The Doctor-Patient Dialogue: Failing at Health Literacy

Recently, three sobering patient encounters highlighted the surprisingly low level of health literacy among the public – a health information gap that is likely due to poor communication between medical providers and patients. Each of the anecdotes, highlights a concerning communication gap between medical providers and the community. It is imperative that providers make the time to educate and clarify health information for our patients. This is the only way to be certain patients have the power and information they need to: 1. participate in the medical decision-making process and 2: ensure their own health and well-being.

The first patient I will call Ms. Jones. Ms. Jones is a 73 year old woman who has diabetes, high blood pressure and high cholesterol. She came to my clinic for follow-up for pneumonia but I happened to inquire about her blood pressure and cholesterol. She said she was still having trouble controlling her cholesterol so I asked her to tell me about her diet. She said, “I eat the same thing every morning. I have two scrambled eggs, with either two slices of bacon or link sausages and then I cook my grits with a little butter”. The horror must have shown on my face because after a moment of silence between us because she asked, “Why? Is that bad?” I took a breath and slowly began to explain how her daily breakfast was overloaded with cholesterol and fat, both of which were probably a big reason why she could not normalize her cholesterol. I asked if anyone had ever spoken to her about nutrition or if she had heard any of the information I just shared. She said she hadn’t.

The second patient is Bob. Bob is 32 year old and recently learned he’s HIV-positive. Bob wanted to know if his family members could contract HIV from sharing utensils or eating off the same plate as he. In addition, as we discussed the meaning of his laboratory results, I explained to him the meaning of the HIV viral load which tells me how active his virus. As I showed him the report, he noticed the range for viral load was 0-1,000,000 and said, “Oh wow. It can go all the way up to a million? That’s just a lost cause, huh? I bet you just can’t do anything for those people, can you?” First, I explained how HIV is transmitted. Then I explained that treatment for HIV is available for people with HIV and AIDS and that even people with a viral load in the millions can expect to respond to the medications just as well as someone with a pretty low load viral load.

The final scenario, which is by far the most humbling, is from a recent experience phone banking for a local TV station. I was asked to answer questions from the public about Swine flu. Questions from the community included: “How do I know if I have the flu?” “How do I keep from getting the flu?”, “How is swine flu transmitted?” and “Should I stop eating pork?” Over those few hours I felt the medical community had failed society. I took it for granted that the answers to each of these questions were well known to the public. As providers, one of our fundamental duties in service to patients is to educate them about common medical conditions but clearly our messages are not getting through to many. I am sure if I asked providers if they educate patients, the majority would say they do. What then can be explanations for this vast medical information gap? Are our explanations too technical? Are patients not listening? Do we give them too much information to digest? Are we taking for granted the public’s ability to absorb and retain basic health information? Of course there is always the possibility that we simply are not tailoringour messages and information in a language they understand. Whichever is the case, we are failing at health literacy.

The United States is the unhealthiest we have ever been and the costs of treating preventable illness is at an all time high. While individuals must exercise some personal responsibility for their health, it is our duty as healthcare providers to help ensure people are well-equipped with the information they need live in health and wellness. The doctor-patient dialogue is critical. If we are mindful and diligent, we can close this communication gap and help position our patients to be healthier, more empowered citizens.