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Posts made in November 2012

Healthcare Literacy, a Barrier to Effective Communication and Patient Engagement

When a patient walks through the examining room door, at their doctor’s office, it is generally assumed that the patient’s health issues will be addressed and the visit will be successful. This is not always the case. According to the Institute of Medicine (IOM), there are over 90 million American adults, one half of the American adult population, who have difficulty understanding complex instructions that often accompany a health diagnosis. Many of these individuals do not read beyond a sixth-eighth grade level and have additional educational, social and cultural factors that influence how health care information is shared and received. Most health care materials are written at a 10th-grade level






The American Association of Family Practitioners (AAFP) has taken the position that cultural, language and communication barriers – together or alone – have great potential to lead to mutual misunderstanding  between patients and their health care providers. Older patients are particularly affected because their reading and comprehension abilities are influenced by their cognition  vision, and hearing status. The AAFP studies show that these patients  have difficulty controlling chronic illness.  For example, patients with diabetes and inadequate health literacy have difficulty controlling their blood sugar and have higher levels of retinopathy; patients with asthma and inadequate health literacy do not use their inhalers properly and therefore do not keep their asthma in control.



These patients ask fewer questions and misunderstand their provider’s instructions more often than not. This places them at greater risk of preventable adverse events.They are also less likely to understand and participate in disease prevention and health promotion programs and are more likely to be hospitalized than those with adequate health literacy, resulting in an additional $69 billion in health care costs annually4



Health illiteracy tends to have a wide-ranging effect that inhibits a patient’s ability to:


(1)  Follow simple instructions for taking medication that most of us take for granted.

(2)  Attend appointments because they cannot follow the directions to the physician’s office.

(3)  Register for health insurance, therefore they cannot get treatment.

(4)  Complete forms correctly, and as a result they leave unanswered questions; or sign documents, they have not understood, creating problems for everyone.

(5)  Understand the explanation their physician offers about their medical condition

(6)  Know when to return or how to follow-up on their visit.



Health literacy is not only a problem for patients, it is a problem and a responsibility that many physicians do not take seriously enough. Overuse of medical jargon and physicians who are working under severe time constraints and do not take the time to be sure their patients understand their instructions contribute to medical errors and  medication compliance issues.



Clear and effective communication between patients and providers remains a core element in the delivery of best medical practice.  Physicians need to have a full understanding of the cultural, social and educational obstacles that their patients bring to the table.  They need to figure out a way to work around those obstacles. It is only then that a greater number of patients will become engaged and empowered to work with their physicians and  insure the best outcomes.

Reducing Health Care Costs with Home Test Kits

Healthcare costs for American families in 2012 exceeded $20,000 for the first time according to the annual Milliman Medical index (MMI) which measures the total cost of healthcare for a typical family of four. The 2012 MMI is $20,728, an increase of $1,335 or 6.9% over 2011.This means that for many people, their health care costs are higher than their annual mortgage payments!


As patients become more empowered and engaged they are looking on their own for ways to reduce some of these costs, particularly office visits and lab fees.  As a result,  many turn to home testing.


Home test kits are available to detect ailments from high cholesterol to cancer and HIV. Using a few, drops of blood, a urine sample, or a snippet of a child’s hair, home tests now provide results related to such serious issues as colon cancer, cardiovascular disease and whether or not your child may be using illicit drugs.




For years, pregnancy tests and ovulation predictors dominated the home test kit market. The fact that they produce speedy results and early confirmation present an opportunity for patients and health-care providers to discuss options, and for patients to seek early education about pregnancy and birth.


Kidney disease, one of the most devastating complications of diabetes, but detectable and treatable in its earliest stages, can also benefit from a home test kit.The kit enables diabetics to test for glucose and even small amounts of protein in their urine–an early sign of kidney dysfunction. It is safe as long as the results are communicated to the patient’s physician and together the patient and doctor map out a treatment plan.


On the other hand, home tests  raise red flags among health care professionals because:

(1) They  fear that a patient misunderstanding and misinterpreting test results could lead to serious, potentially fatal health issues.


(2) These tests frequently present false positives or negatives which cause misunderstanding, trauma and confusion that requires a clinician’s input to straighten out.


(3) Since most patients are not medically trained, they may not be able to follow the instructions which can be quite obtuse.


(4) There is also the issue of how to insure proper collection, storage and shipment of specimens from home tests, so they are usable for an accurate read. Samples held too long, or subjected to severe temperature changes could generate inaccurate results. Urine samples taken too early or too late in the day,or foods eaten that mimic the metabolites being measured also can produce inaccurate readings.


Steven Gutman, M.D., Director of the Food and Drug Administration’s Division of Clinical Laboratory Devices warns that “consumers need to be wary about buying and using kits on their own. People need to carefully read the test-kit labeling and instructions and pay heed to the warnings about the product,” he says.


The FDA recently tested a number of unapproved home HIV test kits sold on the Internet that were confiscated during a criminal investigation.None produced accurate results. The FDA’s Center for Biologics Evaluation and Research, which reviews all blood-related products, continues to investigate firms and people involved in the illegal sale of unapproved HIV home test kits in the United States.


There are a number of other bogus home tests not cleared by the FDA that can be inconsistent and inaccurate and will lead patients to draw false conclusions about their health.


Home test kits are not meant to replace the office visit.In spite of the fact that we encourage people to become e-patients who take charge and assume responsibility for their health care, it is also critically important that e-patients realize the pitfalls, issues, and dangers of home testing without consultation with a clinician who can evaluate results within the context of the whole health picture, not just one test. Additionally, smart patients know that they should use only those  home test kits that have received FDA approval.


For more information on where to buy valid home tests or how to manage results, check the FDA website at