Of course, my Op-Ed opinion piece for the local NPR station got trumped by another piece on the exact same topic, Health Literacy. Never mind them, I’ll just publish it myself. Enjoy. (Click on the play button to… play.) Or just read along.
I visited an elementary school last week to answer some students’ health questions, and it was fantastic. I was thrilled to see them engaged and learning about their health and bodies–because I have a number of patients who know nothing about their diseases or medications.
Being a medical student gives me a magic power: the ability to instantly recognize my patients’ eyes glazing over, confused or unsure about what a doctor is saying. Doctors these days are under immense time pressure, and often don’t even realize when patients are lost. I’m something of a quasi-doctor: I understand the basics of diagnosis and treatment from the medical side, but I’m still able to take a patient’s perspective and realize when something may be over his or her head.
Part of this poor communication comes from “doctor-talk,” the language that we speak to each other, with such wonderful terms as “diaphoretic” (that just means “sweaty”). (Part of my job as a medical student is to learn the doctor-talk so I can communicate accurately and effectively. It’s *not* to make patients feel stupid or small, although I know it often has that effect.)
Sometimes we forget to switch back into English for our patients. Other times patient confusion is due to cultural factors, poor translation, or a lack of understanding about the body or disease. And even if doctors *do* try to make sure patients understand, guilt or embarrassment make some patients nod their heads anyway.
A major component of this confusion is “health literacy.” People who are not health literate have problems understanding pill bottle instructions or side effects, or even realizing why diseases like diabetes or hypertension are important to control. There are almost 90 million adults in the US who have only limited health literacy skills–that’s more than 4 in 10.
We often see the consequences of health illiteracy in the ER–my future specialty. I may diagnose a patient with a kidney infection, only to find out antibiotics were already prescribed by another ER, but the patient simply isn’t taking them. The communication of “You must take these to get better” got lost somewhere along the line, for any number of reasons. An extra 30 seconds of explanation can often save a patient a lot of pain, an ER visit… and many health care dollars.
We often refer to “futile care” as the exhorbitant costs of sustaining a dying patient, but we clearly deliver “futile care” to young, healthy patients all the time, too–it’s effort just as wasted if the patient doesn’t understand what he or she needs to do to get better (or not get worse). Why diagnose and treat patients if they don’t understand the treatment plan? A magic cancer pill is useless if the patient doesn’t understand how, when, and why to take it correctly. As physicians, we must do better.
But we need your help as patients, too, because we’re in a time-crunched world with lots of sick patients with many problems. Here’s what you can do:
1) Ask questions if you don’t understand something.
2) Write your questions down so they’re efficient to answer.
These are simple solutions, and will help us all in the long run.
In fact, I propose a new health care button for doctors’ white coats, right next to the “Ask me if I’ve washed my hands” one. How about: “Ask me… what the heck I’m saying.”