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The Health-Literacy Crisis

Do You Understand Your Doctor?

Dr. Emily Senay link
Dr. Emily Senay: too many patients don't understand what their doctors tell them. CBS/The Early Show

NEW medical studies prompted a number of recent stories on the health-literacy crisis.

The New York Times, USA Today, and The Early Show on CBS all drew attention to the $multi-billion cost of the "communication gap" between doctors and their patients.

In the NY Times article, Jane Brody discussed the importance of understanding what the doctor is talking about. She says that too many people, no matter what their level of education, often leave the doctor's office without fully understanding what they were told. People do not know they have a right to understand and ask questions when they don't. Doctors use medical jargon instead of language adjusted to their patients' understanding.

The Times printed the REALM medical literacy test with the article. Health practioners give this test to see what level of materials the patient can understand.

Joint Commission Report on Health Literacy link

In February, The Joint Commission released a public policy white paper, "What Did the Doctor Say?": Improving Health Literacy to Protect Patient Safety.

This report (right) describes the communications gap between patients and caregivers as a series of challenges involving literacy, language, and culture. It also describes the steps needed to narrow and close this gap.

For too long, medical providers have been giving patients important health care information in medical jargon and unclear language.

Joint Commission Report on Language and Culture link

In March, The Joint Commission published Hospitals, Language, and Culture: A Snapshot of the Nation.

As our nation becomes more diverse, so do the patient populations served by our nation's hospitals. This study looked at the cultural and linguisitic quality of health care in 60 hospitals across the U.S.

Many hospitals reported difficulty in finding and managing culturally diverse staff with appropriate language skills. Even in those institutions with language services, the staffs were often not trained to use them. Future reports will give suggestions for improvements.

Before 2007, the Joint Commission was called the Joint Commission on Accreditation of Healthcare Organizations. It is a US-based non-profit organization formed in 1951. Its mission is to offer evaulation and accreditation of healthcare organizations.

Health-Literacy Resources and Books

Teaching Patients with Low Literacy Skills
Second Edition
By Leonard and Cecilia Doak and Jane Root.

This is the landmark text written for health-care practitioners and those who teach them. Since its first edition in 1985, it became the major resource book available to health providers who knew that the majority of people could not read the health information available. The authors were the sole voices telling health professionals to check not only the accuracy of their information but also the "quality of the learning aspects."

The authors show how to use the REALM literacy test and McLaughlin's SMOG readability formula for adjusting documents to the reading requirements of patients.

Health Literacy from A to Z
Practical Ways to Communicate Your Health
By Helen Osbourne

"If you don't know Helen Osborne, then you don't know one of the most practical and smart experts on health literacy around. Just get hold of Helen's new book, Health Literacy from A to Z. It's first rate, with loads of useful information and insight, an indispensible resource for anyone who wants to understand and work on this important issue." —John McDonough, Executive Director Health Care for All

Oregon's Plain-Language Bill

Addresses Agency Documents


Rep. Riley: waving a magic wand?.

ON March 13, Oregon House Representative Chuck Riley (D-Hillsboro) held hearings in Salem on House Bill 2702, which would require state agencies to use "plain language standards" when addressing the public.

In 1978, President Jimmy Carter ordered federal government workers to use words that are easy to understand. In 2005, Washington Gov. Chris Gregoire signed an executive order banishing bureaucratese from state agencies, and two months ago, Florida Gov. Charlie Crist did the same.

Many other states have similar legislation requiring plain language in agency documents, contracts, and insurance policies.

Riley, quoted in the Oregonian, says his proposal will save taxpayers money in the form of fewer customer service phone calls to state workers and more people complying with laws. "It's such a good bill that I can't imagine it not passing," he says.

Features of the Bill

The bill states that a written document conforms to plain language standards if the document, whenever possible:

  1. Uses everyday words that convey meanings clearly and directly;
  2. Uses the present tense and the active voice;
  3. Uses short, simple sentences;
  4. Defines only those words that cannot be properly explained or qualified in the text;
  5. Uses type of a readable size; and
  6. Uses layout and spacing that separate the paragraphs and sections of the document from each other.

The bill also requires each agency of state government to:

  1. Assign one individual to lead the agency's plain language standards initiative;
  2. Ensure that the individual assigned under this subsection receives adequate training in plain language standards;
  3. Prioritize the nonconforming documents to be rewritten based on frequency of use, receipt of complaints or questions, complexity and lack of clarity;
  4. Establish a schedule for rewriting nonconforming documents and track the agency's progress; and
  5. Incorporate the principles of plain language standards into employee training.

The Struggle Ahead

The bill may be easier to pass than to implement. While plain language is always a good idea, it requires changing the writing culture of large agencies. Managers don't always take kindly to new burdens for which they are not supplied new resources.

Plain language doesn't happen by waving a magic wand. Legislators might do better by funding a special commission that can promote plain language among agencies by offering demonstrations, motivation, and training. Managers must be won over.

One also has to ask why the bill exempts legislation and administrative law. Don't they also belong to the public?


How Plain Language Works
Two New Books from Impact Information

Smart Language: Readers, Readability,
and the Grading of Text
By William H. DuBay

Smart Language matches the reading skill of the readers. The first part of this book covers the national reading surveys. They showed that the average reader in the U.S. is an adult of limited reading skills. Nearly half read below the 8th grade. The second part covers the readability research.. 156 pages, Bibliography, Index. "Excellent historical research, and it's readable. I really hope it gets wide circulation." — Edward Fry Ph.D. Reading Consultant.
Read more...

Unlocking Language:
The Classic Readability Studies
Edited by William H. DuBay

In the first half of the 20th century, some of the best minds in education looked for ways of matching texts with readers. They inluded Edward L. Thorndike, William S. Gray, Ralph Tyler, Edgar Dale, Irving Lorge, and Jeanne S. Chall. Their story is briefly covered in the companion book Smart Language (above). Unlocking Language contains reprints of ten of their original studies. Reading them in context highlights their special place in the story of our language. Read more...


Plain Language in the News

The seductive use of jargon:
http://www.canada.com/topics/finance/story.html?id=51568fff-f70c-408e
-bb64-67c9c3c4e3f8&k=44756

Kids to learn plain language:
http://www.news.com.au/couriermail/story/0,23739,21266907-5007200,00.html

Firm sets benchmarks for document readability:
http://www.bizcommunity.com/Print.aspx?l=196&c=82&ct=1&ci=13480

Oyez, Oyez Plain Speak:
http://www.gulfnews.com/opinion/off_cuff/10110259.html

The language of science at UCI:
http://www.ocregister.com/ocregister/sciencetech/homepage/
article_1615908.php

Florida Governor launches two plain-language Web sites:
http://www.wakulla.com/Wakulla_News/Local_Government_News/Governor
_Crist_Launches_Two_Web_Sites_to_
Ensure_Citizen's_Access_to_Information_200702262719/

Baffling leaflets cost UK government 800 million ($1.570 billion US):
http://politics.guardian.co.uk/homeaffairs/story/0,,1996860,00.html

Executive pay reports confusing:
http://www.latimes.com/business/la-fi-execpay24mar24,1,7195179.story

Plain English, you know it makes sense:
http://commentisfree.guardian.co.uk/ben_beer/2007/03/ben_beer_
plain_english.html

Editors writing badly:
http://www.slate.com/id/2162282/?nav=fix

L.A.'s remedial plain language:
http://www.latimes.com/news/printedition/asection/la-ed-
plainlanguage09mar09,1,2225075.story?coll=la-news-a_section