Video transcript
Have you seen the news about an alarming research finding by the Innovation Center of U.S. Dairy? According to a survey by the center, an astounding 7 percent of American adults think that chocolate milk comes from brown cows. That’s more than 16 million people. And they’re not kids, but grown-ups. Further, 48 percent of those surveyed – roughly half – admitted to being unsure about the source of chocolate milk.
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Okay, before we ascribe this discovery to lack of education or to naïve city slickers who’ve never set foot near a cow patty, let’s address a similar issue in healthcare. In a seminal study the U.S. Health and Human Services department found that a mere 12 percent of Americans have what’s defined as proficient health literacy – the ability to obtain, process and understand basic health information and services needed to make appropriate health decisions.
The feds go on to say – and I quote – “even people with strong literacy skills can face health literacy challenges such as lack of familiarity with medical terms and how their bodies work, and having to interpret numbers and risks to make a healthcare decision.” I repeat: people with strong literacy skills can’t adequately process basic health information. In addition, about one-sixth of Americans have a communications disorder or difference resulting in unique challenges. And these limitations cut across all racial and ethnic lines, says Uncle Sam.
Wait, it gets worse. The HHS department says that more than one-third of U.S. adults have difficulty with common health tasks, such as following directions on a prescription drug label. Now, if 1 of 3 adults can’t fully read a pill bottle, we’ve got problems galore. For millions of patients, under- or over-medicating can be life threatening.
How to help patients better understand health information
So let’s summarize a few techniques for better education and communications with healthcare consumers. You may be familiar with some; perhaps not with others.
Firstly, patient communications are a team sport and by no means the sole responsibility of physicians or even clinical staffs. Every member of every healthcare staff is responsible for guiding patients with effective communications. To better orient your staff in this direction, I refer you to the website of the Agency for Healthcare Research and Quality (AHRQ), a superb resource overflowing with guidance on health literacy. Also, the online survey company Survey Monkey has developed an excellent self-evaluation tool in collaboration with the AHRQ, with 51 questions to support team efforts in improving patients’ health information understanding. I suggest you check it out, too.
Secondly, for clinicians specifically, it may be wise to initiate patient visits with open-ended questions rather than those that can be answered with a “yes” or “no.” You’re likely to unearth more actionable information by asking a patient first to describe her problem and what may have caused it rather than starting with yes-no inquiries about pain, appetite, sleep, fatigue and so on.
Thirdly, periodically verify you’re being heard. One way is to strive to listen as much as talking. As the saying goes, God gave us two ears and one mouth for a reason. In this spirit, many clinicians are followers of the teach-back and show-back methods. The idea is to ask a patient in a non-patronizing manner to repeat or demonstrate on an anatomical model what she’s just heard or seen a doctor say or demonstrate. Because patients are often too agitated to take in everything, one clinician suggests a clever test of a patient’s attention: He hands patients written information upside down while discussing it and observes whether each patient turns it right-side up.
Simplify your communications so it sinks in
Fourthly, proficient communicators don’t rely on spoken words alone. Rather, they use graphics, pictures and models as much as possible. Additionally, don’t hesitate to refer patients to trustworthy websites and other outside information sources, preferably furnished in printed or hand written form for the patient to take home. My own primary care physician keeps a collection of homemade flyers and fact sheets in his exam rooms; these allow excellent opportunities for citing reliable websites.
Above all, I would count on almost no one hearing complex medical information for the first time and remembering it perfectly accurately, especially under clinical duress. Particularly if you’ve just given a patient a life-threatening diagnosis such as cancer or end-stage organ failure, lower your expectations on what the patient will hear next – which is probably nothing or next to it.
Most of all, use plain English. Say bruise instead of contusion, fats instead of lipids, high blood pressure instead of hypertension. There’s no shame in choosing words that people of all ages and all educational levels understand. To the contrary. Albert Einstein is credited with the saying, “If you can’t explain it simply, you don’t understand it well enough.” Some of the greatest intellects in history – Churchill, Lincoln, Galileo, René Descartes, Frederick Douglas and Frederich Nietzsche – are famous for pithy quotes that a third-grader would understand.
Finally, for compelling evidence of the importance of two-way communications, consider that a special committee of the AMA found health literacy to be a stronger predictor of health outcomes than social and economic status, education, gender and age. For this reason, I leave you with my stated conviction that clear communications aren’t just a healthcare courtesy – they’re a life-enhancing and often life-extending essential.