Tackling healthcare illiteracy is an ethical and financial issue that affects all healthcare professionals, particularly physicians under capitation and those concerned about malpractice liability. "For physicians who are at risk, it really behooves them to understand this and participate in helping to solve this problem, because it's costly to them," says Albert Barnett, M.D., medical director and chairman of the Institute for Healthcare Advancement in Whittier, Calif. "And on a moral or ethical basis, it's important, as well, that people are able to understand and follow directions."
Some physicians like Barnett are developing new tools and methods to improve patient-physician communication. Barnett experienced the costs firsthand as founder and CEO of the now-defunct Southern California Friendly Hills Healthcare Network, an integrated, physician-owned network serving 400,000 patients under contract with various health plans.
"We dealt with these problems because we were capitated and couldn't afford to have patients not follow directions," Barnett says. "The more we looked around, it seemed there was an opportunity there to help the system. Few people were dealing with the issue."
Barnett founded IHA, which provides health literacy and other consulting services for physicians and hospitals, as well as educational programs and materials for healthcare professionals and consumers. Its major activities include designing systems and providing care for disadvantaged patient populations.
"Many doctors rely on written handouts and pamphlets or on directions that pharmacies provide patients on how to take prescriptions, which all assume patients can read this material," Barnett says. "Unfortunately, the material is often written at relatively high levels of literacy-eighth grade and up. Data indicates that over one-third of English speakers and one-half of Spanish speakers have inadequate literacy skills, meaning they read at a fifth-grade level or lower."
Patients with low health-literacy skills have difficulty following even basic instructions from their physicians and are more likely to suffer acute illness and to be admitted to the hospital more frequently for longer and costlier stays, according to research reported by Robert Friedland of Georgetown University.
Toni Cordell-Seiple of Griffin, Ga., says she graduated from high school reading at about a fifth-grade level. In her 30s, she had gynecological problems that her physician said would require an "easy repair." When she was admitted for surgery, Cordell-Seiple says she signed every paper put in front of her "without reading a single word."
It wasn't until her follow-up visit, when a nurse asked how she was feeling since her hysterectomy, that Cordell-Seiple learned what she had consented to. "The doctor had done nothing wrong," she says. "We both could have communicated better. I didn't ask the questions I should have asked."
- A typical general practitioner conducts 120,000 to 160,000 patient interviews over a 40-year career.
- 66% of U.S. adults age 60 or older have inadequate or marginal literacy skills.
- 45% of all functionally illiterate adults live in poverty.
- 20% of Spanish-speaking Latinos say they do not seek medical advice due to language barriers.
- A study of 2,659 outpatients at two hospitals found a 52% increase in the risk of hospitalization for patients with inadequate literacy compared with patients with adequate literacy.