The Health-Literacy Crisis
Do You Understand Your Doctor?
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.
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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.
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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.
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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.
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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.
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| 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
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Oregon's Plain-Language Bill
Addresses Agency Documents
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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.
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Rep. Riley: waving a magic wand?.
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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:
- Uses everyday words that convey meanings clearly and directly;
- Uses the present tense and the active voice;
- Uses short, simple sentences;
- Defines only those words that cannot be properly explained or qualified in the text;
- Uses type of a readable size; and
- 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:
- Assign one individual to lead the agency's plain language standards initiative;
- Ensure that the individual assigned under this subsection receives adequate training
in plain language standards;
- Prioritize the nonconforming documents to be rewritten based on frequency of use,
receipt of complaints or questions, complexity and lack of clarity;
- Establish a schedule for rewriting nonconforming documents and
track the agency's progress; and
- 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
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
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