As the American health system continues to find ways to improve care and do so at a lower cost, one of the most costly aspects for the healthcare industry is high administrative costs due to low healthcare literacy. According to the United States Department of Health and Human Services, health literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information … needed to make appropriate health decisions.”1 According to a recent national survey around 50% of patients struggle to navigate the healthcare system: from understanding how to select a health insurance plan or physician to knowing how to take medications as prescribed. Due to the increased use of customer service help lines, it has been estimated that low health literacy costs the industry almost $5 billion annually.
Low health literacy doesn’t mean people don’t know how to read and write; it can be difficult for even educated people to understand medical terms and the risks associated with medications or medical procedures. Health literacy is dependent on a number of factors including the patient’s culture, communications skills, general understanding of health topics, and the demands of a given situation. A patient’s level of health literacy is important because it affects their ability to navigate the healthcare system and appropriately manage their medical treatment.
The national report noted that health insurance companies spend $26 more on a patient with lower healthcare literacy. This may not sound like much, but after multiplying by the number of patients with lower healthcare literacy this equates to an extra $3.4 billion. Addressing this issue could be a real opportunity for providers of health insurance.
So, who is truly responsible for low levels of healthcare literacy? Some argue that health professionals are responsible, while others lay blame at the feet of the broader healthcare system. It might even be argued that patients themselves should ask more detailed questions and educate themselves better. The truth may be somewhere in the middle. Doctors shouldn’t just assume patients understand what they are being told because many patients will say they understand in order to avoid looking silly. Patients could probably do a better job of informing themselves, but it may not be fair to expect them to know the right questions to ask given that they may have little experience with healthcare.
The key question is, what can be done to reduce costs and make sure important health information isn’t being lost in translation? There are a few strategies that can be used:
- Respect social and cultural differences
- Provide focused and limited patient instructions
- Ask questions to check a patients’ understanding
1. Respect social and cultural differences
Each patient should be treated with the utmost respect as they are likely going through a very vulnerable time. This involves making allowances for social and cultural differences such as race, gender, ethnicity, religion, sexual orientation, and level of income. This may also include making allowances for differing perspectives on traditional vs Western medicine, forbidden foods, and rules regarding touching or being within a certain proximity.
Doctors might consider testing their message with people who are members of the intended audience to see whether it is effective. Time may be needed to adjust content before interacting with a patient.
2. Provide focused and limited patient instructions
One of the keys in communicating with patients is to keep it simple. It’s commonly stated that doctors should limit their instructions to four main points.2 When telling patients what to do it’s critical to emphasize the behavior and not the underlying medical facts. Doctors need to use familiar language instead of complex medical jargon, use short sentences, and avoid poor grammar.
Since each patient will have a unique style of communication and preferred learning style, visuals may be the preferred method of instruction. Doctors and patients may be able to communicate better with the help of some form of visual aid especially for the more technical points. For some, a simple drawing on a white board will be sufficient for others more detail may be required. It is important that each picture has a clear meaning which adds to the message.
3. Ask questions to check a patients’ understanding
After presenting a message to the patient and their family, doctors should check in with everyone to assess their understanding. This can be best accomplished by using words such as “what”, “how”, “explain” to ask open-ended questions, and avoiding questions that lead to simple “yes/no” answers. In case patients are not fluent in English, a medically trained interpreter should ideally be provided. Medical interpreters should understand the patient’s cultural values and norms, and so be able to make information relatable.
A second method that doctors use in checking whether patient understand is to ask them to do a “teach back”. In this approach the patient is asked to restate their understanding of what the doctor said. If the patient then says something that is incorrect or incomplete the doctor can fill in any holes, and then have the patient repeat the cycle until they are clear on all aspects.
Conclusion
Enhancing patient health literacy is a valuable way to improve health care and reduce costs in the US healthcare system. Doing so will require leadership, strategy, and cooperation between all stakeholders in the healthcare system.
Kevin Anderson is a graduating medical student at Duke University School of Medicine and will be starting at LEK Consulting later this year. He’s most passionate about healthcare redesign, patient engagement, and the life sciences. His free moments are spent traveling and enjoying sporting events with his wife and daughter.
Image: Pexels
References:
- S. Department of Health and Human Services. 2000. Healthy People 2010. Washington, DC: U.S. Government Printing Office. Originally developed for Ratzan SC, Parker RM. 2000. Introduction. In National Library of Medicine Current Bibliographies in Medicine: Health Literacy. Selden CR, Zorn M, Ratzan SC, Parker RM, Editors. NLM Pub. No. CBM 2000-1. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services.
- Doak C, Doak L, Root J. 1996. Teaching Patients With Low Literacy Skills.2nd Edition.JB Lippincott Co.: Philadelphia, PA.
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