Health literacy: Your patients can't follow instructions they don't understand

Physicians can improve their patients' health outcomes by taking simple steps to improve health literacy.

Editorial. June 16, 2003.

The problem can be easy to spot -- the immigrant patient with diabetes who speaks little to no English and is bewildered by terms like blood glucose levels and hemoglobin A1c tests.

But it can be hidden, too. A middle-aged mom too ashamed to let on that she can't comprehend many of the words in the brochure about mammograms. The elderly patient with multiple medical conditions who doesn't take his medications as often as he should because he's confused about which pills to take and when to take them.

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The health of about 90 million people in the United States may be at risk because they don't understand and can't act on the health information their doctors give them. Chances are some of your patients are part of this group.

Poor health literacy, although more prevalent among minorities and immigrants, stretches across socioeconomic, racial and ethnic lines.

In fact, literacy skills are a stronger predictor of a person's health than age, income, employment status, education level and race, according to the American Medical Association Foundation.

If patients don't understand their physicians' recommendations, they can't follow them. The statistics bring the impact into focus. Patients with low literacy skills have a 50% increased risk of hospitalization, and only half of all patients take medic ations as directed, according to the Partnership for Clear Health Communication.

The problem drains health system resources to the tune of $73 billion annually.

Fortunately, there are easy and inexpensive steps physicians can take to better communicate with their patients.

A good place to start is by adopting the "Ask Me 3" program, which was launched in May by the partnership, of which the AMA Foundation is a member.

The initiative urges doctors to make sure their patients ask and understand the answers to three simple questions: What is my main problem? What do I need to do? Why is it important for me to do this?

The program includes other easy techniques, such as using basic language in discussions with patients, and in medical forms and other written materials. It encourages physicians to adopt the "teach back" method -- asking patients to repeat instructions .

The initiative's Web site (www.askme3.org) offers many practical materials physicians can use in their offices, from lists of confusing words and easy-to-understand alternatives to brochures for patients.

The AMA Foundation, the Association's philanthropic arm, also has launched a number of initiatives with the help of a $1.5 million grant from Pfizer Inc. It is distributing 10,000 health literacy kits at no charge to state and county medical societies, specialty societies, and AMA Alliance affiliates.

The foundation is funding three rounds of grants to dozens of physicians, medical societies, residents, community groups and medical students to create health literacy education and awareness programs. (Individual kits are available through the AMA Pre ss (item number OP221002), and can be ordered online (www.amapress.com) or by calling (800) 621-8335).

Also included in the group's efforts are train-the-trainer programs for 10 medical societies, which will then initiate local health literacy education initiatives.

With managed care and other pressures already forcing physicians to squeeze more into each patient visit, it might seem as if there is no time to spare for patients' questions. Yet there is reason to re-examine that perception. For example, most doctor s allow patients to talk for an average of 22 seconds before taking the lead, according to the partnership. But if allowed to speak freely, the average patient would initially speak for less than two minutes.

So the time investment in communication and understanding is smaller than a physician might expect. But the return is great: improved patient compliance and fewer follow-up visits.

It's a powerful combination that results in a healthier patient and in the most effective use of the doctor's time.