Are You Health Literate? Medical Communication in the 21st Century

Everyone reading this column is literate. However, with increasing responsibilities on patients to understand their health care and to make increasingly more sophisticated decisions about disease prevention, screening for chronic illnesses, and use of vaccinations and medical therapies, health literacy has become a necessary skill which many people lack.  Special comprehension is needed to understand the medical care system in this country, as well as one’s own healthcare. 

For health literacy, it’s not enough just to be able to read and understand news and books. Because so much information is provided by physicians, pharmacists, doctors, insurance companies, medical clinics, phamaceutical companies and nurses, an ability to maintain attention and concentration, and listen and comprehend what is being said are required if proper decision making can take place. Even decision-making itself requires an ability to understand choices and to be able to commit to one choice or another. In that regard, an understanding of probability and likelihood of risk becomes important, since so much of medicine is not a black and white choice, but rather involves a patient understanding the relative risk of certain illnesses or complications, and understanding what amount of risk the patient is willing to accept, in return for what benefits. Health vocabulary is important as is a good ability to use the English language because so much of what is communicated is conveyed most adequately in English. In addition, today an ability to use the internet effectively is very important since so much standard information is no longer conveyed in printed form, but rather on one or another websites. As well, more supplemental information can be obtained from internet sources, although many sources may not be accurate. Having judgment to know which websites are to be trusted is an important part of health literacy.

Many types of patient attitudes are important in truly being health literate. Patients must be able to keep appointments so that testing, treatments, and patient education can effectively be completed. In addition, one must be willing to accept recommendations and be willing to turn over their care to doctors, nurses, and hospitals. People must be able to understand “insurance talk,” the long communications that come from their insurance companies that can be confusing and incomprehensible because they have often been written by lawyers. 

Patients must also be willing to ask questions when they do not understand what is being said. All too often, people nod their heads as though they are understanding, while failing to appreciate the importance of what is being discussed with a nurse or physician. When confronted with information in a scary type of interaction with a health care professional, bringing a patient advocate (a friend or family member who can help you to understand what is being said or discussed, and take notes) is important in getting the most out of health care interactions. Even the most health literate person remembers only 50 percent of what is told in an office visit, unless notes are taken, tape recordings made, or another person is present to help.

There are many kinds of problems that continue to exist with the health care system. Only 6 percent of patient consent forms are written at less than an 8th-grade reading and comprehension level, and nearly all internet communication is written at above the 9th-grade reading and comprehension level. Doctors continuously use “doctor-talk” using a health care vocabulary that is incomprehensible to many patients. “Hospital consent-talk” and “insurance-talk” are other examples of situations in which material is often confusing because it has been written by lawyers rather than health educators. 

With increasing age of patients, problems develop with poorer comprehension, reduced memory, and impaired cognitive skills that prevent a total understanding of diagnosis, possible treatments, and decision making. In this regard, even just the simple pressures of a health care interaction result in poor recollection by patients of what they had been told.

Who is at risk for having less than adequate health literacy? Patients with less formal education are less likely to have the vocabulary, reading, and comprehension skills necessary to interact well in the health care environment. Immigrants are at risk because of language challenges. Certain illnesses, such as mental illness and chronic health conditions, impair individual’s ability to concentrate on advice or information from their physicians. Poor understanding is characteristic of people with learning disabilities. Minorities are at risk because of their greater likelihood of having lower education. Elderly patients often have problems in comprehension which are magnified in the health care setting compared to their ability to function very effectively with family and friends. 

What can you do to help maintain your health literacy, and that of your family and friends? First, always ask questions of health care providers if you don’t completely understand what is being said. Offer to be an advocate for others, or take a health care advocate with you when you are going to doctor’s appointments or to the hospital. Always take notes of what is being said by nurses or physicians and make certain that you can understand those notes before you leave the hospital or doctor’s office.

Learn how to use the internet either by yourself or with another person so that you can make use of health care information on the internet, just as you are doing now.  If you feel that you require more support when you go to a physician’s office or when you are using the internet, “buddy up” with someone who is willing to share their expertise with you.

Social networking groups have been helpful. Patient advocacy societies (such as the American Heart Association or American Cancer Society) provide an opportunity to find other people who are concerned about the same types of health problems you might have. Working closely with family and friends helps you to discuss problems that you are having with understanding and decision making about a health condition. Patient support groups are also available in clinics, in churches, in hospitals, and even through insurance companies. 

Almost always hospitals and larger medical clinics have a patient advocate available to help confused or perplexed patients. Even smaller doctor’s offices can provide an office manager, medical assistant, nurse, nurse practitioner, or physician assistant to help the doctor to make certain that all of the information is being understood by patients.  Be certain to utilize all of these resources when you are considering any aspect of your health care, including medications.