When a doctor can’t explain their patients' diagnoses and treatments in plain language, people suffer.
Poor health literacy -- a patient’s inability to understand health information – was first linked to poor health a decade ago. People who find their doctor’s advice confusing don’t manage their chronic diseases as well and are more likely to wind up hospitalized; among the elderly, the death rate is higher.
The public budget also suffers when patient and doctor don’t understand one another: in California low health literacy predicts lack of medical insurance, according to a first-of-its-kind survey published in the May issue of Health Affairs. Regardless of ethnicity, income or availability of employment-based insurance, if someone can’t understand their doctor or their pharmacist, they are less likely to have medical insurance. At the national level, health care expenses are increased three to six percent [pdf] by low health literacy; of that increase, 66 percent is public money, either Medicaid or Medicare.
Health literacy is also correlated to other types of literacy -- almost one in four California adults cannot use written English at a basic level. That means more than nine million people and their children are at increased risk of missing out on important health screenings, and are more likely to wind up in the emergency room.
With such a pervasive problem, improvement will likely result from a mix of approaches rather than a single magic bullet. Several strategies have proven effective. For example, patient education is more successful when the essential information is presented first and with a minimum of distraction. Another successful strategy, called “teach back,” increases comprehension during appointments. Patients “teach back” by using their own words to explain what they just heard their doctor say. This gives the doctor a valuable opportunity to correct misunderstandings.
But “teaching back” takes a little longer, and physicians are under pressure to adhere to a schedule of appointments. Nearly a third of doctors in a recent survey admitted that their own inability to convert medical jargon into “plain English” creates a problem for their patients.
“Physicians have limited time to devote to patient education,” and their capabilities vary, said Lourdes Baezconde-Garbanati, in an interview. Baezconde is the director of patient education at the USC Norris Comprehensive Cancer Center.
Another way to boost retention is adding video to verbal narratives, according to the Agency for Healthcare Research and Quality. Baezconde and Associate Professor Sheila Murphy of the Annenberg School for Communications are studying if a short narrative film can teach women about cervical cancer screening better than a more traditional “talking heads” program.
Routine screening makes cervical cancer a highly preventable cancer in countries like the US, but American Latinas are nearly twice as likely to be diagnosed and to die of the disease. The researchers also knew that health literacy is generally lower among the elderly, ethnic minorities, adults who spoke a language other than English before starting school, and people living in poverty. With those things in mind they worked with professional filmmakers to create Tamale Lesson (excerpt): a frank, multigenerational discussion about Pap smears that takes place among Latinas working together in their kitchen. The script includes key points such as where the test is available and at what age a woman should start getting it.
Tamale Lesson is designed to be used in multiple ways: individually and in small groups, onsite in clinics and out in the community. Although the story is about a Latino family the video has also tested well with non-Latinos. Early findings indicate that Tamale Lesson does in fact lead to better retention of information than a video without a story.
Baezconte and Murphy believe the storytelling approach may be particularly effective. They wrote: “The power and perseverance of a narrative or story structure has been recognized and utilized for thousands of years.”
Ultimately, Baezconde said, the goal is for people to understand and remember the information their physicians provide.
Eve Harris is a Bay Area writer. Check out her health blog, A Healthy Piece of My Mind.