Study: Low 'health literacy' widespread

90 million Americans have trouble with medical directions

Nearly half of American adults face higher risks of health problems because of trouble understanding medical terms and directions, experts said Thursday in a report that calls for a national effort to improve health literacy.

Comprehending medicine's arcane jargon is difficult for even the most educated of laymen. It's almost impossible for millions who can't read well, aren't fluent in English, or have vision or cognitive problems caused by aging.

Now the prestigious Institute of Medicine has put a number on just how many people have "limited health literacy" -- a surprising 90 million adults.

They have problems following instructions on drug labels, interpreting hospital consent forms, even understanding a doctor's diagnosis and instructions.

It's a problem exacerbated by the increasing complexity of the nation's health care system -- one contributing to health disparities among the poor and minorities -- and it may be costing billions of dollars in avoidable costs, the report concludes.

"I hope this will be a call to action," said Dr. David Kindig of the University of Wisconsin, who chaired the institute's two-year probe.

"It's a public health problem, a societal problem," not just an individual patient's problem -- one that requires work from doctors, educators and regulators, he said. "Everybody has a piece of this."

Shame and stigma play a big role, the report found. Patients are embarrassed about reading difficulty or worried the doctor will think they're dumb if they ask questions.

But even the college-educated can have a hard time with medical information like this example the institute uncovered: "Patients should be monitored for extraocular CMV infections and reinitis in the opposite eye." That instruction wasn't written for doctors -- it was on a treatment information sheet for patients.

Another example cited: The mother who poured an oral antibiotic into a 2-year-old's infected ear, because the prescription label didn't say to swallow the liquid.

Communication gaps

In videotaped sessions with patients, the institute documented worrisome misunderstandings: A mother who misread how much medicine to give her child. A woman who didn't realize she was signing a consent form for a hysterectomy. A man who thought his doctor considered him "hyper, can't sit still" because she diagnosed hypertension, the medical term for high blood pressure.

Health literacy isn't a new problem. Surgeon General Richard Carmona has made the issue his cornerstone; the American Medical Association has long sponsored efforts to improve doctors' communication; and pilot programs to help Medicaid patients or people in adult reading classes better understand health instructions are under way in several states.

But if doctors actually quizzed patients about what they understood after a visit, they'd be stunned, said Dr. Harvey Fineberg, president of the Institute of Medicine, which advises the nation on ways to improve health.

"Health literacy -- enabling patients to understand and to act in their own interest -- remains a neglected final pathway to high-quality health care," he said.

Education statistics show one in five adults reads below the sixth-grade level, while most health materials are written at the 10th-grade level or above.

Numerous studies show patients with limited health literacy are more likely to be hospitalized and need emergency-room care, have poorer health habits and are less likely to use preventive services to ward off disease. That in turn increases costs. One study found hospital spending is $993 higher, on average, for a patient with inadequate health literacy.

Among the report's recommendations:

--The government should pay for research on ways to improve health literacy.

--Accrediting organizations should require that schools follow national health education standards, from elementary school through college.

--Health organizations and medical schools should teach health literacy and how to communicate with patients.

--Medicare, insurers and other health groups should develop creative ways to communicate clear health information, and use cultural and linguistic competency as an essential measure of care quality.

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