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Kiran Foster

Lack of reading ability correlates to poor understanding of prescription labels for millions of Americans.

A prescription for understanding your doctor

by Jade Kolker
May 14, 2014

Millions of Americans don't understand their prescription drug labels or their doctor's instructions due to limited reading ability, according to Dr. David W. Baker. Some 93 million Americans have basic or below basic reading skills that inhibit their grasp of basic health information, reports Baker, chief of the Division of General Internal Medicine and Geriatrics at the Feinberg School of Medicine, Northwestern University.

Baker became interested in health literacy while working on a study about emergency department overcrowding at a public hospital in Los Angeles. Participants interviewed were supposed to fill out a questionnaire about the reasons why they came to the emergency room. A third of the people in the study had to have the questionnaire read to them, Baker said.

"What I was always told as a resident was ‘write it down’ [for patients], and it never occurred to me that people couldn't read," or read well enough to grasp written instructions, Baker said. The future of health communications relies on how doctors and patients can work together to make complex information easy to understand.

How is the lack of patient understanding linked to a doctor's ability to communicate clearly?

It's a big part of it. Early on in our work we emphasized the written word and tried to make written information clear. It's very clear now that the spoken word is just as important. We've realized the problem often is that someone who has had low health literacy his or her whole life has very poor background knowledge about their body and health. So a doctor is talking about something and using simple words, [yet] they don't understand what you’re talking about. Even something as simple as an injured nerve – many people don't know what a nerve is.

Is talking to patients in laymen's terms discussed in medical school/residency?

Yes, but it needs to be emphasized more. We spend a lot of time with medical students talking about listening to patients, asking open-ended questions, and how to talk about difficult issues. When it comes to explaining things clearly, I don’t think we spend a lot of time on that, and it’s really hard. Our research group has worked to develop a whole variety of these communications tools. All of us have found that after we work with patients and figure out the simple way of saying something, we then go back to clinic, and we use that same language to explain things to our own patients. So it’s helped us in our care.

It's just hard to explain some of these really complicated things; many of the diseases that we deal with, and the treatments, are really complicated and it takes a lot of time to figure out how to say things simply.

What needs to be done to improve quality and reduce disparities in health care?

There's a whole host of things that need to happen. One of the most important things we need to do is improve education for K-12 about health issues. People need to leave high school understanding what a heart attack is, what a stroke is, what cancer is, and they don't. I think there are great learning opportunities in teaching this material.

Second, we need to teach medical students and residents communication techniques. I think we've made really good strides on that, and I think almost every medical school has a curriculum. But, I don’t think we're doing as good a job with medical residents. One of the things I do with residents is stay in the room and hear how they explain diagnosis and treatments to patients. Typically, we come into the room, help make the diagnosis then we leave and the resident talks to the patient. I would stay in sometimes and say "go ahead, explain what you’re going to do." They often can't. Some of the terms they use are just jaw-dropping. And the reason why they struggle is they don’t have plain-language words to explain these things; they’ve learned medical language and it almost feels awkward for them to talk in plain English and say blood clot rather than thromboembolism. I've actually heard people use that term talking to patients, and patients nod their head like they understand.

We've got patient portals, we’ve got smartphones, we’ve got all of these things new communication tools. So, while we need the good clear explanations, we also need to use these new technologies to improve the communication and give patients more time to digest the information and understand it and ask questions.

Is there anything a patient can do?

For the average patient, the most important thing is to have a true dialogue with their doctor until they're comfortable with their level of understanding about the problem. People should feel they have a right to get an explanation of what’s wrong and what the recommended treatment plan is.

I really believe in the empowered patient. But, I suggest that people not go to the internet to try to diagnose what is wrong with them. It's problematic when people come in having diagnosed themselves. There's an old saying “Listen to the patient, she’s telling you the diagnosis.” What this means is that patients are telling you what they’re feeling and experiencing. If you listen, ask questions, and really understanding what a patient is feeling, you're usually able to make a correct diagnosis.