Health literacy and patient safety: Help patients understand

I was sick a lot I was sick a lot because I probably miss dosage and didn't realize that I was in hospital a lot when they did give me medicine I didn't take it right I admit to it I just didn't understand them and I didn't have the nerve to ask them the right way of doing it I just didn't have the nerve to ask them and I didn't want anyone to know I couldn't read we had a child that was physically handicapped that I had to do physical therapy on I would show up on Tuesdays instead of Thursdays for the appointment I would be exercising the wrong side of the body I have an abscess in a year one time well I had to fill out forms and I couldn't fill out so I didn't go I come back home I ended up having to go to the emergency room that night because it burst huff literacy is the ability to read understand and act on medical information unfortunately millions of adult Americans lack adequate health literacy skills the doctors researchers and patients in this video are real not actors the situation's frustrations and complications are also real nearly half of Americans have health literacy challenges odds are some of them are your patients can you imagine what it's like you being a patient and sick and you know that you have limited skills okay and your topic and until it's a doctor like yourselves and these people or are using words that you really don't know because they're not speaking in layman's term okay most doctors are just presuming that everybody's intelligent as well and that is just not decay so what you do you come out of that let that room that examination room with this intelligent woman or man thinking god I hope I don't make a mistake with my medicine cuz I did not understand anything he or she say it to me the heart of the problem is a disconnect between patient ability and healthcare communication the average American reads at an eighth grade level but health care information is often communicated at a college graduate level this disconnect leads to confusion frustration and a feeling of helplessness for patients and physicians while health care information can confuse even highly educated patients those most vulnerable to misunderstanding are the one in five adult Americans who are functionally illiterate take one one capsule encapsulate way okay so what so how would you take this when I see is is that on that tell you how to take it you say take it twice daily but it's also what's hannah taking for people with limited literacy skills the world can be a challenging 21% of adult Americans can't read the front page of a newspaper 48% can't decipher a bus schedule or make sense of a bar graph the problem is even worse in the health care setting where emotions run high and vocabulary is unfamiliar based on our decade of research on health literacy our research group has documented clearly that patients who have inadequate health literacy are more likely to be hospitalized for their chronic illnesses and this is regardless of their socioeconomic status whether or not they have a primary care provider regardless of how ill they are morning I take that little peel so this is the present this is lithium in it yeah okay okay anything he tells me to take I'll take it okay so you trust him oh you better believe it my life research has shown that many patients have a hard time understanding basic medical instruction 26% didn't understand when their next appointment was scheduled 42% didn't understand instructions to take medication on an empty stomach 86% couldn't understand the rights and responsibilities section of a Medicaid application hypertension means if I asked you what that was because when I look at this I think well maybe you have hypertension and I've been taking care of that for a long time pop heard copper like you're hyper what is being hyper mean to you yes or you can't be still you always gotta be doing so do you think I think you're hyper I have my pretension yeah I don't know that's what I consider it okay to be in you know but you know you have high blood pressure mm-hmm okay but hypertension doesn't mean the same to you mm-hmm so if I ask you if you have hypertension you're gonna just think I think you're jumping around on chair or something like that it's something different just being hyper King oh okay all right well I haven't done a very good job teaching you what hypertension is because I think you take that medicine for the hypertension and that's one of the things that I try to work with you on is your blood pressure and high blood pressure and hypertension to us it's the same thing same thing yeah low health literacy impacts patients and all aspects of the health care system in many ways in financial terms patients with low health literacy use healthcare services more often and increase health care costs by an estimated fifty to seventy three billion dollars every year the cost of patients can be equally high at approximately 30 or 31 I went into the gynecologist and complained about part of this not working correctly and he said we can repair that great I didn't ask all the right questions when I showed up two weeks later at the admissions office at the hospital they put enough papers in front of me I bet there were five papers that I needed to sign well I wasn't gonna say excuse me but I don't read really well and I certainly don't read fast and I'm concerned with some of these words to me it was lines and circles over sheets and sheets and sheets and I wasn't going to reveal my sense of stupidity so I signed everywhere they told me to sign never read it and then a couple weeks later in the follow up office visit the nurse said how are you feeling since your hysterectomy now I acted as normal as I could inside my mouth fell open and I thought to myself how could I be so stupid as to allow somebody to take part of my body and I didn't know it a patient signs a consent form that they don't understand they undergo a procedure and there's an adverse outcome that might have been one of the risks there are legal cases clearly showing that these individuals can sooo successfully in this setting because they