Low health literacy: Don't assume patient knows own illness, meds

Researchers say this lack of information can be dangerous, but health literacy advocates say not all knowledge is equal.

By — Posted Sept. 5, 2005

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Wayne Reynolds, DO, a family physician in Newport News, Va., is struggling with what is increasingly being recognized as a national problem. Patients don't know much about the medications they're on.

Dr. Reynolds has signs in his waiting room asking patients to bring in the bottles of all medications they're taking. His nurse reviews the medication history with the patient before he sees them, and then he reviews it again, often discovering that the patient is taking drugs that weren't mentioned the first time through.

If the patient has just been discharged from the hospital, determining medications often can be even more challenging. The patient might not remember what drugs were prescribed. The patient might not bring discharge instructions. The report the hospital sends to him might not arrive until after the first follow-up visit.

"[Patients] tell me they're taking a little white pill. Or they're taking a medication for their diabetes or hypertension, but they don't know the name," Dr. Reynolds said. "I can understand if they don't remember. There's so much going on at discharge. They're packing up, and they want to go home. But it's frustrating."

A study in the August Mayo Clinic Proceedings gives evidence that Dr. Reynolds' problem is common. The study found that of 43 patients discharged from a municipal teaching hospital in New York, only 18 were able to name their diagnosis, 12 were able to list their medications and six were able to name the common side effects of their medications. The authors blame this phenomenon on the time crunch to provide care: Educating the patient on what is going on could be falling by the wayside.

"We're too busy," said Eli Friedman, MD, one of the paper's authors. He's a distinguished teaching professor of medicine and chief of the renal disease division at Downstate Medical Center in Brooklyn. "And patients don't understand what we say to them about their care because we don't present it in an intelligible form."

The AMA Foundation has long been working on the issue, along with many other medical societies and government agencies, and for health literacy advocates, this small study is yet more evidence of the gap between what happens in a health care setting and what the patient understands.

"Patients don't have much of the information that most physicians assume they have," said Ruth Parker, MD, chair of the AMA Foundation's health literacy Initiative. "It's not the fault of anyone, but we've got to realize how hard it is to be a patient."

And experts suspect that similar results might have been found if the survey had been carried out in an office setting.

"I would bet that if you did the same study in the outpatient setting, the numbers would not be quite as bad -- but not as good as doctors would like," said Darren DeWalt, MD, MPH, assistant professor of internal medicine at the University of North Carolina.

The big question now challenging physicians and health literacy activists, however, is what to do about it. The Agency for Healthcare Research and Quality, along with the National Institutes of Health, is funding several studies to investigate the link between literacy and health status, and develop interventions to address the issue.

"We need to do a better job, but the devil is in the details," said Dr. Parker, a professor of medicine at Emory University School of Medicine in Atlanta. "We have a lot of work to do."

An accompanying editorial in the Mayo journal advocated assessing patient understanding as a sixth vital sign to improve patient compliance and reduce the risk of hospital readmission.

"This is a horrendous problem that costs billions of dollars because we assume naively that patients will do what I say, and it's not true," said Edward Rosenow, MD, a pulmonolgist and internist at Mayo who wrote the editorial.

Dr. Rosenow proposed several solutions, ranging from ensuring that patients and physicians agree on the treatment strategy to assessing literacy and providing education at the patient's level, which most advocates say makes a lot of sense.

"It's crazy that we would ever give information that patients couldn't read," Dr. DeWalt said.

Experts stressed, however, that it was important to differentiate between information that physicians would like patients to have and the information that patients actually need. For example, physicians say that memorizing the names of medications may be less important than being able to access this information easily.

"I always instruct my patients to make a written list," said David Barbe, MD, a family physician in Mountain Grove, Mo. "The key is to communicate effectively with the patient about their medications."

Health literacy advocates also said it could be more important for patients to know what they're supposed to do rather than naming their medications, their side effects or why they've been prescribed.

"Is it more important to know that you're on four medications or to name them?" Dr. Parker said. "We need to make sure that our patients know what they need to do to get through the day."

Back to top

External links

Patients' Understanding of Their Treatment Plans and Diagnosis at Discharge, Mayo Clinic Proceedings, August (link)

Patients' Understanding of and Compliance With Medications: The Sixth Vital Sign?, Mayo Clinic Proceedings, August (link)

AMA Foundation's health literacy program (link)

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn