Missed messages

Millions of patients lack the literacy skills to fully understand their illnesses and treatment plans

The doctor explains. The patient nods. The problem is, does the patient really understand what the doctor is saying about the diagnosis and treatment plan? In very many cases the answer is no.

It's a question of medical literacy, or more to the point, illiteracy. More than 40 million American adults are functionally illiterate, and an even greater number, 50 million, are only marginally literate. What happens when they become patients is that prescriptions are not taken correctly, treatment plans are ignored, and self-monitoring goes undone. All at a cost of increased suffering and many millions of dollars wasted or unnecessarily spent.

The scope and implications of this widespread lack of medical literacy are the subject of a new report by the AMA's Council on Scientific Affairs. The authors reviewed the literature on medical literacy and what emerges is an alarming picture. In one hospital study, "42% of patients were unable to comprehend directions for taking medicine on an empty stomach, 26% could not understand information on an appointment slip, and 60% could not understand a standard consent form."

While the issue is often framed in terms of chronic health problems -- those illnesses affecting nearly 100 million Americans also require the most patient self-management -- medical illiteracy poses a threat at every point on the health care continuum. Health warnings and immunization notices are lost on someone who can't read them. The same applies for information about preparing for a test or procedure, or about what symptoms should prompt a visit to the doctor. Another striking statistic from the study cited above is that a third of the English-speaking patients observed "were unable to read the most basic health-related materials."

All this comes at a time when both medical advances and cost consciousness in the health system have raised expectations that patients will take a more active role in the monitoring and treatment of their illnesses.

Physicians can play a significant role in addressing this problem. The CSA report recommends awareness -- many patients try to hide the fact that they can't read -- and suggests making instructions simple and clear. Another strategy recommended in the report is to communicate interactively: "Show the patient a pill bottle and ask, 'If this were your medicine, tell me, how you would take it?'á"

Still, more research is needed on the very open question of how to most effectively convey health information. In approving the CSA report last month, the AMA House of Delegates pledged the Association to encourage public and private financing for additional study into this problem. The AMA also supports additional communication training for physicians and other measures to raise awareness and find solutions to the problem.

Literacy is a fundamental issue for the medical profession. The marvels of modern medicine don't amount to much for patients who can't master something as simple as taking the right pill at the right time.