Looking back on the last three years, it’s really amazing how much knowledge medical school has crammed into my head. My undergraduate education didn’t focus on medical science; nearly all the biology I studied was molecular in scale. Despite having a degree in biology from a good school, I’d have been completely unable to explain how to evaluate and treat even something as basic as diarrhea. Three years later, it’s become difficult to talk about anything related to health and disease without using a barrage of jargon. And I’m still a medical student – who knows what I’ll be like after twenty years in practice. It shouldn’t be a surprise that most physicians’ explanations leave their patients completely bewildered (especially since the average patient’s health literacy is shockingly limited).
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Part of the medical student’s job on most services is to field questions from patients. Your attending and resident probably don’t have the time or inclination to explain what heart failure is, how it causes problems, and why the usual medications work, but those explanations are crucial to patient adherence. Ideally, the explanations you give should better equip patients to deal with their other healthcare providers, too. A nurse in the hospital at Vandy just turned me on to a great website for patients and doctors called AskMe3. The website is part of a larger initiative by the National Patient Safety Foundation to help facilitate communication between patients and providers. It recommends that patients ask (and physicians try to answer) three simple questions during each visit:
- What is my main problem?
- What do I need to do?
- Why is it important for me to do this?
After all, these are the basics – and the last one is the most important and the most neglected. “You’ll go into respiratory failure” is more of a threat than an explanation, but “You’ll have a harder and harder time getting around the house and keeping up with your grandchildren” might work better. Do your patients a favor – try to give meaningful, simple answers to these questions and direct them to the AskMe3 website (or give them printouts). It doesn’t help much if you tune up your patients and then discharge them with no idea of how to manage their problems.
As a side note, the strongest predictor of poor health literacy is poor literacy overall. That should be obvious – if patients aren’t comfortable with reading, they’re likely to have an exceptionally difficult time understanding medication inserts and even online resources like WebMD. Initiatives like AskMe3 are great ways of coping with poor health literacy, but the foundation of good healthcare is a well-educated population – and that means better public schooling.