Chairman's Message => Fall 2004

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Fall 2004

Can You Hear Me Now?

According to the report recently published by the Institute of Medicine, Health Literacy: A prescription to end confusion, 1 out of every 2 adults cannot understand and implement health care information. Almost 25% do not understand an informed consent, 25% do not understand an appointment slip and 40% do not understand how to take medication properly.

The problem is more than just an inability to read and is not limited to the poor or uneducated. Indeed, because of the increasing complexity of healthcare, "zoning out" after hearing bad news, insurance requirements and medical procedures, most individuals at some time in their life will encounter medical information they have difficulty understanding. Further complicating this problem is the time pressured environment of many patient-physician interactions.

These "misunderstandings" that occur because of health illiteracy result in medication errors, lack of preventative and follow up care, longer hospitalizations, increased severity of illness and worse health outcomes. The direct economic cost of low health literacy exceeds $73 billion. Add to this the cost of professional liability when, because of low health literacy, a patient does not follow through with recommended follow up or does not take her medication as directed. In reviewing many depositions from cases in litigation, the discrepancies between what the doctor said and what the patient heard is amazing. Some of these differences might be from legal coaching by the plaintiff attorney but I believe most are from health illiteracy.

We can take several steps to improve healthcare communication and help our patients. First, be aware of this problem and realize it can affect patients from every socioeconomic and educational background. Second, learn to recognize this problem in patients who have trouble filing out forms, giving a coherent history or seem non-compliant. Third, ask your patients if they want to bring a family member or friend for office consultations, especially if you are discussing bad news or surgery. Fourth, after you explain a diagnosis or treatment to the patient, don’t ask, "Do you understand?" Patients with low health literacy are often too embarrassed to ask for help. Instead have the patient tell you how to take the medication or what procedure they need. Fifth, use a variety of tools to reinforce your message – nurse discussion, video tapes and printed materials may be helpful. Finally, and most important, take whatever time the patient requires to make sure that they understand your diagnosis and recommendations. Spending a few extra minutes with the patient to overcome problems with health literacy will pay many dividends. There will be increased patient satisfaction, increased compliance, improved health outcomes and decreased litigation.