"The problem of health literacy is widespread and goes beyond those who can't read or those who don't speak English." P Weiss Chairman of ACOG Committee on Patient Safety.
Here is the US Department of Health and Human Services Quick Guide to Literacy:
- Tailor speaking and listening skills to individual patients. Use open-ended questions starting with the words "what" or "how," and use medically trained interpreters when needed. Especially during the informed-consent process, but also in general, check patients' comprehension by having them restate the health information given in their own
- words. Encourage staff and colleagues to use culturally sensitive plain language to obtain training in improving patient communication.
- Tailor health information to the intended user by ensuring that it reflects the target group's age, social and cultural diversity, language, and literacy skills. Include the target group in the development (pretest) and implementation (posttest) phases of developing information and services to improve effectiveness of the program. Consider cultural factors, including race, ethnicity, language, nationality, religion, age, sex, sexual orientation, income level, and occupation when preparing health information.
- Develop written materials conveying no more than 4 simple messages per handout. These materials should focus on action and give specific recommendations based on behavior rather than on the underlying medical principle. Use the active voice instead of the passive voice, use familiar language, and avoid jargon. Use culturally relevant visual aids such as drawings or models for key points, use 12-point type size or larger, and leave sufficient white space around margins and between sections.
In general, I am not opposed to any of these and completely agree that it is important for patients to understand fully their choices. But, I, who consider myself literate have a hard time comprehending how one of the items they suggest is even remotely manageable. The suggestion to develop written materials conveying no more than 4 simple messages per handout - sounds easy enough - but contrast this with what the Texas State Medical Board requires when informing patients about non-conventional treatment:
(2) Disclosure. Prior to rendering any complementary or alternative treatment, the physician shall provide information to the patient that includes the following with the disclosure documented in the patient's records:
(A) the objectives, expected outcomes, or goals of the proposed treatment, such as functional improvement, pain relief, or expected psychosocial benefit;
(B) the risks and benefits of the proposed treatment;
(C) the extent the proposed treatment could interfere with any ongoing or recommended medical care;
(D) a description of the underlying therapeutic basis or mechanism of action of the proposed treatment purporting to have a reasonable potential for therapeutic gain that is written in a manner understandable to the patient; and
(E) if applicable, whether a drug, supplement, or remedy employed in the treatment is:
(i) approved for human use by the U.S. Food and Drug Administration (FDA);
(iii) a pharmaceutical compound not commercially available and, therefore, is also an investigation article subject to clinical investigation standards as discussed in paragraph (7) of this subsection.
All of this seems incredibly reasonable and patients should absolutely know what they are choosing - but physicians can't do both - they can't be simple and thorough. To the rescue, the English teacher who may or may not have certification in ESL - the one who was taught that the general population doesn't read above the 8th grade level (no matter how much money we throw at our public school system). And regardless of the amount of time and money you spent on your own education - the physician or teacher should never assume that you can think past the end of your nose.
My remedy - Those that are choosing to go into the healthcare field should be matched with a spouse that has an English Teaching degree with a focus in grammar and technical writing. This should not be optional. It will be an arranged marriage of sorts - that way we can make sure that all patients receive their medication and can read the prescription too.