Keep it clear and simple for your patients

Patients may not understand what doctors are telling them; a CME video helps physicians make sure the message is getting across.

By Myrle Croasdale, amednews staff. Aug. 5, 2002.

A sharply dressed woman, probably in her 60s, is asked what medications she takes. She says lithium. No, she doesn't know what it's for, she just follows doctor's orders.

Well, she isn't taking lithium, she's on Lipitor. She isn't a manic depressive, she has high cholesterol. The point? People may look like they understand what their doctor is telling them, but often they don't have a clue.

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This and other patient interviews are captured on a continuing medical education video on patients' literacy about their health care -- a video that started out as a self-study CME course but has taken hold among physicians and health care administrators and been transformed into CME presentations at conferences and medical staff training sessions.

"Give doctors something practical to use, and they will," said Joanne Schwartzberg, MD, director of aging and community health in the AMA's medicine and public health section. "We've gotten a number of calls telling us they were using our materials for a class. This just goes to show you, you never really know how [materials] will be used."

The video comes in a kit that includes a study on health literacy, fact sheets and a discussion guide. Completing the enclosed CME questionnaire can garner a physician up to two hours of category 1 credit.

Anecdotal reports suggest the kit has been used as the basis for many credit-worthy classes at conferences.

46% of U.S. adults have trouble understanding sentences that have both numbers and words.

"They call and say they used our fact sheets as slides for residency training programs and Grand Rounds. One group wanted to know how to turn it into a CME class for nurses," Dr. Schwartzberg said.

More than 3,000 kits have gone out since their introduction in 2000. The kits were a joint project of the AMA and the American Medical Association Foundation. The AMA Foundation is expected to roll out more of these projects in the next two years.

The AMA sent surveys to 400 addresses from the kit mailings, with 199 reporting they had used the kit or were planning to.

Of those, 124 said they had taught others using the material, raising the audience to almost 10,000. Medical students and residents were among the top viewers of the video.

Of the physicians who saw the video, 55.2% said they had changed the way they practiced in their office.

Of those who changed clinical practices, 92.5% reported changing how they handled patient education, and 25% said they had altered how they monitored patients. Of the doctors who changed their practices, 94.1% said they had simplified directions, 88.6% said they now asked patients to repeat back instructions, and 84.8% said they had increased the quality of care.

Fifty-five percent of respondents added staff training as a use of the video, and doctors reported that 68.4% of them now had a staff that was better able to support patients who have a low understanding of health care. Precisely 57.9% felt they were better equipped to identify patients with low health care literacy.

Many patients do have this low literacy. According to a 1992 National Adult Literacy survey, 46% of U.S. adults have difficulty understanding sentences that have both words and numbers. And, of course, nearly all health directions include words and numbers.

Patient education potentially increases the length of physician visits. "One of the big questions is the question of time," Dr. Schwartzberg said.

What many have found, she said, is that using clear, simple language without lapsing into medical jargon is an easy way to raise patient comprehension. And a few minutes of explanation may save patients and physicians from poor outcomes later.

The kit can be obtained by calling (800) 621-8335 and asking for the patient literacy kit.