Friday, October 29, 2010
Improving health literacy by healing the doctor-patient relationship
When it comes to understanding medical information, even the most sophisticated patient may not be "smarter than a fifth grader."
In one of the largest studies of the links between health literacy and poor health outcomes, involving 14,000 patients with type 2 diabetes, researchers at the University of California-San Francisco and Kaiser Permanente found that more than half the patients reported problems learning about their condition and 40% needed help reading medical materials. The patients with limited health literacy were 30-40% more likely to experience hypoglycemia--dangerously low blood sugar that can be caused if medications are not taken as instructed--than those with an adequate understanding of medical information.
Now, federal and state officials are pushing public health professionals, doctors and insurers to simplify the language they use to communicate with the public in patient handouts, medical forms, and health websites. More than two-thirds of the state Medicaid agencies call for health material to be written at a reading level between the fourth and sixth grades.
A new federal program called the Health Literacy Action Plan is promoting simplified language nationwide. And some health insurers, doctors' practices, and hospitals have begun using specialized software that scans documents looking for hard-to-understand words and phrases and suggests plain-English replacements.
More than just giving approachable information, I suggest that doctors have an opportunity to really make a difference in a patient's life by remembering the sacredness of the doctor-patient relationship, true HEALTH literacy. However, a recent study says that hospitalized patients don't even know who their doctor is. The doctor-patient relationship is sick.
Some possible explanations are:
--Patients are stressed while hospitalized and do not remember what is said;
--Many patients are heavily medicated and that affects ability to learn and remember;
--Doctors are too rushed and deliver information too quickly to be understood;
--Hospitalized patients have too many consultants and no one is identified as the "responsible physician;"
--The trend to get patients out of the hospital quickly short changes communication time;
--Nurses, consultants and hospitalists don't communicate well together and the patient gets a different message from each visit; and
--Poor outpatient communication with no physician reimbursement for emails, calls, etc.
There may be many other potential reasons. Everyone in medicine should take a pause to look at this study very carefully because it shows so much room for improvement.
CMS Administrator Dr. Don Berwick eloquently summarized the sacredness of the doctor-patient relationship in his recent Yale Medical School graduation speech:
Congratulations on your achievement today. When you put on your white coat, my dear friends, you become a doctor. You see, today you take a big step into power. With your white coat and your Latin, with your anatomy lesson and your stethoscope, you enter today a life of new and vast privilege. You may not notice your power at first. You will not always feel powerful or privileged--not when you are filling out endless billing forms and swallowing requirements and struggling through hard days of too many tasks.
But this will be true: In return for your years of learning and your dedication to a life of service and your willingness to take an oath to that duty, society will give you access and rights that it gives no one else. Society will allow you to hear secrets from frightened human beings that they are too scared to tell anyone else. Society will permit you to use drugs and instruments that can do great harm as well as great good, and that in the hands of others would be weapons. Society will give you special titles and spaces of privilege, as if you were priests. Society will let you build walls and write rules.
But now I will tell you a secret, a mystery. Those who suffer need you to be something more than a doctor. They need you to be a healer. And to become a healer, you must do something even more difficult than putting your white coat on. You must take your white coat off. You must recover, embrace, and treasure the memory of your shared, frail humanity--of the dignity in each and every soul. When you take off that white coat in the sacred presence of those for whom you will care--in the sacred presence of people just like you--when you take off that white coat, and, tower not over them, but join those you serve, you become a healer in a world of fear of fragmentation that has never needed healing more.
This post by Jennifer Shine Dyer, MD, appeared at Get Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.
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Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
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Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
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