Checking up on health literacy


“Hypersensitivity reactions including the following: skin eruptions (maculopapular to exfoliative dermatitis), urticaria, laryngeal edema, fever, eosinophilia; other serum sickness-like reactions (including chills, fever, edema, arthralgia, and prostration); and anaphylaxis including shock and death.”

The above snippet is brought to you by penicillin G benzathine, and as a physician, most of that is probably a breeze to comprehend.

As a patient, a layperson to the medical world, I can also parse out without too much difficulty what most of that label is telling me. I’ve had fevers; from the phraseology of "skin eruptions" I can put together a pretty robust picture of what could be happening there. Skipping over urticaria, laryngeal edema, eosinophilia, other serum sickness-like reactions, and arthralgia like conjugations in Latin class, I’m left with shock and death.

Literally. Now I’m terrified, and I’m not the only one.

Health literacy and understanding doesn’t start and stop at the medication scrolls stapled to those white pharmacy bags either — this is a problem that arrives at the point of care and stays long after discharge and at some interval, it’s an issue for everyone.

According to statistics from the National Assessment of Adult Literacy, “approximately 36 percent of adults in the United States have limited health literacy — 22 percent have Basic and 14 percent have Below Basic health literacy. An additional 5 percent of the population is not literate in English…and…only 12 percent of the population has a proficient health literacy level.”

In a commentary for the American Academy of Family Physicians, Javette Orgain, MD, MPH, vice speaker for the AAFP, spoke to the widespread detriment at hand: “If patients don't understand us, how can we possibly expect them to follow our instructions? This massive shortcoming puts patient safety at risk, jeopardizes our patients' quality of life and adds costs to the healthcare system. According to the NIH, health literacy — or lack of it — costs our nation up to $236 billion a year.”

What’s more, general education levels are only a fraction of why health literacy is persisting. Orgain notes that only 30 percent of those who have received a bachelor’s degree or higher were considered proficient.

Obviously, it’s a massive medical conundrum, but one physicians don’t have to feel helpless to.

“One easy, critical step to gauge the level of health literacy in our practices is to include the following question on patient history forms: 'How far did you go in school?’ Then include check boxes so patients can indicate the appropriate grade level. It should be a standard question, and we need to teach our medical students and residents to ask it,” Orgain suggests.

Next, practice the art of teaching back: “Ask patients, ‘Do you understand what is being said?’ Teaching back is vitally important, not only for students and residents, but for all healthcare professionals. At least 40 percent of information patients receive is forgotten soon after an appointment, and roughly half of what they do remember is inaccurate. The brief time it takes to ask a patient to repeat the instructions you have given them can make a huge difference in compliance and outcomes.”

Sending word over to physician organizations and lawmakers regarding health material requirements — specifically, that all health materials should be written at a fourth-fifth grade reading level rather than an eighth grade reading level, as is the case now — can also make a difference.

Lastly, making sure that as a physician, you are educated on health literacy and its effect on patient engagement is a must. Click through some of the resources below to get up to speed on the latest tactics and stats:

  • FamilyDoctor.org
  • National Network of Libraries of Medicine
  • NIH: Talking to Your Doctor
  • AMA: Help patients understand
  • HHS: Health Literacy