Health literacy is becoming a Georgia priority — though there’s still plenty of room for improvement. The state’s schools of medicine, nursing, public health,... Health literacy: Many patients don’t understand what their doctors mean

Health literacy is becoming a Georgia priority — though there’s still plenty of room for improvement.

Health literacy is becoming a Georgia priority — though there’s still plenty of room for improvement.

The state’s schools of medicine, nursing, public health, dentistry, pharmacy and education, as well as community organizations, are all working on improving people’s ability to understand health information so they can make good decisions about their medical care.

An estimated one in six adults in Georgia do not have sufficient health literacy.

In a Pharmacy and Therapeutics journal interview, Dr. Ruth Parker of Emory University said that “many people can’t read and understand and act on a medicine label, so we’ve started thinking: ‘What is it that we’re asking them to do, and [then asking] how good a job are we doing?’ ”

Poor health literacy among the public is the kind of weak link that can undermine even the best health care system.

Laura Hauser of DeKalb Public Library’s Literacy Services says, “We cannot assume that most people today fully grasp what health care professionals are trying to convey when giving directions and explaining medications or medical procedures.”

Health literacy is a particularly low among the poor and uneducated. But it is not simply an issue of reading ability, nor is it necessarily based on a person’s IQ. Research shows there are people from all ages and backgrounds — and all income and education levels — who run into problems because they’re unable to understand their own medical information.

The consequences can be very serious. When hospitals have to readmit patients they’ve already discharged, it’s often because poor communication caused patients to not maintain the proper care  once they got home.

According to the American Medical Association, “individuals with limited health literacy incur medical expenses that are up to four times greater than patients with adequate literacy skills.”

The economic burden of poor health literacy is estimated at $106 billion to $240 billion per year in the United States. It’s far too high a price to pay in terms of dollars, but more importantly, the human toll is staggering.


The reasons behind the rules

Take a fictional patient, Jack.

Jack’s prescription says: “Take one pill twice a day.” But he works nights, and his schedule is harried. So he swallows both pills at night to avoid taking the second one in the morning, when he may be tired and forget. That short cut may seem more convenient than following the directions exactly, but it’s a bad idea.

For many medications (such as digoxin), it’s important to maintain a certain level of the drug in the bloodstream around the clock. Otherwise the medicine may not work properly. So ignoring the instructions and taking the whole daily dosage at once is counterproductive and even unsafe.

No one explained that to Jack, or it wasn’t explained clearly. His lack of knowledge may make him the next medical emergency.

Even though he didn’t understand its importance, the language of Jack’s prescription was clear. But in some medical situations, patients are confronted by terminology they simply don’t grasp. And nowadays many Georgia residents are not native speakers of English.

Georgia has well-documented health disparities and high rates of chronic medical conditions that can be exacerbated by an inability to understand directions.

“We all are working on messages that tell people what they need to do, where to get help, and empower them to ask questions — and then deliver these messages at the point of care,” explains Kara Tarantino, director of marketing at Georgia-based Vericom Corporation, a company that focuses on health messaging. “People need information that’s easy to act on.”

Health care instructions can be tough to understand. But the rules and provisions of health insurance can be downright bewildering. And things may get worse, at least for a while, once the federal Affordable Care Act is fully implemented in January.

Attention to the readability of health documents and medication labels is critical.

“Readability is of immense importance, but so is the clarity of face-to-face interaction,” says Don Rubin, professor emeritus with the University of Georgia’s Center for Health and Risk Communication. “The trick is never to lose sight of all communication needs, even amidst all the complexity and crises of medicine.”

Research shows that patients who take part in their own health care decisions are more likely to get better faster.

Patients should speak up and say, “I don’t understand,” if the information is too complicated or is explained in terms that are meaningless to them. Every person should have the ability to receive, think about, and understand the treatment and care they will be receiving, experts say.


Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.


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Judi Kanne

  • carolynthomas

    March 27, 2013 #1 Author

    Thank you for this, Judi. It’s such an important message on so many levels, yet it seems to be widely under-appreciated (and not just in Georgia!)

    Your fictional example of Jack is a good scenario to illustrate how simple it sounds to just make sure the patient knows the difference between one pill twice a day vs two pills once a day. It’s not simple! Physicians may insist they just don’t have time to clarify this important difference at the time they write the prescription. But that is the ‘teachable moment’ for patients like Jack, and if docs are not explaining it, they’d better assign the lesson to somebody (nurse practitioner, pharmacist, etc).

    And even for patients whose health literacy is considered to be adequate, the reality may not be much better. One recent study from the Center For Advancing Health showed that a whopping 91 percent of all chronically ill patients did NOT receive a written care plan when they were discharged from the hospital. NINETY ONE PER CENT. And we wonder why hospital readmission rates are so problematic.

    As you astutely remind us, “research shows there are people from all ages and backgrounds — and all income and education levels — who run into problems because they’re unable to understand their own medical information.” Last year’s study published in Health Affairs on the “wealthy, highly educated” Palo Alto patients surveyed about their reluctance to be perceived as “difficult” patients confirmed this. That study found: “Even relatively affluent and well-educated patients feel compelled to conform to socially sanctioned roles and defer to physicians during clinical consultations” and “the fear of being categorized as ‘difficult’ prevents patients from participating more fully in their own health care”.

    That reluctance to make a fuss, to take up too much time from a busy health care professional, or to appear “difficult” can keep even the most privileged patient reluctant to ask simple questions to clarify their health care issues.


  • Sarah Smiles

    March 27, 2013 #2 Author

    Amen, Judi. I am a registered radiologic technologist, published writer, and professional speaker with a passion for health literacy. I developed a class for healthcare professionals titled, “Communicating Clearly with Patients,” and a class for the public titled, “Communicating Clearly with Your Doctor.” Poor health literacy leads to poor health outcomes and higher costs. Period. Thanks for a great article on health literacy awareness.


  • Steve Wilkins

    March 29, 2013 #3 Author

    There’s an interesting fact worth noting here…

    Research shows that the average primary care physician, when prescribing a new medication to patients, on average spend less than 60 seconds explaining to the patient why the medication is needed, how to take it, side effects, when to stop taking the medication and so on.

    Yes health literacy is an issue…but perhaps theres a bigger issue lurking here and that’s the simple fact that doctor’s don’t spend nearly enough time building consensus with patients on the need for a new Rx, what to expect from the new Rx and how to take it.

    Steve Wilkins, MPH
    Mind the Gap


  • Steve Leuck, PharmD

    April 6, 2013 #4 Author

    Hi folks: This is tremendous. How many of these patients get home with a stack of paperwork from their pharmacy. Do you think they read all of thei information. How many of these people would learn better by listening. Take a look at this recent interview with AudibleRx and see how “medication information you listen to” may be just what these people need to have a better outcome with their pharmaceutical therapy.


  • Sulis Anes

    June 21, 2013 #5 Author

    Thanks judi,good n helpfull information…


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