Health literacy: Help your patients understand directions
■ Doctors can take steps in their practices to help the 90 million Americans who have trouble comprehending health information.
Posted May 10, 2004.
Take one pill once a day. These directions seem crystal clear. But they sent a man to the emergency department. How could that possibly be?
In the patient's native Spanish, "once" means 11. Thus, he believed he was properly following these instructions, which appeared on the bottles of both the diuretic and the beta-blocker prescribed for his high blood pressure. He was taking 22 pills a day.
This real-life example shows how patients' grasp of health information cannot be taken for granted. The anecdote was included in a new Institute of Medicine report, one of two released last month to draw attention to the health literacy problem. An estimated 90 million Americans -- nearly half of the adult U.S. population -- have difficulty understanding and acting upon health information.
The problem goes beyond patients simply misreading medication bottles. It impacts every aspect of care, and the results can be utterly devastating.
People with poor health literacy are less likely to get potentially life-saving screenings, such as mammograms and Pap smears, or to get flu or pneumonia vaccines, according to an Agency for Healthcare Research and Quality study, commissioned at the American Medical Association's request and released in conjunction with the IOM report.
These patients are more likely to be hospitalized. They have difficulty understanding informed consent forms or comprehending their diagnoses and medical instructions. They are less likely to know about the health effects of smoking, diabetes, asthma and AIDS.
Low health comprehension plays a role in the nation's racial health disparities and could hurt the quality of care and even contribute to medical errors, AHRQ found.
The problem is not just one experienced by poor immigrants with an inadequate grasp of English. The majority of people with low health literacy are native-born English speakers. Some groups hit hardest are the elderly, minorities and individuals with limited education. But even well-educated people can have trouble understanding difficult medical concepts.
The huge number of people with poor health literacy skills means that the issue is one of concern for every physician. The scope of the problem is daunting. It touches every type of medical communication -- patient history questionnaires, consent forms, medicine labels, face-to-face discussions, educational pamphlets.
Patients' reluctance to admit that they can't read or simply can't understand the information at hand makes rooting out and addressing the problem that much harder for doctors.
Fortunately, there are steps every physician can take in his or her practice. One of the most effective is the "teach back" method -- asking patients to repeat medical instructions in their own words. And there are sources doctors can turn to for help.
The AMA has been a leader in this arena. In 1998, the Association was the first national organization to recognize that limited patient literacy is a barrier to effective medical diagnosis and treatment.
The AMA, along with its foundation, created a multiyear effort to determine how doctors, patients and others are experiencing low health literacy and to give them the tools needed to attack it. The Association offers continuing medical education credit to doctors and is working on ways to incorporate the topic into medical school curriculums and residency programs.
Last year, the AMA developed an expanded educational kit, "Health Literacy: Help Your Patients Understand." It contains a manual, a video, patient information and buttons that say, "Ask me -- I can help," for doctors and their office staff members to wear. The package is available for free to AMA Alliance chapters and medical societies launching educational programs. Individuals can purchase it for a small fee.
These efforts are starting to pay off in the use of more basic language and materials in doctors' offices. But more needs to be done. The health literacy problem is beyond physicians' ability to solve on their own. It will take work from the government, health care institutions, academia, businesses, community groups and even patients to bridge the understanding gap.
But physicians are in a unique position to have an immediate impact on patients' lives. With relatively small efforts, doctors can improve health literacy, one patient at a time.