Health literacy 101 for physicians
There is a lot of interest about patient centred health care but before getting caught up in all the hype about using technology to engage e-patients, why not first start with the basics. The average American reads at 8th grade level but most health communication is written at college level. How do you address this terrible disconnect? I recently watched this excellent video on how health professionals can acknowledge and cater to their patients’s health literacy. The video is part of the American Medical Association Foundation’s Health Literacy Kits.
Poor health literacy can have devastating consequences. A woman in the video signed a form authorizing a hysterectomy without knowing it. The video powerfully challenges the common assumption that low health literacy is only associated with the unskilled and unemployed. Many of the patients are skilled workers including a pharmacy technician and a machinist. Why expect an engineer to understand medical jargon any more than a doctor should understand engineering terminology? The video makes such good, practical points that they bear featuring here.
- Create a shame-free environment: patients who have limited reading skills tend to be ashamed of this – they shouldn’t be but they are. One patient reported that they dealt with their frustration by covering up their reading limitations, getting angry and even walking out of the consulting room. Health professionals can support patients by making it easy for them to get help. Staff need to be non-judgemental and alert to cues that patients are having difficulty – for example, front desk staff can discreetly observe how long a patient takes to fill a form and whether they seem unsure and hesitant.
- Understand patient needs: administer a questionnaire to assess reading level; take the patient’s social history – find out their cultural background, ask them how happy they are with their reading level
- Improve communication skills: in taking to patients, health professionals should:
- slow down when they speak
- emphasize important concepts
- use lay language: in one interview, the patient said to him, “hypertension” means one who is “hyper” or restless. The doctor was surprised to learn that the concept of high blood pressure was not getting across to him.
- employ the use of visuals such as models, posters and graphics. A good example is taping an actual pill to the sheet with medication instructions. Patients with limited reading skills rely on the color and shape of the pill to identify it.
- use familiar analogies. A good example in the video is a physician who compares arthritis to a joint in the door frame that lacks oil
- involve family members who can help patients understand the information better
- use the teach back method: Rather than ask “do you understand?”, ask “how would you explain this to someone else?”