When Your Patient Can’t Read Along

An ill patient who cannot understand his diagnosis has two problems. More problems add up if he cannot follow your written instructions. Trouble with words and numbers may lead to poorer health. It also puts him at extra risk of a bad outcome. Outcomes linked to the patient’s reading or math ability can mean trouble for caregivers. Sometimes that includes doctors and nurses who made no clinical errors. [8.3]*

Patient comprehension (i.e., literacy and numeracy) across the course of care and treatment, for both acute and chronic conditions, is, on average, well-below that of the average clinician. Because so much of health occurs along a continuum of collecting, analyzing, and responding to sequential information, we should not be surprised when a patient loses hold of bits and pieces of that information along the way. Those gaps in understanding the nature of his symptoms, the reason for the diagnostic tests and labs ordered, the particulars of his diagnosis, specifics of the treatment regimen, and your follow-up instructions leave sufficient room for allegations that the patient was not appropriately informed, educated, or followed. A jury of peers sorting through the complexities of the patient’s medical encounters and medical records may have a hard time parsing out empathy for the well-meaning physician; even one who followed the standard of care. [15.0]*

Data about health literacy (and numeracy) in the United States abound. Generally, they identify a significant gap between what most patients can understand about their health care and how that information is presented to them. Patients under the duress of sickness, pain, fear, etc., are likely even less able to grasp and retain the flood of information. You are safe to assume your patients will be safer with simpler forms, instructions, and education about their health. [11.0]*

Fortunately, advice and tools for simplifying clinician-to-patient information are plentiful. Some will help you with existing documents; others suggests alternate materials (e.g., video, web tools) that are increasingly accessible to providers and patients. Start by measuring what you need to tell your patients against what they really hear, read, and comprehend. If you’re worried that you’re oversimplifying, check with a colleague or risk manager for advice (and continue to include the boilerplate materials). Having the patient (or close family member) recount what they’ve read or heard may be the most informative method for you to determine if your patient truly knows what he needs to know. [12.0]*

*Numbers indicate the reading grade level for each paragraph of this article, as determined by one of many online tools available for such measurement. Recommendations for patient materials range from 5th to 8th grade reading level.

Additional Materials

• Health Literacy Activities by State
• Quick Tips to Help You Write More Clearly
• Plain Language Thesaurus for Health Communications
• Ask Me 3