Do They Understand? Learning to Spot Patients who Can't Read

(A condensation of an article by Neil Chesanow in Medical Economics 7/7/06.)

Literacy is a greater problem than many people realize. If you think literacy is not a problem in your practice, think again. A 2004 Institute of medicine report found that one out of two adults has problems understanding patient education literature, forms that need to be filled out, medication instructions and information about their health conditions and treatment.

It's not just the inability to read. Consider the elderly, eyesight problems, semiliterate, non-English speaking/reading, cultural variances, hard of hearing, emotionally upset, mentally-challenged, dyslexic and attention deficit disorders.

Yet many who may not understand are quick to say they do. Many people would rather die than let others know they have reading and/or comprehension problems. It all boils down to shame and saving face.

Here are some suggestions to help you deal with this problem in your practice:

· Learn to spot patients that are at risk:

· Watch for incomplete and inaccurate registration forms

· Frequently missed appointments

· Test results that indicate the patient is not taking their medication

· A reluctance to read in front of you

· Hesitation over a "brown bag" medication inspection – ask the patient to bring in the drugs and to read the name and instructions for it.

Once you have identified at-risk patients, here are some tips and tools to improve their comprehension:

· Simplify your forms and avoid clinical terminology

· Avoid medical jargon. Benign means "not cancer"; oral means "by mouth"; monitor means "keep track of".

· Limit forms to essential information

· Have forms available in large print

· Offer forms in the native language of your patient

· Have staffers help fill out forms for the patient

· Remember the 3. Tell patients what is wrong, what they need to do and why they need to do it

· Verify comprehension by asking the patient to confirm small segments of information back to you before you move on

· Think in terms of what the patient would want to know

· Utilize video clips, multimedia presentations and other aids (easily available on the Internet) to help patients understand.