Our health literacy is at the center of healthcare changes the whole country may face very soon. Do you dread going to the doctor? Dread can come from not understanding the process. Do you mistrust the healthcare system? Mistrust follows on the heels of dread, when processes are not understood.
A new Institute of Medicine, IOM expert workshop summary about the language of US healthcare came out on Feb 14th, 2012. The group of experts asked: What can we do to improve communication? Our healthcare systems in the US are changing. Experts think that millions of new patients will be coming in for care. New patients face a world of difficult choices, complex procedures, new drugs. And soon they will be able to choose their healthcare insurance, even if they have never had coverage before.
About 90 million adults in the US, half of us, have “inadequate health literacy” to navigate the healthcare system. [IOM 2004]
No one wants to be thought of as “inadequate”. But to be clear, this applies to the healthcare system as well as to the patients. We can’t understand the information that we need to use the system and make good decisions. Maybe the healthcare systems present information in a confusing way. Or they use an elite language – jargon. Sometimes they don’t pass the information on to the patient at all – too busy or what have you. Whether it is the sender or the receiver who is at fault - many of us don’t get it.
Here is an example. I picked up a new prescription at the pharmacy the other day. I guessed maybe my pharmacist fell into this group of “health illiterate” adults too, right along with me. You be the judge:
Me: Anything I need to know about this drug?
Pharmacist: (Shakes his head “no”. Gives me a funny look, like I’m speaking Greek or Latin.)
Me: Like, how to take it?
Pharmacist: (Looks at the bottle in front of him, points to the label.)
Me: Any side effects I need to know about?
Pharmacist: No. I don’t think so. (Looks at me like I’m crazy for asking him.)
And then I sign the form that says he counseled me, as required, and go. After my trip to the pharmacy, I read the package insert for the drug. It’s that tightly- folded bit of paper that comes with the packaging. It takes me a while. The print is tiny, the words are big. But after getting through it, I am crystal clear on at least one thing. This is not a medicine I am going to take, not ever. Not unless I am unconscious and someone administers it without my consent. The physical side effect warnings are way outside of my comfort zone. So, back to the healthcare provider to talk about other options another day. If I hadn’t understood the package insert, I never would have known.
Does this scene sound familiar? You may have many examples of your own, where communication didn’t quite happen. According to the new IOM workshop summary, written information should be somewhere between 4th grade and 8th grade reading level. This little article here is at grade level 6. Healthcare information often is at a higher reading level. And of course, communication should include a description of risks by the healthcare provider - doctor, nurse, pharmacist - too.
Now, with the new healthcare changes that are coming, each state in the US will be setting up a “market”. Here, patients will get to shop for health insurance. It will be an “insurance exchange”. But will we understand the language this marketplace uses? The new IOM workshop focused on 4 things about state insurance exchanges:
- Lessons learned in states that already have insurance exchanges.
- Impact on consumers (us).
- Relevance of health literacy.
- Best practices in communicating.
A gem, from the IOM workshop summary, is a checklist of ways to improve communication. This is from insurance plans’ surveys and interviews:
• Conduct inventories of jargon and acronyms used by the company. Create lists of ‘words to avoid’ and ‘words to use’ as alternatives…
• Create checklists (or electronic tools) for evaluating written documents…
• Consider a company-wide policy that new documents and those being revised must conform to principles of clear health communication.
• Provide training to a broad group of employees to increase awareness and enhance skills.”
Effective communication by healthcare system to consumers – all of us – is a lofty goal. It is one well worth pursuing. To read more about what people are doing to meet this goal, have a look at the free workshop at the IOM site: http://www.nap.edu/catalog.php?record_id=13255
Please leave a comment. Start a conversation, join the discussion. But please, don’t use big words.