One of the most important things I try to keep in mind as a physician is health literacy, or the degree to which patients can obtain, understand and process basic health information. This idea may seem arbitrary at first, but try to remember your last visit to a physician: It may have been in an emergency room or a walk-in clinic, or perhaps your primary care doctor or specialist might come to mind. Was there a point during your visit when you didn't completely understand information that was provided to you? Did you leave the building with questions unanswered? If you later decided to look up those questions on the internet, were you unsure about which resources to use?
If so, you're not alone: the National Assessment of Adult Literacy previously reported that 88% of American adults do not have competent health literacy skills. This number is disturbing, since low health literacy has been correlated with poor personal health knowledge, poorer health status, incorrect medication use and higher rates of hospitalization. I've heard countless stories of the most extreme cases of poor health literacy: one patient placing her birth control pill in her vagina, another spraying an albuterol inhaler in front of his face and attempting to "suck the air in." Yes, of course, these are extreme cases, but for every one of these there is another occurring much less conspicuously.
Consider a situation where a well-educated female is prescribed tetracycline, an antibiotic, to clear her acne. She fills the prescription and, upon taking the first pill, experiences extreme gastrointestinal (GI) upset. As a result, she refuses to take the medication again. This is a relatively common situation that could have been easily avoided. If the prescribing physician or the pharmacist had taken the extra few seconds to inform the patient not to take the pill with dairy food, the stomach discomfort (a major and well known side effect) could have been avoided.
Health literacy does more than save time and money- it can also play a major role in preventing further injury or illness, or even death. Have you or a loved one experienced a healthcare-related situation where you felt misinformed, unaware or uncomfortable? Have you ever started a fad diet, supplement or activity that was later deemed unhealthy? I invite you to please share your story in the comments below.
You haven't been in school for 11 years receiving medical training, and professionals understand this. But, with doctors now being forced to see more patients just to keep their practices afloat, they typically won't take the time to explain specific concepts and instructions unless they are prompted to do so. So, what can you do to improve your health literacy before your next visit?
- Don't be afraid to request that your doctor take a moment to explain a drug, prescription, blood test result or diagnosis.
- Know the specific function of each medication you are taking (i.e "this is my blood pressure pill, this is my water pill.") If unsure, don't be afraid to ask.
- Use trusted resources when seeking answers to your health questions at home. I've included several reputable resources on our website.
- Keep in mind that your physician is here to help you. He or she will never get upset or offended that you are asking for clarification.
- Continue to follow The Daily Diagnosis, as we will keep you informed by consistently adding healthy living tips and opinions on the latest topics in healthcare.
References
Grossman S, Arabshahi F, Gunter D, Harrell G, Patel S, Schaap S, Quest TE.Chapter 218. Psychosocial, Cultural, and Spiritual Aspects. In: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS. eds. Principles and Practice of Hospital Medicine. New York: McGraw-Hill.
Health literacy and public health: a systematic review and integration of definitions and models. Sørensen K - BMC Public Health - 01-JAN-2012; 12: 80.
Literacy, cognitive function, and health: results of the LitCog study.
Wolf MS - J Gen Intern Med - 01-OCT-2012; 27(10): 1300-7
Low health literacy: a barrier to effective patient care.
Seurer AC - S D Med - 01-FEB-2013; 66(2): 51, 53-7
Dr. Joseph,
ReplyDeleteI am a philosophy/psychology major at Bowling Green University and I am writing a research paper for a course in Medical Ethics. I stumbled upon your website and it practically zeroes in on the exact issues I will be trying to explore. Your references are great as well and have given me a great springboard to continue my research. I did have a couple questions if you have the time (I actually have many more but I don't want to go overboard lol). First, do doctors have any sort of professional obligation (maybe from the American Medical Association?) to disclose drug interactions like the one you described in your post? Or is the pharmacist the person who is supposed to do that? Second, do you think health literacy and actual literacy are correlated? I would think if a person can't read they would have difficulty, you know, reading about the drug and its side effects and interactions and dosages. And this wasn't one of my important questions but I'm just curious, don't they make birth control pills that females can insert directly into their vaginas? I thought I had read in a medical journal that they made vaginal entry pills now. Anyway, thanks for the article, it was extremely informative. I'll definitely be stopping by again to see what else you have to offer. Thanks.
Hello Richard,
DeleteThank you for your comments and concerns. To answer your question, physicians absolutely have a professional obligation to discuss the proper administration, dosage and associated adverse effects of any medication that they prescribe. While the pharmacist is certainly very knowledgeable and willing to answer questions regarding medications being filled, they are not required to discuss anything unless prompted. In response to your question regarding literacy, I absolutely believe it is related. Actually, there exists a list of questions physicians are encouraged to ask during a first encounter for early identification of poor literacy. A point I'd like to stress is that even well-educated, literate individuals can struggle with health literacy. Lastly, I should specify that the female patient in this case attempted to use a contraceptive pill designed and tested for oral use. Vaginal contraceptive methods do exist, but to my knowledge there are currently no contraceptive pills designed for insertion into the vagina. Thank you again for your continued support!
Dr. J
Dr. J,
DeleteThank you for actually taking the time to respond. I am sure you are very busy! Your answers were extremely helpful. I was trying to think of where I had read about the vaginal pill issue (since I remember coming across it during my research) and I think it was here:
http://goaskalice.columbia.edu/birth-control-pills-inserted-vaginally
But it wasn't a pill designed for the vagina, I just didn't remember it correctly. But it's interesting that maybe the oral pills work even if you put them in the vagina, so maybe that girl that wasn't health literate got lucky lol!
Your point about well educated people still suffering from health illiteracy is one of the central theses of my research paper. But your example about the well educated girl with the gastrointestinial upset is an interesting scenario to analyze. Like you said, all it would have taken is a few words of warning from the doc or pharmacist cautioning her to avoid dairy. So is the problem really that she's not "health literate" or that her doctor and pharmacist didn't provide a key and easily explainable piece of information? It almost seems like their failure to provide the relevant information is to blame rather than the patient's inability to process or understand it. What do you think? Thanks for the help, Dr. J!
Hello Richard,
DeleteThank you for sharing. I've heard similar claims regarding the oral contraceptives, but have not seen any concrete studies to back up such claims with any significant findings. An important point to remember is that even the well educated patient such as the female in question shouldn't be expected to know the same amount of medical information as the physician. The responsibility falls on both parties- the physician should take the time to be sure they're on the same page and, likewise, the patient should be effectively communicating any lack of knowledge, misunderstandings or concerns.
Dr. J