An elderly woman sent home from the hospital develops a life-threatening infection because she doesn’t understand the warning signs listed in the discharge instructions.
A man confused by an intake form in a doctor’s office reflexively writes “no” to every question because he doesn’t understand what is being asked.
A young mother pours a drug that is supposed to be taken by mouth into her baby’s ear, perforating the eardrum.
And a man in his 70s preparing for his first colonoscopy uses a suppository as directed, but without first removing it from the foil packet.
These are not isolated events.
A 2006 study by the U.S. Department of Education found that 36 percent of adults have only basic or below-basic skills for dealing with health material. This means that 90 million Americans can understand discharge instructions written only at a fifth-grade level or lower. About 52 percent had intermediate skills: They could figure out what time a medication should be taken if the label says “take two hours after eating,” while the remaining 12 percent were deemed proficient because they could search a complex document and find the information necessary to define a medical term.
Studies have linked poor health literacy, which disproportionately affects the elderly, the poor and recent immigrants, to higher rates of hospital readmission, expensive and unnecessary complications, and even death. A 2007 study estimated the problem cost the U.S. economy as much as $238 billion annually. This problem will become even more severe in 2014 when tens of millions become insured.
The Joint Commission, which accredits hospitals, is requiring them to use plain-language materials and to “communicate in a manner that meets the patients oral and written communication needs” in providing care. For example, instead of “myocardial infarction”, use heart attack; instead of “febrile”, use fever; replace “hyperlipidemia” with high cholesterol. Doctors are also encouraged to replace “diet” with food; many folks when they hear diet believe doctors want them to go on a diet. It is also recommended replacing “exercise” with walking. In this case when patients hear exercise they believe they have to go to the gym. Replacing ”medicalese” with plain language will save lives.
If you want to be sure you’re getting the right care, you have to be able to understand instructions. If you don’t understand, speak up! Don’t be embarrassed; you’re not alone. These are life and death situations. There is no room for embarrassment.
Jeffrey I. Kreisberg served on the faculty the University of Texas Health Science Center at San Antonio where he was a Professor of Pathology, Medicine, Surgery, Urology, and Molecular Medicine. He is the author of Taking Control of Your Healthcare.
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