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When given the instruction
"take two tablets by mouth
twice daily," fewer than
35 percent of patients with limited literacy skills could correctly interpret the
number of pills they should
take in one day. 2

Help Your Patients Understand

Low health literacy is a silent nationwide epidemic with symptoms that often present as early as the first medical encounter. Consider: Why do many patients seeking care not improve? Are they simply noncompliant? Or are they among the 90 million Americans with limited health literacy who donít understand what their practitioner is saying?

Despite providers soliciting questions from patients, many feel overwhelmed by the amount of information they receive. They may also be embarrassed by being put on the spot, do not want to take up the busy practitionerís time or have feelings of shame for not knowing how to respond. As a result, countless Americans leave their doctorís office each day uncertain of what they need to do. And so the epidemic continues.

Low health literacy, which disproportionately affects the elderly, the poor and recent immigrants, is linked to higher rates of hospital readmission, expensive and unnecessary complications, and even death. As a result, health plans and providers alike are seeking ways to communicate information more effectively.

In addition to making benefit plan communications easier for members to understand, EmblemHealth encourages members to be active health care consumers and ask questions. Since communication is an interactive process, we also want to assist our practitioner community in improving the quality of its interactions with patients.

To help bridge the gap between health care complexity and patient skills, we offer these tips from the American Medical Association Foundation to assist you in improving your patients' health literacy and ultimately health outcomes.1

  • Refrain from lapsing into "medicalese." Use simple, clear language with everyone.
  • Make a point to look directly at patients when speaking, not at the chart, laptop or other electronic device.
  • Slow down when giving complex information. Periodically check yourself for speaking too quickly.
  • Use the same term for a procedure or condition throughout a visit. For example, if you use the term high blood pressure, continue using that term rather than switching to hypertension later.
  • Avoid using words that have two meanings, such as stool, dressing, appendix or range, which may confuse patients.
  • Provide analogies for risk probabilities and for hard-to-understand percentages. For example, "The chance of needing that procedure is the same as winning the lottery."
  • To assure patient comprehension, "chunk and check" information in manageable amounts as you go along, using the teach-back method. This is especially important when instructing patients how and when to take their medications.
  • Avoid value judgment words to describe thresholds for action. Example: "If you have excessive bleeding, call my office." How much blood is excessive? The doctor knows, but chances are, the patient does not.
  • Show or draw pictures. Visual images can improve a patient's recall.
  • Look for signs that the patient may not comprehend what youíve said, including folded arms across the chest, a blank stare, lack of eye contact or a furrowed brow.
  • Make patients comfortable asking questions by sometimes remaining silent and using prompts, such as:
    • "That was a lot of information I gave you. What part should I go over again?"
    • "What questions do you have for me?"

Avoid asking, "Do you have any questions?" Many patients will be too embarrassed to admit that they didnít understand your instructions.

In the end, increasing patients' health literacy is all about developing relationships. When practitioners take steps to improve their communication skills, they help patients become more knowledgeable health care consumers, increase patient satisfaction and ensure that time invested in treating them has been productive — and translates to tangible health benefits.

Learn more about removing barriers to communication from the American College of Physicians Foundation.


1 Health Literacy and Patient Safety: Help Patients Understand. Manual for Clinicians. 2nd ed. Weiss BD. Chicago, IL: American Medical Association Foundation; 2007

2 Literacy and misunderstanding prescription drug labels. Terry C. Davis, Ph.D.; Michael S. Wolf, Ph.D., MPH; Pat F. Bass III, MD; Jason A. Thompson, BA; Hugh H. Tilson, MD, Dr.PH.; Marolee Neuberger, MS; and Ruth M. Parker, MD. Annals of Internal Medicine, December 2006 volume 145 Number 12, pp. 887-894. http://www.annals.org/content/145/12/887.full.pdf


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