Reprinted from the Health District's quarterly publication mailed to district residents (Spring 2007)

The label on your bottle of prescription medicine says to take two pills twice daily. Does that mean two pills or four pills? Morning or evening? If you’re a little uncertain, relax – you’re in good company.

Nearly half of participants in a study misinterpreted at least one or more of the five prescription labels they were shown. Those with low reading skills did much worse, but even people with a high-school education or higher had problems, according to the study published last year in the Annals of Internal Medicine.

The study illustrates a major issue, one that isn’t just limited to prescription labels: many Americans don’t understand the health-related information they receive. In fact, an estimated 90 million patients in the United States have difficulty understanding and using medical information, a problem known as low health literacy, a report by the Institute of Medicine found.

The U.S. Department of Health and Human Services defines health literacy as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” Low health literacy is thought to be such a serious problem that the federal agency has set national goals for improvement. The reasons are simple.
 

People with low literacy skills have poorer overall health, make more treatment and medication errors, are less likely to detect and treat serious illnesses at an early stage and are 30 percent more likely to be hospitalized. Overall, health literacy is a stronger predictor of a person’s overall health than age, income, employment status, educational level or racial or ethnic group.

Although low health literacy is more common among low-income, immigrant, minority and elderly patients, the problem cuts across all educational and socioeconomic levels. “Half of people with low health literacy skills graduated from a 4-year college, and the majority are white, native-born Americans,” says Lin Wilder, mental health services coordinator at the Health District of Northern Larimer County.

Contributing to the problem is the fact that healthcare providers have less time than ever to chat with their patients. “In a six-minute visit how could anyone feel like he or she could ask questions?” says Dr. Jackie Fields, a Fort Collins family physician who dedicates a minimum of 30 minutes to each patient visit.

Both patient and provider have a role to play in improving communication, says Kim Marvel, Ph.D., a clinical psychologist and educational associate director of Fort Collins Family Medicine Residency Program. “It’s a partnership.”

Healthcare providers can help by using simple, nontechnical language, not overwhelming patients with too much information and setting a tone that establishes a trusting relationship. “The benefit of a trusting relationship is that patients feel more comfortable asking questions,” he says.

“I feel strongly that as a primary-care provider, I am an educator,” Dr. Fields says. “I’m not on a pedestal. I’m here as a team player. I want to empower my patients.”  Part of her role, she says, is to ensure patients understand that, “there are no silly questions.”

Marvel encourages patients to be direct about their fears and concerns and not make the physician hunt for them. Some people find it helpful to bring a prioritized list of questions to their appointment, he says. A friend or family also can come along to help ask questions or take notes.