Use these techniques to enhance understanding

Make sure your patients are getting the message

It’s up to you, the provider, to make sure your patients understand what you say to them. "Patients don’t come with labels. It’s very important for physicians to set up a system where each patient’s understanding is checked," says Mark Williams, MD, associate professor of emergency medicine at Emory University in Atlanta. That’s why you need to try to determine each individual patient’s level of literacy.

"People need to get information through a variety of different communication channels, but most physicians and most health plans think the old-fashioned way," asserts Scott Ratzan, MD, of the Academy for Educational Development in Washington, DC, and a member of the American Medical Association’s steering committee on health literacy. Instead of a giving patients a quick run-through from the doctor or a sheet of paper with instructions, Ratzan suggests using the Internet, videos, CD-ROMs, audio cassettes, and for illiterate people, visual presentations that don’t even have words.

Rewrite your patient information sheets to give the information as simply and plainly as possible, suggests Ruth Murphey Parker, MD, associate professor of medicine at Emory University School of Medicine and chairwoman of the AMA’s steering committee on health literacy. However, she cautions, you can’t assume that simplifying your written materials will necessarily bridge the gap. Find ways in your own office to re-engineer your systems to ensure patients understand what you are saying. Consider enlisting the aid of the office manager or the nurse to help patients understand their care.

"It may mean saying to the nurse, the office manager, or the pharmacist that they need to spend an extra five minutes with a patient because he doesn’t know how to read or isn’t understanding the instructions," says Barbara A. DeBuono, MD, MPH, medical director, public health for Pfizer in New York.

"The information system in most physician offices is paper-based and dates from when they started the practice," Ratzan points out.

Revise your forms to make them simpler and have a couple of places that prompt you to ask for the same information in a different way to make sure you are getting everything you need to know. If the nurse or someone else asks for patient information verbally, try to ascertain what they are asking and how. Do a mini-trial to find out if the information you are getting is accurate. "I guarantee that there is information you need that is slipping through the cracks," Ratzan says.

Look at what your patients take home with them. Do they get only a prescription slip, or do they get something that gives them information about their care? Give patients additional information beyond just the prescription. Refer them to their health plan’s toll-free number or an Internet site for more information. "In a competitive marketplace, physicians have to have value-added services. Giving patients more information can be a big help because it shows the patients that you care," Ratzan says.

Here are some other tips for ensuring that your patients have the information they need:

• Make an assessment of every patient. Ask yourself if this patient is struggling with health literacy because of culture, illiteracy, or for other reasons.

• Make it a point to use language that your patients can understand.

• Use visual and other cues to make sure patients understand the appropriate treatment plan and what they should do to follow up.

• Develop materials that don’t require high literacy to understand them. Remember that if a patient can’t read, it doesn’t help to give him a brochure or information sheet.

• Ask your patients to show you or "teach back" how they are supposed to take their medications or what diet they should follow.

• If you find that patients don't understand what you are saying, develop strategies to deal with that. You could refer them to an adult literacy program. Or, in the meantime, show them a video about their disease.