From the Chief Medical Officer’s Desk
by Dr. Dave Edwards
“The greatest problem in communication is the illusion that it has been accomplished.” -Daniel W. Davenport
A recent article in the NEJM’s Perspective section (N Engl J Med 2010; 363:2283-2285 December 9, 2010) focuses on one of the weakest links in the health care chain, American’s health literacy. For years, attempts have been made to improve our patients’ understanding of their own health, illness and options. Yet time and time again, we see patients who are readmitted or whose outcomes have been less than optimal because of their lack of understanding of our instructions and their disease. There have been several attempts to improve the health care literacy of the US population, but by and large they have not been successful.
Studies support what we intuitively know, that worse health care outcomes are associated with lower health care literacy rates. It is becoming clear that it is up to health professionals to make sure the information we provide patients and their families is accurate and, more importantly, useable. This is a daunting task as half of the American population has difficulty using commonly printed material to accomplish everyday tasks. In fact, if you look at the health care information we commonly provide patients, it is written at a reading level above a high school graduate. Some research has suggested that this material should be at an 8th grade level. More research is being focused in this area as it is being viewed as a critical factor for health care reform.
So what can we do right now? Ask your patients if they have someone else to help them read health care information. Those who request assistance need special attention and help with their instructions. Use the technique of teaching back, where the patient tells you in their own words what they understand you have been telling them. Keep instructions simple. For example, tell the patient to watch for a 20 pound change rather than 10 percent of their weight. These simple things can really make a difference.
I have no doubt that research will help us in this important area. But until then remember, "What we've got here is...failure to communicate." The Captain in Cool Hand Luke (played by Strother Martin)