A Prescription for Understanding Your Doctor

Illiteracy prevents many from deciphering drug labels

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Millions of Americans don't understand their prescription drug labels or their doctor's instructions due to limited reading ability, according to Dr. David W. Bakerchief of Division of Medicine-General Internal Medicine and Geriatrics at Northwestern University. Some 93 million Americans have basic or below basic reading skills that inhibit their grasp of basic health information, he said. 

Baker became interested in health literacy while working on a study about emergency department overcrowding at a public hospital in Los Angeles. Participants interviewed were supposed to fill out a preliminary questionnaire about their experiences in the emergency room. A third of the people in the study had to have the questionnaire read to them, according to Baker.

"What I was always told as a resident was write it down [for patients], and it never occurred to me that people couldn't read," or read well enough to grasp written instructions, Baker said. The future of health communications relies on how doctors and patients can work together to make a necessary change.

How is the lack of patient understanding linked to a doctor's ability to communicate clearly?

It's a big part of it. Even though early on we emphasized the written word and tried to make written information clear. It's very clear now that the spoken word is just as important. We've realized the problem is that someone who has had low health literacy his or her whole life has very poor background knowledge. So you’re talking about something and you’re using simple words [yet] they don't understand what you’re talking about. Even something as simple as an injured nerve - they don't know what a nerve is.

Is talking to patients in laymen's terms discussed in medical school/residency?

It needs to be featured more. We spend a lot of time talking about listening to patients, asking open-ended questions, how to talk about difficult issues. When it comes to explaining things clearly, I don’t think they spend a lot of time on that, and it’s really hard. Our research group has worked to develop a whole variety of these communications tools. We all say that after we work with patients and figure out the simple way of saying it, we then go back to clinic, and we use that language. So it’s helped us in our actions.

It's just hard to explain some of these really complicated things; many of the diseases that we deal with, and the treatments, are really complicated and it takes a lot of time to figure out how to say things simply.

What needs to be done to improve quality and reduce disparities in health care?

There's a whole host of things that need to happen. One of the most important things we need to do is improve education for K-12 about health issues. People need to leave high school understanding what a heart attack is, what a stroke is, what cancer is, and they don't. I think there are great learning opportunities there.

Second, we need to teach medical students and residents communication techniques. I think we've made really good strides on that, and I think almost every medical school has. I don’t think we're doing as good as of job with residents. One of the things I would do with residents is I would stay in the room: usually we come into the room, help make the diagnosis then we leave and the resident talks to the patient. I would stay in sometimes and say "go ahead, explain what you’re going to do." They often can't. Some of the terms that they use are just jaw-dropping. And the reason why is they don’t have those other words; they’ve learned medical language and it almost feels awkward for them to talk in plain English and say blood clot rather than thromboembolism. I've actually heard people use that term talking to patients, and patients nod their head yes.

We've got patient portals, we’ve got smartphones, we’ve got all of these things, so we need the good clear explanations but we also need to use these new technologies to improve the communication and give patients more time to digest the information and understand it and ask questions.

Is there anything a patient can do?

I really believe in the empowered patient. It's problematic for people who before a visit go onto the Internet and they come in having diagnosed themselves. There's an old saying listen to the patient, they're telling you the diagnosis. What they mean is they're telling you what they’re feeling. If you're doing a good job asking questions and really understanding what they’re feeling, you're usually able to make a correct diagnosis.

For the average patient, the most important thing is to have a true dialogue with their doctor until they're comfortable with their level of understanding about the problem and knowing that that’s their right.

How do you measure health literacy?

After I got interested in this, there was virtually the identical story a research team at Emory University was working at Grady Hospital. We were at a conference and we were lucky we hooked up with Joanne Nurss at the Georgia Center for the Study of Adult Literacy. She headed that center and developed the test called "The Test of Functional Health Literacy in Adults" and it included pill bottles, appointment slips, real world materials. Everything was taken directly from our clinics, and turned that into a test as well as some reading passages that we used. That has now become probably the most widely used test of health literacy in health care research.

Originally published by Medill Reports Chicago 

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