Are you health illiterate?
CBC Radio: 7.27.2015 by Dr. Brian Goldman
Modern medicine is complicated, which is what smart
doctors are for, right? Well, maybe not. More and more experts think the key to
better outcomes is a smarter patient - one who is informed about personal
health. An
article published last week says doctors should dumb down
their instructions to patients. I think that idea is even dumber.
The article - by doctors at Thomas Jefferson University
in Philadelphia - says that doctors should assume that in general, patients do
not understand medical advice. In other
words, until proven otherwise, doctors should assume that patients are
illiterate in health information.
Therefore, they should avoid using medical jargon when explaining
diagnosis or treatment to the patient - unless the jargon is essential, in
which case it should be explained clearly.
The authors also say that in general, when doctors talk to patients,
they should speak or provide written handouts aimed at the grade five or six
level. When speaking, the authors say
doctors - should - speak - slowly - and break down information into small
manageable steps. There's a lot more,
but you get the drift.
The authors say studies show that more than a third of
adults living in the U.S. have limited health literacy, making it more
difficult for them to read, understand and apply health information. That includes information presented on
medication bottles, hospital discharge instructions, consent forms patients
sign prior to surgery, medical forms, and health education handouts. Studies show that more than 75% of patient
educational materials are written at a high school or college reading level -
far above the average American patient.
I have no reason to think Canadian patients fare any better at reading
comprehension. Patients don't understand
a lot of the words doctors use. They also don't understand the way we use
numbers.
It's disturbing to realize that doctors and patients
overestimate how much patients are capable of absorbing. Turns out there are real tools out there that
assess health literacy. REALM-R is a word recognition test in
which patients are asked to de-code or pronounce medical words like anemia,
jaundice and colitis. It screens for poor literacy skills. The Short Test of Functional Health Literacy in Adults
assesses reading comprehension and numeracy skills over two prose passages and
four items assessing numerical ability.
There's also a longer version of this test with three prose passages
followed by a 50-item reading comprehension section. The Single Item Literacy Screener has just one
question: How often do you need to have
someone help you when you read instructions, pamphlets or other written
material from your health professional or pharmacy.
Poor health literacy contributes to lower health
standards and health disparities between informed and uninformed patients. Poor health literacy has been cited as a
factor in patients not following doctor's instructions, not taking medication
properly and often not taking it at all. Studies show health illiteracy leads
to longer stays in hospital and rising rates of poorly managed chronic diseases
like type 2 diabetes and high blood pressure.
It leads to lower success rates curing cancer. Not surprisingly, it also leads to bad health
outcomes and in some cases to higher mortality rates. READ MORE !
Title of Screening Tool
Rapid Estimate of Adult Literacy in Medicine (REALM)
Rapid Estimate of Adult Literacy in Medicine - Revised
(REALM-R)
Test of Functional Health Literacy in Adults (TOFHLA)
Short Test of Functional Health Literacy in Adults
(S-TOFHLA)
Newest Vital Sign (NVS)
Brief Estimate of Health Knowledge and Action – HIV
Version
Single Item Literacy Screen
How confident are you filling out medical forms by
yourself?
SOS Mnemonic
Description and Average administration time
Measurement of literacy levels
Strengths and Limitations
Location / Availability: Free, Purchase, or Citation
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