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Patient health literacy: Why your patients may not understand you

18 Mar 2018

Communication tips to reach your patients

By: Misti Shilhanek White, MSN, RN, Manager of Operations, Service Excellence and David Barlow, Director, Service and Care Continuum

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Patients with limited health literacy may not have a good understanding of basic medical vocabulary. They may not be aware of concepts related to diseases that are common to our world.

This communication challenge is made worse by acute illness. The mismatch between provider communication and patient comprehension leads to medication errors, adverse patient outcomes, higher rates of hospitalization and increased costs of care.

Jefferson Loa, MD, shares this story from a patient he treated:

“I had a patient who needed to have his colon removed. I gave PARQ [procedures, alternatives, risks, questions] with him about the potential to have colon removed. He gave consent and I believed that he understood the issues facing him. Luckily, as I was leaving the room, I heard the patient ask the nurse, ‘What’s a colon?’ Can you imagine? I believed we’d had an entire conversation about this procedure but the most basic point was missed!”

The Institute of Medicine defines health literacy as the “degree to which individuals have the capacity to obtain, and process information and services needed to make appropriate health care decisions.” Only 12 percent of English-speaking adults have proficient health literacy skills. 

Many providers are unaware of the magnitude of this issue. Therefore, as an organization we need to help providers develop clear and effective communication strategies.

Here’s what you can do: Take a “Universal Precautions” approach

Assume that all patients and caregivers may have difficulty comprehending health information and should communicate in ways that anyone can understand.

Use Plain Language: Commit to removing medical jargon from your patient conversations. Choose words that are common to your living room. For example, instead of ‘oral’ say ‘by mouth’ or in place of ‘referral’, say ‘send you to another doctor.’

Try the Ask Me 3® approach: Encourage patients and families to ask three specific questions of you:

  1. What is my main problem?
  2. What do I need to do?
  3. Why is it important for me to do this?

Answering these questions will help the patient better understand their health conditions and what they need to do to stay healthy.

Ask Me 3® is an educational program through the Institute of Healthcare Improvement.

Use the “Chunk-check-chunk” method: Limit new concepts to one to three “chunks” of information. Check for understanding after each concept with a question such as, “What questions do you have for me about what we’ve just talked about?” Clarify any information you need to before moving on.

Thank you for the care that you give and the relationships you create with our community.

If you have questions or comments, please email Misti Shilhanek White, manager of operations, service excellence or email David Barlow, director, service and care continuum.