Patienthood and Health Literacy

August 17th 2012   ·   1 Comment

By Steven Z. Kussin, M.D., FACP

When medical decisions need to be made, there have to be at least two smart people in the room. Nowadays, that’s a problem right out of the gate. Why? First, patients don’t prioritize the single feature they should value the most — a doctor’s brains. Second, consumer health care literacy is lacking. Sorry, that’s you.

When it comes to healthy attitudes and health aptitudes, you are not cutting it. That means that sometimes during that all important encounter, there’s no smart person in sight. Hey, no disrespect, I’m talking medical-smarts.

Dumb Docs?

Half the doctors you meet are not as smart as the other half. Brains should trump all else. Convenience, proximity to home, recommendations from neighbors and a kind supportive staff are nice. Nice is nice. But it’s not nearly enough.
I’d sacrifice (and have done so) a great parking spot, a doctor’s empathy, communication skills, and a short wait, for one thing. Brains. That’s what you are paying for. That’s what determines your fate.

Smart doctors can diagnose uncommon things and cure you. Dumb docs miss the common things and off you go into the wild blue yonder. You can make your doctor chattier and more caring.; there’s nothing you can do to make him smarter. But you can make yourself smarter. I’ll address choosing smart docs in a future post. First, let’s talk about you.

How about you?

Most medical information in a doctor’s office is presented at a college level. A 2010 federal study showed that health information is presented in a way that is beyond most Americans. Almost 90% of adults have difficulty using the health information that is routinely found in our health care facilities.

I’m not talking about folks who never made it through high school. Even the overeducated are under-motivated when it comes to health literacy. Having number smarts (numeracy) is a first class ticket to geekdom. Even professors brag about not having the math skills to balance their checkbooks.

Who’s At Risk?

Those who need health care savvy the most, are those are most lacking in it. People over 65 years, who have the most need of medical care, have the least literacy, which goes a long way to making your life shorter.

The feds compared death rates for elderly patients who had three levels of health smarts. In a 6-year period, those who were very smart were the least in number but enjoyed the most in years of life lived. Only 20% of this group died during the study period.

At the other end of the ‘smart spectrum,’ almost half of those with inadequate health literacy died during those 6 years. It has nothing to do with number of years of school completed. It has everything to do with the awareness that you are on your own in our health delivery system. And being armed prevents your doctors from being dangerous.

What Is Health Literacy?

Health literacy has been defined 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.”

It includes a number of skills that you need in order to function effectively in the complex and demanding health care environment. These include skills in reading and writing, listening and speaking, and numeracy skills that include the ability to interpret the very basic principles of statistics and probability.

Those with poor health literacy have greater difficulty in communicating with their doctors, are less likely to participate in shared decision making (something close to my heart) and have dangerous lapses in managing their chronic illnesses.

Having a low health IQ creates barriers. It starts with knowing how, where and when to seek care and then being able to communicate your needs clearly. Preventive technologies can be lifesaving but also life threatening.

Those who know the difference will live better and longer lives. Health smarts means you will be safer by both knowing why you’re on your medications, whether you need them, and then managing them safely.

Understanding educational brochures and your doctor’s directions are vital. Today’s consent forms for risky and possibly unnecessary testing are shoved in front of your face for a quick signature. Will the eight minute visit give you all you need to know? Of course not. And they aren’t created to protect you. They are protect your providers from malpractice suits. Giving consent requires knowledge and the ability to say “No!” until you or your ‘Designated Einstein’ do some basic research.

Is It All Just Too Much?

Patients are often faced with difficult decisions. It may be demanded that you be able to:

• Know if the information is believable and if it comes from reputable sources.
• Learn about relative and absolute risks and benefits.
• Calculate dosages.
• Interpret test results.
• Know where to locate health information.
• Or, if you aren’t up to it, then knowing someone to consult. That ‘someone’ better be health literate  — especially if you’re not.

Are You Able to…

• Understand graphs and educational material?
• Get on a computer to find what you are searching for?
• Understand that everything in medicine is uncertain. Dealing with uncertainty requires some degree of basic numeracy?
• Hook up with someone who has these skills if you don’t?

I have written about the best resources on the Internet, free doctor-only apps on your smartphone and iPads as well as consumer health apps.

Next week let’s work on knowing the right questions to ask. Sometimes acting smart is as good as being smart.

By Mark Ziobro