did not give informed consent the majority patients try to hide this the majority of patients are not aware of it fully they believe this is their fault that they don't understand if you have a reading problem you go to the doctor that can be very scary it's like a nightmare you walk in that office and mostly if you realize first thing you have to do if that's your first visit it's fill out a form your heart beat real fast you're scared you don't know what to do you want to turn around and walk out I have you have panic attacks did I do it right is this done right am i imagining things do I go back over and check it again I've caught mistakes that I made simple mistakes but it paralyzes your thoughts completely to think that you may say something or something is put before you to read and you can't read it I mean you live with that on a daily basis people sooner or later will discover and that is your most greatest fear what day is it gonna be when somebody discovers you can't read in there right I will get mad about something and blame them that this is not the right place for me you're not respecting me and walk out it had nothing to do with that it was just I need to cover that I couldn't read this I didn't need to I didn't want them to know that I'm walking out because I can't read so you found solutions that sort of make it work at work and hide the real problem yes others won't notice right doesn't that take a lot of your time yes doesn't it take a lot of effort a lot very emotionally yeah it drains you yep it almost doesn't matter why they're having problems understanding it's my job to overcome that barrier so that I can get them the information they need to let me help them while we're waiting for research to be done on this topic so that we understand the best way to educate patients we can still use the advice of the true experts both patients and physicians who have cared for these patients there are some things that we can do to help this one we need to make sure that the environment in which we deliver the care is an open environment in shame free creating a shame free environment in a doctor's office or a hospital means that there's an attitude of helpfulness by every person there when I walk into a doctor's office or a reception room I would like to be treated as even though I'm a stranger that they know me because you're walking into it well you might consider a hostile environment it drops the defense all the guards are down the walls are down the line lines of communications are up patients want to be able to feel safe that they can tell the physician about their literacy skills about their inability to understand their medical condition and receive help creating a shame free environment can start with the forms that patients fill out as a screen for health literacy first to identify them short and quick a questionnaire seven or eight questions and these are straightforward questions I mean we've really geared it at fifth-grade level and some of them can't answer the questions but since the form is present on my desk then I can immediately notice if they haven't answered the questions so during the interview I can bring that up you know my medical assistant I noticed earlier was helping you out with the with that questionnaire yes I i'm dyslexic so i have a difficulty in reading yes and also in auditory memory so things that I forget so I'll ask you to you know write them down or I'll have my husband come in and whatever you we discuss so that I have a memory when we had a patient a form we don't just hand them the form and they sit down and we kind of forget about them so if they're having a difficult time you can pretty much tell from how long they've actually had the form I see somebody sitting with that clipboard in their hand for five minutes and I know that something is wrong I take a detailed social history which gives me information about a lot of things other than just their literacy their cultural background and approach to health care how much education they've had is a big question and I always ask people who have had limited education or say that they have had difficulty in school I always ask them how happy they are with how they read or how well they read and often it's as if people been waiting for somebody to ask them that and I've gotten a lot of mileage out of that particular question what kind of work do you do I'm a pharmacist tech and our farms are DME technician DME durable medical equipment oh okay and how far did you go in school 12th grade how happy are you with how you read I'm not very good I'm there's always room for improvement I'm better than I used to be it's not my reading that really troubles me is my writing one of the important interactions that can contribute to a shame free environment is how you review a patient's medications with them a very effective way to ensure that the patients understand how to take those medications is to have them bring those medications into the office it's commonly called the brown bag test and then I sit down with the patient and say show me how you're supposed to take these medications how did you get from the doctor writing you a prescription for you to getting to where you knew what pill came out of what pill bottle but just by I guess I think what I did is the recognition of letters but not being able to read the word I could recognize a letter and I knew would be my echo light and if they're different colors and different things that helps but sometimes because two of my pills echo late and my trance eliezer are the same almost the same they're the same color but because of the size I have to put them together to make sure I'm not taking two of the same thing so I try to be very careful there are times if I don't feel well if I'm not thinking right I'm in a hurry I have taken the two tranquilizers instead of one insulate and one travel icer if someone can read they're gonna pick up the pill bottle and read the label and tell you how to take it whereas a patient has inadequate health literacy it's gonna pick up that pill bottle take off the top and they're gonna look and say ah this is my oval little blue