How much thought do you give to health literacy?


It’s Friday afternoon at 4 p.m., and Mr. Anderson walks into my endoscopy suite as the last patient of the day. He’s a 65-year-old publicly-insured male who presents for a screening colonoscopy. He’s 20 minutes late, because he went to registration in the surgery department. He is convinced “looking for cancer” requires surgery.

In triage, the nurses learn that he has held his Coumadin for five days as personally instructed by his cardiologist, but that he did not follow instructions for adequate bowel preparation and hence is still passing light brown stool. Upon further questioning, the nurses also learn that he did not understand the mailed educational materials on bowel preparation. Mr. Anderson has to be rescheduled. He’s frustrated. He took time off from work, stopped his Coumadin, and believes his instructions weren’t clear.

I’m frustrated too; I’m not sure if Mr. Anderson will return for the necessary screening, and from a recent talk with my administrator I recognize patient satisfaction scores and RVUs are under the microscope. What’s even more frustrating is that this could have been prevented if Mr. Anderson had access to educational materials tailored to those of low health literacy. While Mr. Anderson is a fictional example, this situation is far too common.

How much thought do you give to health literacy? It is how patients obtain, process and understand basic health information services, which enables them to make better health decisions. Populations at highest risk to experience low health literacy include adults older than 60, people with low income, racial and ethnic minorities, and those who speak English as a second language. Contrary to common belief, health literacy is less associated with standard literacy and education levels. Even more surprisingly, only 12 percent of adults are proficient in health literacy, according to the National Assessment of Adult Literacy. Therefore, even your most “educated” patients may not understand or process health information appropriately to manage their conditions.

According to NIH, health materials should be written at a 7th or 8th grade reading level; however, researchers at Drexel/Hahnemann University Hospital found that most GI patient materials on the Internet are written above an 11th grade reading level. As health care providers, we have a duty to ensure that we provide high-quality care in a way that our patients can understand, engage in the management plan and act on their own outside of our office walls.

The American Gastroenterological Association recently launched a completely revamped collection of patient engagement materials. I was pleasantly surprised to see that the materials found in the AGA PatientINFO Center were all written at the lowest reading level possible. I think these serve as a nice example for other specialties looking to help physicians improve their interactions with patients, with health literacy in mind. Though some of the materials may seem basic, they present complicated health information that is useful and actionable for our patients. Remember that just because a patient nods along to your recommendations or says they have no questions at the end of a visit doesn’t mean they are equipped to take on disease management or procedure preparation on their own. Supplying them with instructions and education materials at proper reading levels is one step we can all easily take to create safe spaces for open conversations during our limited time together.

There are a lot of misconceptions about health literacy, but its positive impact on us as physicians and on patient care is undeniable. It’s time we harness the power of health literacy, learn more and use it to empower those for whom we provide care.

Darrell M. Gray, II is a gastroenterologist and member, American Gastroenterological Association Diversity Committee. He can be reached on Twitter @DMGrayMD.

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