June 2004 Bulletin

Speaking “medical” presents challenges to patients

Institute of Medicine says 90 million people can’t understand health information

By Joen P. Kinnan

Nearly half of all adults in the United States—about 90 million people—have problems understanding and using health information and the health care system, according to a recent report from the Institute of Medicine (IOM), Health Literacy: A Prescription to End Confusion.


People with limited health literacy may have poorer outcomes, use fewer preventive health measures and be unable to manage chronic disease or effectively participate in their own health care management in general. These problems inevitably lead to greater need for emergency room and hospital care, with subsequent escalation in avoidable health care costs.

The magnitude of the health literacy problem obviously requires a concerted effort on many fronts: governmental, educational and institutional. But at its core is the communication—or lack thereof—between health care providers and their patients. What can you, as a practicing orthopaedist, do to improve the health literacy of your patients?

Defining health literacy

First, don’t confuse health literacy with literacy in general. People with lower educational levels and those for whom English is a second language do face greater obstacles than college-educated or native-English speakers. But “medical” is not a native language for most patients. Even people who are highly educated in other areas need to have their diagnoses and treatments described in layman’s terms.

Improving health literacy involves more than simply stating information in understandable language, however. Patients must be able to process the information, so they can act on it to participate in their own health care management. Begin by being clear and specific. Instructions such as “take one pill as needed for pain” or “apply ice to reduce swelling” are not enough. Instead, provide guidelines: “When pain reaches 7 on a scale of 1 to 10, take a pill” or “Apply ice for no longer than 20 minutes at a time, with at least 20 minutes between applications, during the first 24 hours.”

If a prescription is needed, make sure the patient knows the name of the drug, what it’s for, how to take it and when to take it. As a safety measure, encourage patients to ask the pharmacist to double check that the medication is indeed what you prescribed and that the dosage is correct. Don’t depend on the pharmacist to cover possible side effects. Provide patients with written information.

Overlapping or incompatible medications are a real issue in health literacy. Patients who are seeing more than one physician often don’t know whether or not to continue taking prescriptions they’ve received. To clarify the picture, ask patients to bring whatever they take—including herbal and over-the-counter (OTC) medications—to the office visit and then plan accordingly.

Interdisciplinary cooperation and teamwork are important when a patient is being treated for multiple conditions or has more than one physician. Patients need to know that they must notify every doctor involved if one doctor orders a new prescription. Every doctor should also be notified if the patient wants to begin taking new OTC or herbal treatments. Ideally, all members of the team will participate in a discussion about the overall treatment plan.

Promoting health knowledge in a visual age

The media both help and hinder a patient’s health knowledge. Television saturates the airwaves with health care news and advertisements. Patients are bombarded with direct-to-consumer advertising for popular drugs and miraculous new diets. Nightly news reports regularly feature amazing health care breakthroughs. Too much of this is hype, however—even on news broadcasts.

Although the Internet can be a wonderful source of health care information, it is also a huge repository of misinformation. As a result, patients may have a smattering of knowledge about particular health care issues, but they don’t know how to put the pieces together in a meaningful way. Physicians need to help them do this, and they need to probe for misinformation that may have crept into the picture. Using the AAOS “Rx for Patient Education” prescription pads, which include the URL for the AAOS Patient Education Web site (http://orthoinfo.aaos.org/), is one way you can guide patients to accurate musculoskeletal information. To request free samples, e-mail Nancy Fehr at fehr@aaos.org

This is a visual age, and many patients can better understand their orthopaedic problems through visual media rather than verbal descriptions alone. Many orthopaedists use rough sketches, photographs, radiographs, commercially produced drawings, models or even videotape. Here too, the AAOS has useful print and Web materials.

Helping patients remember

Even though patients may understand what is said in the office at the time, they may not remember it later—particularly if you’ve delivered bad news. Literature can provide a reminder.

Take-away information, such as brochures and fact sheets, should be typed or printed, not handwritten. The type should be large and dark enough for the elderly and others with poor eyesight to read. You can download specific materials from the AAOS Web site. These materials are culturally sensitive and written in simple language. Pictures and photographs also help.

Encourage patients to bring someone else along to the visit. Be diplomatic with this suggestion. Older people in particular may bristle at any implication that they are not competent to assimilate information. You might even suggest that the patient bring a tape recorder to record the discussion.

The future of health literacy

Improving patients’ health literacy takes time, but it is an investment that pays off in the long term.

The Agency for Healthcare Research and Quality and the IOM have recommended that health literacy be incorporated into school curricula from kindergarten through high school, at community colleges and adult education programs, and in medical school. Other recommendations include more responsible media coverage of health issues and involving health care consumers themselves in program planning. If these changes are implemented, “medical” may not be an entirely foreign language to future patients.

Joen P. Kinnan is a freelance writer specializing in health care issues and medical topics.

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