Physician Focus: March 2012
By Andrew Morris-Singer, M.D.
A critical but often overlooked aspect of health care is a topic
called 'medical or health literacy' - defined as a patient's
ability to read and understand health information and make informed
decisions about his or her health.
In its landmark 2004 report, Health Literacy: A Prescription
to End Confusion, the Institute of Medicine, an arm of
the National Academy of Sciences and the nation's advisor on health
matters, wrote that "clear communication is critical to successful
health care" and that "health literacy remains a neglected, final
pathway to high-quality health care." IOM estimated at the
time that some 90 million Americans, nearly half of the adult
population in the United States, have low levels of medical or
health literacy. Eight years after the report, the problem
persists.
Several factors contribute to our medical illiteracy:
educational levels, language barriers, cultural differences, and
age - especially for people older than 65 - are some of the
barriers affecting communication between patient and provider. Even
fear can play a role, when patients don't want to admit they don't
understand something the doctor or nurse has said because they
might be thought ignorant.
The language of medicine also confuses patients. Physicians and
other health care professionals, with their own jargon, are not the
best at communicating simple information, and terms such as
hemorrhage, edema, myocardial infarction, and carcinoma can be
foreign words to many patients.
Continuing medical discoveries, technological advances, and the
burgeoning size and complexity of our health care system have
combined to add more mystery and confusion to health care.
The irony is that this is happening in an age when health
information - whether about the human body, diseases, diet,
fitness, or insurance - is more readily available than ever from a
multitude of sources.
The consequences of medical illiteracy are severe. It leads to
higher rates of disease and death, more use of emergency rooms, and
billions of dollars in avoidable costs for our health care system.
Patients with low medical literacy have poorer health outcomes, are
more prone to medication errors, and are more likely to be
hospitalized or re-hospitalized. Tragic results can also occur,
through misunderstandings over medical procedures or the improper
use of medications.
Millions of Americans have difficulty with common tasks such as
following directions on a prescription bottle, and even the well
educated among us can be challenged by serious illnesses or the
constant care of chronic conditions such as diabetes or heart
disease.
As part of its prescription for health literacy, IOM has called
for "great efforts from the public health and health-care systems,
the education system, and society overall." That global
perspective is appropriate, but improvement can first and more
quickly begin at a basic level: within the physician-patient
relationship. Fixing the problem is about what the patient and
provider both need to do.
Physicians must become bilingual, not in the sense of being able
to speak another language, but being able to use words that
patients can understand. Communicating with words like bleed
instead of hemorrhage, swelling for edema, heart attack for
myocardial infarction, and cancer for carcinoma, would go a long
way to improving patient understanding. The entire medical team -
nurses, medical assistants, and others - can also play key roles in
communicating more plainly and helping patients gain greater
understanding.
Patients must do their part as well. I ask my patients to come
to their appointments ready "to teach and to learn." Patients must
teach the physician about themselves and understand the basics
about their bodies and their medical conditions. They should be
ready and willing to ask questions, despite how basic they may
seem. A patient should never leave a physician's office confused
about a doctor's instructions or with a question unanswered.
For physician and patient, the goal of increasing medical
literacy is the same: to make care better and safer and improve the
patient's health. Each must contribute to reach that goal.
To learn more about medical literacy, visit the Centers for
Disease Control at www.cdc.gov/healthliteracy/
or the US Department of Health and Human Services at www.health.gov/communication.
For a video discussion, visit the Massachusetts Medical Society at
www.physicianfocus.org/medicalliteracy
Andrew Morris-Singer, M.D. is a primary care physician at
Brigham and Women's Hospital in Boston and co-founder and president
of Primary Care Progress. Physician Focus is a public service of
the Massachusetts Medical Society. Readers should use their own
judgment when seeking medical care and consult with their physician
for treatment. Send comments to PhysicianFocus@mms.org
