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When I first started my pediatric practice, I would casually tell mothers of four-to-six-month-olds that they could start with some solid foods, like peas. It never occurred to me to tell them how to feed their babies peas. But, after several mothers reported that they had trouble mixing the solid baby food and the formula and feeding through a nipple, I began to think about one of the most pressing and still unresolved problems in the health system: doctors too often do not speak to patients in language the patients understand.
According to the National Assessment of Adult Literacy, the most comprehensive measure of adult literacy, just 12 percent of adults have proficient health literacy, meaning that they understand and use health information correctly to make good health decisions.
Inadequate health literacy has been linked to avoidable emergency room visits, prescription drug confusion, increased hospitalizations, and, in extreme circumstances, death. It also costs the country between $106 billion and $236 billion annually.
As I began to see more patients, both children and adults, I paid more attention to communications. I found that too often my patients had a completely different understanding of what I was attempting to communicate.
In part, patients bear responsibility. We have a culture in which people – including those from underserved medical communities where I now work don’t ask their doctors questions about their health and medical needs. I regularly see patients who cannot tell me what their specialist found, details of their prognosis, and what the next steps are in their care.
Patients should ask their doctors three questions at each appointment: What is my main problem? What do I need to do? Why is it important for me to do this? When it comes to tests and medicines, patients should ask what the test/medicine is for, how they do/use it, and about side effects. They should bring note paper and a pen to write down the doctors’ answers.
Patients should also bring their medicines, vitamins, and supplements to appointments so they can review them with their doctors and ensure they are taking them the right way.
But, doctors bear responsibility too. In medical school we spend a considerable amount of time learning how to ask patients the right questions and how to make sure we understand what the patient is saying. We are taught not to assume what “recent” or “very painful” means, for example. However, we spend virtually no time learning how to make sure patients understand what we are saying.
At the Community Healthcare Network, which provides 75,000 under- and uninsured patients with comprehensive health care services at a dozen sites throughout New York City, we have spent the past five years figuring out how to create a system that promotes patient health literacy. It boils down to three things every medical office in this country should be doing:
1. Simplify all communications to a 5th grade level and drop the medical jargon, making it easy to understand for the majority of patients. Speak in plain English, or, in many cases, speak plainly in the native language of the patient.
2. Complement oral instructions by providing patients with easy-to-read educational materials on diagnosis and treatment.
3. Implement the “teach back” method, prompting patients to explain the information a medical provider has given them in their own words. If your doctor is not doing these things, talk to him or her about streamlining communications at the office.
Our country has expanded health care coverage thanks to the Affordable Care Act, but too many individuals cannot read their prescription instructions; they do not understand their hospital discharge papers; they cannot decipher their treatment plans; and they misinterpret their diagnoses and prognoses. The results can be damaging, costly, and even deadly. Only when health care professionals begin to clearly communicate with patients will we be able to mitigate health literacy problems and ensure better health care outcomes.
Matthew Weissman, a pediatrician, is the Chief Medical Officer of the Community Healthcare Network (CHN). CHN is a nonprofit that runs 12 community based health clinics and provides services to 75,000 New Yorkers annually.
