Patients don’t always understand what doctors and other health care providers tell them — and that’s a problem.
“As physicians, we tend to use a lot of jargon when we talk to patients,” says Jared Magnani, MD, a cardiologist at the UPMC Heart and Vascular Institute. “For instance, we might use the term ‘diet’ to mean overall caloric intake, while a patient might associate that word with a plan to lose weight. Or, we tell them a biopsy was negative without really explaining what that means.”
The way symbols and significations become meaningful communication is largely a subconscious process. They are part of our everyday lives. When done right, their messages are automatically apparent to us. Hot water comes out of the red tap, cold from the blue. That sounds simple, but the automatic decoding that goes on in our minds (and how the information came to be coded that way in the first place) is complex.
Language is related to this system of communicating using spoken, visual and written symbols. When language is used poorly, the message is improperly coded — and delivered. Just like in molecular biology, a signal has to be properly sent and received at each stop along the pathway to get to the right outcome. If there’s a disconnect, the message is garbled, and communication breaks down.
Dr. Magnani recently chaired a scientific statement on health literacy published by the American Heart Association (AHA). The takeaway? Informed patients — those with a high level of health literacy — have a reduced risk of cardiovascular disease and related factors such as high blood pressure, obesity, and diabetes.
“As physicians and scientists, we tend to focus on practical matters: What is making our patient sick? How can we fix it? Biology and chemistry come first in our minds, and although we do our best to interact with our patients in ways that foster productive communication, we don’t always succeed,” says Dr. Magnani.
“Plenty of very smart patients don’t understand basic information about their own health. As doctors, we have to work on our communication skills to ensure our patients have the tools they need to thrive.”
What Is Health Literacy and Why Is It Important?
Health literacy — the ability to find, comprehend, and use basic health care information to make informed decisions — has been a concern for decades. It’s needed to understand basic health care information, from healthy diets and blood pressure readings to insurance coverage.
Dr. Magnani and his fellow researchers learned that health literacy is lacking in the United States. According to a U.S. Department of Education survey cited in the AHA statement, more than a third of our nation’s adults have only a basic or below-basic health literacy — they don’t read nutrition labels or ask their doctor to explain complicated medical procedures. Only 12 percent of Americans have the health literacy skills needed to navigate the health care system.
As medicine becomes more complex and more reliant on technology, health literacy will become increasingly more important. Patients need to know how to research their conditions and connect with online communities. Telemedicine requires informed participation; advanced procedures need jargon-free explanations that people can comprehend. Everyone involved in health care must be committed to health literacy to ensure clear communication with patients.
What’s Holding Us Back?
There are three basic challenges to health literacy, according to Dr. Magnani. One is tech literacy, or the ability to use computers to access information. Next is prose literacy, or the ability to understand written or verbal information.
The third is document literacy, or the ability to make sense of confusing medical documents. “A good example is the informed consent form,” says Dr. Magnani. “It was developed to protect people and inform them of risks. But it can be very hard to understand.”
As detailed in the AHA statement, health literacy is related to socioeconomic position, English language proficiency, and general literacy. A person’s age and cultural background also play a part.
Dr. Magnani relates a personal story of his diabetic aunt, a college-educated woman in her eighties who had trouble using her glucometer. “She was a very smart person, yet she was not able to use the equipment appropriately at home. The instructions were a barrier to her.”
Improving Health Literacy
First and foremost, says Dr. Magnani, health practitioners and organizations should make health literacy a priority. “They need to make information accessible, so that no matter what a patient’s background or reading level, they get it,” he says. For medical device manufacturers, that may mean writing clearer instructions using special software to assess and improve readability for a specific reading level. For patient experience executives, it may mean analyzing hospital materials for accessibility and ease of use. For everyone involved in health care, improving health literacy means avoiding jargon and communicating in plain language.
The old advice to “meet patients where they are” also applies. According to the AHA statement, neighborhood and school-based educational programs are good places to start. If there’s a blood pressure screening scheduled in the community, get the word out at neighborhood hair salons, houses of worship, schools, and community centers.
For doctors, Dr. Magnani recommends the “teach back” method. “You simply ask the individual to paraphrase what was said and repeat it back to you. It’s simple to do in an office visit and after a while, it becomes an expectation on the patient’s part,” he says. A simple “tell me more” also encourages patients to relay information in their own words.
UPMC is paying attention to health literacy with the MyUPMC portal and other ways of communicating with patients, says Dr. Magnani. “UPMC really appreciates that health literacy needs to be universal.”