Do Patients Understand?

Background Communication barriers often go undetected in health care settings and can have serious effects on the health and safety of patients. Limited literacy skills are one of the strongest predictors of poor health outcomes for patients. Studies have shown that when patients have low reading fluency, they know less about their chronic diseases, they are worse at managing their care, and they are less likely to take preventive measures for their health. However, patients do not need to have limited literacy skills to have low health literacy. The Institute of Medicine defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Limited health literacy is a hidden epidemic. It can affect health status, health outcomes, health care use, and health costs. The entire health care system relies on the assumption that patients can understand complex written and spoken information. Patients are expected to navigate a complex medical system and then manage more and more of their often complex care at home. If they do not understand health information, they cannot take necessary actions for their health or make appropriate health decisions. The 2003 National Assessment of Adult Literacy found that nearly half of the US population has inadequate literacy. These individuals cannot use instructions on a prescription drug label to determine what time to take that medication. Individuals classified as having low literacy skills cannot locate an intersection on a map or calculate the total cost of purchases on an order form. After years of education and training, physicians find themselves in the small minority of the population with high-level literacy skills. They may often unknowingly present health information at a literacy level higher than their patients can grasp. Additionally, medical training comes with its own vocabulary that can further encrypt health information presented to patients. For the health and safety of patients, the gap between the literacy of clinicians and that of their patients must be bridged to achieve effective communication and understanding. It is important to recognize that there are individuals with adequate literacy who still may have difficulty understanding written and spoken health care information because of the medical terminology and jargon that is used in the health care environment. Individuals with limited health literacy are at risk for error and poor health outcomes. They have trouble understanding medication instructions, appointment reminder forms, informed consent, discharge instructions, and health education materials. This leads to lack of adherence to medication regimens; missed primary care appointments, laboratory tests, and referral appointments; and lack of proper health self-management. Such actions may appear to be noncompliance but may instead be the result of limited health literacy. Patients with limited health literacy often end up back in a physician’s office with more serious conditions or, worse, in the Emergency Department (ED). Low health literacy costs the US health care system up to $73 billion annually. Corridor Consult