pill this must be my pill for my diabetes I think my biggest asset is my front desk and my staff they're very good at making sure that things happen in a timely fashion and they can then give me a heads up about someone who they don't think can read the second thing physicians need to do is improve their communication skills when you're trying to ensure patients understand you can slow down don't speak so quickly so that the patient's can understand what you're saying well you're right about the arthritis okay it does affect the joints yes patients or anyone can only remember one two or three things from a conversation identify what's most important to teach that patient and ensure they understand that before they walk out of the door and go home in the form of arthritis that you have which is the most common usually what happens is that inside the joints there are two bones at least two bones okay and the bones are just rubbing off use living room language use language that anybody walking on the street would understand not just the nurse and another doctor you mentioned earlier that you were working on your home yes 100 years old you noticed my door it creaks it wears down that door has a little oil so it doesn't creak when that oil wears off it starts creaking what was interesting is that he used visual aids in the sense of he made a visual picture of what was going on describing arthritis tis being a joint and a doorframe and not having oil so this really helps out in the fact that you have a visual picture of what might be going on in your body it doesn't matter whether people are highly educated because this stuff is difficult to understand they're not doctors and since they're not doctors they shouldn't understand doctors terms I am married to an engineer now and this man has some health issues so we are in the doctor's office from time to time we will walk out of the doctor's office and my husband with all of that left brained intellect will say to me why did the doctor say what up what am I supposed to do I don't understand Mary brought in her husband and it was it was very clear from the from the beginning once they were together how they have a dynamic that works and the majority of things that she doesn't healthcare she may not be able to go a hundred percent with it but he's there to fill in the gap I use a lot of posters so I have lots of posters and models and I think people remember it better if they can see it or if it's associated to something that they understand already so I think the models and the visuals all make a big difference if the patient comes in with medication a lot of times they're on so many medications they're confused on when to take it what it's for so we do have a medication compliance sheet and we do actually tape a pill that they bring in out of their medicine bottle we tape it to the sheet we write down when they take it and what the medications for it's really important that you don't say do you understand because they're going to say yeah and that'll be the end of it and you won't know what they understand they may understand but it may not be which is there I think I used to teach the teacher mechanism it's like now that you know this I know you've got friends when they ask about this issue how are you gonna tell it what are you gonna say one of the things that you can do if you have a really bad pain I mean where you can't stand on it and it's it's really getting in your way is to use what I call this is my little pain protocol here it has I be pro Fionn which decreases those little cells I was talking to you about the inflamed part and your tylenol that just works on the pain and the I is for ibuprofen and t is for Tylenol and this just shows you how to do it over the course of the day for breakfast lunch and dinner there's an I so you use ibuprofen right because you have to have something on your stomach with that one because this one will irritate your stomach so in between meals and at bedtime you use a Tylenol this way you get something every three hours you don't overdose on either one so it's i t i TI t and if you do that for a couple of days when it's really bad then you can just go back to your regular regimen but this usually breaks the pain pretty nicely so I know you have a lot of friends with arthritis how would you explain it – well for breakfast I take I 10 a.m. I take tea lunch I take I 3 p.m. I take tea I at dinner and tea at bedtime is that correct that's gonna work just fine thank you very much I think there are a lot of simple things that physicians can do to improve their office and make it a shame free environment there's a lot of simple things doctors can do to ensure their patients understand them and ensure these patients have better health as we've seen a shame free environment is one that conveys an attitude of helpfulness it's a safe place where patients feel more comfortable and are more likely to reveal literacy problems engage the entire staff and remember there are clues that indicate the possibility of low health literacy for example incomplete forms Clues can also come from the information derived from the social history and insights gleaned from the medication review as far as improving communication keep in mind these simple techniques slow down use living room language convey only the most important concepts involve family members use visual aids and employ the teach-back method the physicians you have just seen are using a variety of communication techniques to better inform their patients as research continues to unearth best practices we ask you to join them and all of us at the AMA and finding and implementing simple ways to communicate with all your patients please let us know what techniques you have tried and what has worked in your practice there's no question when a patient understands how to take their medication when a patient recognizes that the physician really cares about them their face lights up and that is so gratifying to see that in a patient that they know their doctor cares about them and that they now know how to best take care of themselves see the manual that accompanies this video and visit

