Doctors concerned with patients' health illiteracy


By Sarah Stanton
Arizona Daily Wildcat
Monday, March 8, 2004

One of the biggest problems facing patients today isn't high blood pressure or arthritis, but a lack of health literacy, officials say.

Doctors and health advocates say patients often cannot understand the medical information given to them by their doctors and the media.

A conference at University Medical Center this weekend titled "Health Literacy, Medical Ignorance and the Media: The Central Role of Questioning" tackled the topic.

On Friday, in front of an audience of about 50, a panel of physicians and teachers discussed the communication problems that exist in the examination room.

A video by the American Medical Association stated that the average American reads at an eighth-grade level, but medical information is usually given to patients at a college-graduate level.

This discrepancy causes confusion, embarrassment and sometimes life-changing consequences, panelists said.

The AMA video featured patients whose health illiteracy had led them to misunderstand their doctors.

One woman in the video signed all the papers her doctor gave her even though she couldn't read them. She was too embarrassed to ask what the papers said.

The woman had a hysterectomy and didn't find out until after the operation.

Panelists said health illiteracy can be caused by an inability to read, cultural differences and fear.

"Fear causes illiteracy; if someone is fearful, they can't take in any information," said Dr. Robert Root-Bernstein, a professor of physiology at Michigan State University.

Mary Brown, an adjunct lecturer of communication at the UA, echoed those sentiments.

"Even those of us who are articulate and capable in other areas cannot get our needs met in health care because of things like fear," she said.

The panelists said overcoming health illiteracy is the responsibility of both the doctor and the patient; both should ask questions to ensure that everything between them is understood.

"Explain everything that happened, and answer any questions before you turn them loose," said Dr. Robert Moser, a former editor of the Journal of the American Medical Association who lives in Green Valley.

The AMA suggests that doctors use simple language and visual aids to help patients understand their diagnoses.

Moser said the first five minutes of a patient's initial visit are essential to building a doctor-patient relationship.

"It's a time when you are able to identify the educational, intellectual and cultural nature of the patient. It's a time when patient and physician, communicating one-on- one, get to know each other," he said.

Moser said limited time is a constraint that can hinder that process.

"The problem is time. I've heard the initial visit with a patient lasts an average of 13 minutes," he said.

Another problem several panelists addressed was the lack of training for medical students in how to communicate with their patients.

Dr. Zell McGee, a professor of medicine at the University of Utah, said doctors need to encourage their patients to ask questions.

"We should teach doctors how to elicit questioning behavior on the part of the patient," he said.

McGee added that doctors should try to make their patients feel comfortable.

"Patients shouldn't be intimidated; they shouldn't feel like they have to cover up their lack of understanding," he said.

Cultural differences can also cause miscommunication between doctors and their patients, according to Moser.

Amy Milsom, a teacher at Rio Rico High School, said one of her Hispanic students came to her because she didn't understand the diagnosis her doctor had given her.

The student said her doctor told her she had "leukemias in her blood." The student had no idea what leukemia was, and her parents didn't speak English.

"These people don't have any idea how sick they really are," Milsom said.

The doctors said medical education should focus on how to deal with people of different cultures.

"We tend to impose our version of quality of life on a patient, especially those who are terminally ill," Moser said.

But the panel agreed that there are positive aspects of health care.

"There are doctors who take time, express kindness and don't intimidate their patients," said Moser, adding, "They mean to do well."