

This story was translated from Medscape’s Portuguese edition.