Patients who have trouble understanding, or acting upon, the information as it relates to their health are more than twice as likely to die.
So writes Pauline Chen in recent column, where she writes about how patients need to take a more active role understanding their health. It’s indeed a big problem, especially given the trend towards a more patient-centered orientation for medical care.
But, that means doctors need to spend the time with patients to guide them through the shared decisions. And that is something in short supply as the pressure to see more and do more continues to be ratcheted up.
Sure, there are plenty of techniques to ensure patients understand, such as asking them to “teach back” what they were just told, and encouraging them to pro-actively approach medical staff if they don’t understand their instructions completely.
But, if the system discourages doctors from spending the requisite time to implement these solutions, the hurdle in trying to improve the public’s overall health literacy becomes very tall.
Related posts:
- Should private insurers be kept in the health reform mix?
- Health literacy is at an all-time low
- Theater and medical education
- The FDA tries to practice medicine
- Reader take: Moral hazard, and whether patients should consider cost in their health care decisions
- A cost-effectiveness analysis
- Failure to communicate
{ 6 comments }
When I graduated from residency I was told no one will listen to you when you tell them to quit smoking. No one will listen to you when you ask them to be compliant.
But that is not true. Patients do listen. Most of the time they do not do what we tell them to do is because they don’t understand why?
I have spent 30 minutes of talking time with hardcore non – compliant patients. I told them the dirty details of everything that can happen to them if they do not take their medications. I even mentioned death. It had amazing results. They have become one of the most compliant patients of mine. Those were the most effective thirty minutes of treatment I ever gave.
I have failed also. Despite numerous thirty minutes of discussion I could not get an alcoholic to stay quit and he eventually died.
But patients do listen and follow. We need three things:
1) Get patient’s trust by not rushing them.
2) Show genuine concern
3) Be direct about consequences with no wishy washy sugar coated pill
4) Talk in a language they will understand.Just as in marketing – explain benefits not just features.
” This cholesterol pill will make your cholesterol go down so you will not have a stroke. That way you will not get paralyzed, unable to move in a nursing home.”
There will always be a few who will continue to harm themselves (smoking comes to mind), but most everyone else are very aware of their interests in staying healthy, financially solvent, etc., sometimes helped by family and friends. Information is readily available today, mainly on the internet, for people to refer to. ‘Limited literacy’ may be a catchy phrase inside The Grey Lady, along with overwrought concern about imagined failures of ‘the system’, but not indicative of anything in particular.
Chuck Brooks
FutureWare SCG
You hit the nail on the head! I talk about this issue a great deal and it is complex, indeed. For us to do a better job with patients and teach them to be better advocates for themselves, we need more time – plain and simple. At the same time, patients need more community supports to understand the complex health world and build the skills they need to work with “Dr. Google” and the health system at large. This isn’t just about health literacy – it starts to involve computer literacy, media literacy and reading literacy. This is where the rubber meets the road. As physicians, we should be pushing for whatever system changes are necessary for our patients to get the supports they need on all levels.
This a big problem as with lack of computer literacy, so goes health literacy too sometimes as so many don’t read. That’s not the entire solution I know, but a start.
The Gates Foundation is “paying” Viocom to run ads and perhaps expand some knowledge there too. Usually foundation have to wait for charitable time given to promote education, but they are paying for the time with ads and information related to healthcare.
Doctors can only do so much with the limited time and exposure with a consultation and there’s no control over how much soaks in.
http://ducknetweb.blogspot.com/2009/04/gates-foundation-and-viacom-team-up-for.html
gee seems like THE perfect role for mid levels.
I was one of those health illiterates who pretended to understand but didn't until I decided to take health matters into my own hands.
You have to realize that the majority of the population have limited or no knowledge about the anatomy & physiology of the human body. If you tell a patient that he or she has bronchitis, that patient's mind is set to think that you will prescribe antibiotics to get rid of the problem.
That patient will not think about the inflammatory effects that just occurred or about how much neutrophils, basophils, etc., just got wasted to fight this infection.
Patients don't think this way because they don't see the whole picture. They don't know that as we age, the thymus atrophies, which means that the immune system will not be as good as before. And getting too many bronchitis "could" possibly wear out the immune system faster than it was intended for.
Personally, I doubt the issue of health ill-literacy will ever be resolved because most patients are unwilling to learn beyond anatomy & physiology. And most doctors do not have time to give lengthy lectures.
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