32 thoughts on “Health literacy and patient safety: Help patients understand”

  1. Let's be careful to not blame our patients.  Our whole system is set up to benefit the wealthy and to handicap the poor.

  2. Thank you for this video. I have used it in the past for my Medical Surgical Students. I recently rediscovered it and now share it with my Nursing Basics students. Incredibly informative for students because it gives the patients' perspective. My nursing students are acquiring lots of great knowledge and they need to understand that just because they have this knowledge doesn't mean their patients have the same. So important for doctors and nurses to appreciate the need to explain their actions and treatments in ways a non-medical/nursing person can understand.

  3. Rockefeller paid Abraham Flexner to visit all the medical schools in the US at that time. He released the so-called “Flexner Report” in 1910, which called for the standardization of medical education and concluded there were too many doctors and medical schools in America.

    Rockefeller then used his control of the media to generate public outcry at the findings of the report – which, by means of the classic elite strategy of “Problem, Reaction, Solution” as David Icke calls it, ultimately led Congress to declare the AMA (American Medical Association) the only body with the right to grant medical school licenses in the United States.

    This suited Rockefeller perfectly – he then used the AMA (which may be better called to the American Murder Association due their widespread use and endorsement of toxic vaccines, drugs, chemotherapy and radiation) to compel the Government destroy the natural competition, which it did through regulating medical schools.

  4. set up video. Real patients? Maybe, maybe not. How is this eye opening? I'm guessing most here have to watch for school. These folks are bus drivers and maintenance worker. Maybe reading wasn't important to them but sure as hell seems to important here! So I don't know if its a joke or not, but seeing a lot of misspelled words and incorrect tenses. Oh man.

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  6. Powerful video, very saddening to think so many people go through this and are so ashamed to speak up. This is why we have to speak for them and be sure they understand their care and medications and that their questions are answered! In nursing school this was also common, the instructors spoke and so often we later "googled" what they were talking about so that we wouldn't feel stupid.

  7. I am amazed. I am a foreign trained nurse and my background required to teach our pt's population as it is on this video. From now on I will not just assumed because the pt verbalized understanding that he or she really do until I get a teach-back feedback from the pt.

  8. Excellent, informative video! I think ALL nurses and physicians should be required to watch this video before providing care to patients. I'm working on an MSN in education. I would LOVE to work for a large medical group after graduation as their "health literacy nurse educator."

  9. Nice video, very informative.  Too bad Dr. Alvarez was convicted of child porn.  That's totally unexpected.

  10. On my God!!! The differences between a Professional and a Layman is knowledge and Certainly NOT Intelligence!!!
    So, slow down your pride, you are only more knowledgeable and not more Intelligence!!!! I will never use the expression "this patient is dumb" for crying out loud the knowledge I have as a healthcare provider is over 15years of knowledge acquisition. My patient may just have 30min of this knowledge….How smart do I expect my patient to be?????

    Oh, one more thing in my 15 years of practice, I did not realize that this concerns of the patient even existed. How smart was I after all? You tell me!

  11. Excellent video! Really opened my eyes to previous patients who were upset and defensive, but probably hiding a literacy issue. It's our job as health care providers to reach through to the patient, no matter what the barriers may be.

  12. I'm a labor and delivery nurse and love to use visual aids to help patients and their support people understand what is going on inside their body. What do I mean when I'm talking about "effacement" or "dilation" or "station" or how the baby is positioned or why they're getting so much pressure on in their bottom. They get it when they see my little pictures!

  13. This is incredibly eye opening. I needed this to help me adjunct how I educated patients and other nurses.

  14. At 8:13, Mr. Wheelhouse is a pharmacy technician. The screen says "Graduated high school; reading at 6th grade level." How is this even possible? Based on my understandings, pharmacy technology program's students have to take medical terminology courses.

  15. As a nursing student, this provided great insight as to what cues to look for to ensure that my patients know how to best take care of themselves.

  16. Working in the medical field we get so busy sometimes and we forget little things that are so important. I think this video is a great teaching tool and a great reminder for doctors and for the staff.

  17. I think this video is an excellent training tool for all healthcare providers! I can't tell you how many times I have asked a patient, "do you understand?" and they have responded "yes" when clearly they did not. I will steer away from that question in the future and use better communication techniques.

  18. at 18:45, ibuprofen is on the beers criteria and inappropriate for geriatric patients but you don't see her telling her patient that..

  19. It's important for doctors to realize that patients are diversified, and that they have a responsibility to serve their patients with genuine care and concern. They should not take it for granted that all patients have the same type of education, and that they understand everything they are being told. The patient's responsibility is to realize that doctors are human. They should not place doctors on a pedestal and be afraid of them.

    I had an amazing doctor in Jamaica. He listened!

  20. I am a provider, but have also been a patient….and I have felt exactly the same
    way the patients in this video have felt. I went to a neurologist and she was awful….I cried and had anxiety for weeks after the visit. No fun…I try to really ask questions of the patient..I am not perfect, but am so aware of this problem.

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