Tuesday, January 30, 2007

Doctor Talk

The New York Times Jane Brody writes today about "health literacy". Most people are health illiterate and leave their doctor's office with more questions than answers.

National studies have found that “health literacy” is remarkably low, with more than 90 million Americans unable to adequately understand basic health information. The studies show that this obstacle “affects people of all ages, races, income and education levels,” Dr. Richard H. Carmona, the United States surgeon general, wrote in the August issue of The Journal of General Internal Medicine, which was devoted to health literacy.

The fallout is anything but trivial. Researchers have found that poor health literacy, which is especially prevalent among the elderly, results in poor adherence to prescription instructions, infrequent use of preventive medical services, increased hospitalizations and visits to the emergency room and worse control of chronic diseases.

The consequences are poorer health and greater medical costs. All because doctors fail to speak to patients in plain English (or Spanish or Chinese or any other language) and fail to make sure that patients understand what they are told and what they are supposed to do and why.

This is a major problem. In our office, one solution is a monthly health night conducted at the local library. It is free and patients are welcome to bring friends and family. People may ask any question--we don't necessarily have all the answers but we can help patients get them. The atmosphere is relaxed and conversational. It actually saves in-office time, because more than one person is being educated and patients know they have a forum to bring up questions if they don't "get it" the first time.

But what if your doctor doesn't conduct an information night? What can a patient do to help themselves? Here are some tips:
  1. Bring a friend/family member to the appointment. This is especially important if you fear what the doctor is going to say. Is this a potential cancer/diabetes/heart disease/stroke/Alzheimer's, etc. conversation? You need someone with you. First, under stress, you won't hear all the information. Your friend will. Second, you need someone to drive you home, while you process the information. And make sure the companion takes notes. This person might have questions you won't think of, when you're on the spot.
  2. Ask clarifying questions. Most people won't ask, "what does 'hematoma' mean?" They're too afraid to look stupid. By the time they get home they've forgotten the word and can't look it up on the internet and they can't call the doctor because they'll look doubly stupid--they don't know the word and they don't know what it means. But if they ask, they'll know the answer. Is this scary bad or just a little bad? And if the patient doesn't know the problem, how can they know how to interpret the solution? It is imperative that the patient ask lots of questions. (By the way, hematoma is just a dressed up word for bruise, but it can have serious implications depending on where it is in the body.)
  3. Ask again. I remember when my son was in the NICU and the nurses gave me information about all the monitors and medications. At that point, I was still numb and in la-la land from just giving birth to 24 week, premature babies. About three days later, I started coming to and asked them to repeat everything they told me before, except slowly this time. They happily did just that. Even with fresh medical training, I just couldn't process during the stress. Any doctor will tell you that it's a whole different bunch of bananas when you're the patient. Sometimes knowledge can inhibit even doctors from asking--they, of all people, don't want to be viewed as stupid. Here's the thing though, the medical field is changing so fast, with so many specialties, that no one doctor can stay on top of it all. So doctors ask questions, too.
  4. Ask these questions:
    1. Are there alternatives to this treatment?
    2. How often do you perform this procedure? When my husband got cancer and his doctor told him that he "saw this about once a year", guess what? We found a doctor who saw this every day. You want an expert.
    3. What if I don't take this medication/do this procedure? Sometimes not doing anything has an almost equal success rate. You need to know that. Sometimes not doing anything is deadly. You need to know that, too.
    4. Would you do this treatment?
    5. How long will I have to take this medication? If the answer is "forever", go to question #1.
    6. How does this medicine interact with these (your other meds)? He might not know. To follow up, ask the pharmacist.
  5. Tape-record the conversation. If that freaks the doc out, just say, "I'm afraid I'll forget what you say and I know it's important."
The article goes on to give doctors advice about how to communicate with patients, but don't count on doctors doing it. Your health is most important to YOU and no one has to live with the consequences but you. Don't be a human New Orleans, waiting for someone to rescue you from your health.

Take charge. Communicate. It could be a matter of life or death.

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