Health literacy: Help your patients understand directions

Doctors can take steps in their practices to help the 90 million Americans who have trouble comprehending health information.

Editorial. May 10, 2004.

Take one pill once a day. These directions seem crystal clear. But they sent a man to the emergency department. How could that possibly be?

In the patient's native Spanish, "once" means 11. Thus, he believed he was properly following these instructions, which appeared on the bottles of both the diuretic and the beta-blocker prescribed for his high blood pressure. He was taking 22 pills a day.

This real-life example shows how patients' grasp of health information cannot be taken for granted. The anecdote was included in a new Institute of Medicine report, one of two released last month to draw attention to the health literacy problem. An estimated 90 million Americans -- nearly half of the adult U.S. population -- have difficulty understanding and acting upon health information.

The problem goes beyond patients simply misreading medication bottles. It impacts every aspect of care, and the results can be utterly devastating.

People with poor health literacy are less likely to get potentially life-saving screenings, such as mammograms and Pap smears, or to get flu or pneumonia vaccines, according to an Agency for Healthcare Research and Quality study, commissioned at the American Medical Association's request and released in conjunction with the IOM report.

These patients are more likely to be hospitalized. They have difficulty understanding informed consent forms or comprehending their diagnoses and medical instructions. They are less likely to know about the health effects of smoking, diabetes, asthma and AIDS.