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|Posted on April 14, 2011 at 10:06 AM|
Helping Patients Understand Their Medical Treatment googleoff: all
Topics: Delivery of Care, Quality, Public HealthBy Sandra G. Boodman Mar 01, 2011
This story was produced in collaboration with (Illustration for Kaiser Health News by Jack Black)An elderly woman sent home from the hospital develops a life-threatening infection because she doesn't understand the warning signs listed in the discharge instructions. A man flummoxed by an intake form in a doctor's office reflexively writes "no" to every question because he doesn't understand what is being asked. A young mother pours a drug that is supposed to be taken by mouth into her baby's ear, perforating the eardrum. And a man in his 70s preparing for his first colonoscopy uses a suppository as directed, but without first removing it from the foil packet.Each of these examples provided by health-care workers or patient advocates illustrates one of the most pervasive and under-recognized problems in medicine: Americans' alarmingly low levels of health literacy — the ability to obtain, understand and use health information.Translating Medical JargonSome technical terms and what they mean in plain English:
A Positive TestJaved Butler, a heart surgeon at Emory University Hospital in Atlanta, said one obstacle to improving health literacy is the language that doctors typically use. "When we say 'diet,' we mean 'food,' but patients think we mean going on a diet. And when we say 'exercise,' we may mean 'walking,' but patients think we mean 'going to the gym.' At every step there's a potential for misunderstanding," said Butler, who added that he tries not to lapse into "medicalese" with patients.It's not a problem only for those with basic skills. Paula Robinson, a patient education manager at the Lehigh Valley Health Network, which includes three hospitals in eastern Pennsylvania, said that even highly educated patients are affected, particularly if they're stressed or sick.She cites the initial reaction of former New York Mayor Rudolph Giuliani, who thought he was cancer-free when his doctor told him several years ago that his prostate biopsy was "positive." Actually, a positive biopsy indicates the presence of cancer.Many patients, Robinson said, won't ask questions or say they don't understand, either because they are intimidated or worried about looking stupid. Some simply tune out or shut down, she said, and "a lot of people take things literally because of anxiety."Robinson recounts one such case: A patient who had been prescribed daily insulin shots to control his diabetes diligently practiced injecting the drug into an orange while in the hospital. It was only after he was readmitted with dangerously high blood sugar readings that doctors discovered he was injecting the insulin into an orange, then eating it.AHRQ's Brach said that some time-strapped doctors have complained that their schedules are too packed to add literacy concerns to the list.But she said simple measures that are not unduly time-consuming can be integrated into the visit. They include a method called "teach back," which asks patients to repeat in their own words what they have just been told.Illinois geriatrician Cheryl Woodson said she avoids making assumptions about her patients' health literacy. "You can't tell by looking," said Woodson, a solo practitioner in Chicago Heights."I never ask, 'Do you understand?'" she added, "because they say, 'Uh-huh,' and you don't know what they understand. So instead I'll say, 'I know your daughter is going to want to know about this, so what are you going to tell her?'"No Literacy Sometimes the problem is not health literacy, but the ability to read or write at all. It is estimated that 14 percent of adults are illiterate, but many find ingenious ways of compensating and take great pains to hide the problem.Archie Willard said he avoided going to the doctor for years before he learned to read at age 54. Even today Willard, now 80, said he struggles with reading — he is severely dyslexic — and identifies his medication by the shape and color of the pill, not by reading the label.Willard, who divides his time between Iowa and Arizona, said that before he learned to read he employed a strategy in medical settings common among those who cannot read or write. "I would say I couldn't fill out the paperwork because I forgot my glasses. And I didn't even wear glasses."Many experts predict that efforts to boost health literacy may benefit even the minority who are proficient. "People worry about dumbing things down," Brach said, "but in the research, no one has ever complained that things were too simple. Everybody wants clear communication."
Categories: Medical Interpretation