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.