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6 Ways to Improve Patient Communication and Address Health Literacy

By Jennifer Larson, contributor

Have you ever talked to a patient in an exam room or by a hospital bed, and then walked away and wondered if they’ll follow up on the suggestions or instructions that you gave them? 

It’s very likely that they won’t—not entirely, anyway.

Here’s what you’re up against, according to researchers:

  • Between 40-80 percent of that important medical information conveyed to patients will be forgotten almost right away;
  • And approximately half of what they do remember is remembered incorrectly, according to the Agency for Healthcare Research and Quality (AHRQ)1;
  • Just 1 in 10 patients are considered proficient in health literacy.

Many well-meaning physicians and advanced practitioners do not realize the depth of the patient communication problem. 

"It’s just a blind spot," said Heather Bittner Fagan, MD, MPH, a practicing physician and associate vice chair for research in Christiana Care Health System’s Department of Family and Community Medicine. "It’s one blind spot that is worth becoming aware of because it really is something that you can improve." 

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The problem of low health literacy

Most people are not health literate. Lower education levels, limited English proficiency, disabilities, even age can play a role in affecting their ability to understand and process health information well enough to make good choices about their health. 

Yet health literacy isn’t just an issue that affects people with limited English or low literacy skills. 

In fact, just 12 percent of adults have what is termed "proficient health literacy," according to the National Assessment of Adult Literacy (NAAL). That means that they’re able to understand health information well enough to make appropriate decisions about their healthcare. 

Even among the 12 percent who are considered proficient, you can’t count on that proficiency all the time. 

"Everyone has low health literacy at some point," noted Steve Sparks, health literacy director at Wisconsin Health Literacy. 

Sparks cited several factors that can temporarily reduce a person’s health literacy, including certain medications, stress and illness. All of these can reduce a person’s ability to really grasp what’s happening to them, and what they should know about how to take care of themselves afterward. 

Fortunately, there are tools and resources available to help you better communicate with your patients. It starts with being aware of the problem and then determining what you want to work on first.

6 strategies to improve patient communication and understanding:

1.  Make a human connection.

Paul Smith, MD, is the medical advisor for Wisconsin Health Literacy, but he’s also a practicing physician. When he walks into an exam room, he sits down and faces the patient. He looks them in the eye and he smiles at them. It doesn’t take any extra time, but it sets the tone. 

"These things are like an instant human connection," he said. "You can make people feel that you give them your undivided attention."

2.  Use Teach-back

The Teach-back technique is a strategy for improving communication between clinicians and patients, and promoting better comprehension. The clinician strives to explain information as clearly as possible and then asks the patient to explain what they heard, using their own words. Then the physician can hear what the patient thought they said and clear up any misinformation before they walk out of the office or hospital. 

Clinicians should acknowledge that they’ve shared a lot of information and then ask patients what they remember or how they would explain everything to their family when they get home, said Barbara Andrews, MPPM, MPH, director of grants and projects for the Institute for Healthcare Communication, which offers training and resources on numerous topics. 

"It’s asking an open-ended question, and then closing your mouth and listening and then reflecting back," said Andrews. 

3.  Define medical terms that you use

It’s understandable that you might not already be doing this, at least not every time. "Physicians can hesitate to translate because they’re fearful things will get lost in the translation," said Bittner Fagan. 

But patients often don’t understand those precise medical terms that you use, and they’re often too intimidated to ask what they mean. That’s why Smith has gotten into the habit of quickly defining medical terms as he goes along. If he uses the word "pharyngitis," he automatically follows it up with a quick phrase like "which means a sore throat."

You may not be able to completely avoid medical jargon in your patient encounters, but you can at least make it easier to understand for your patients. 

4.  Ask the patient what he or she wants to talk about.

Before wrapping up any patient encounter, Bittner Fagan likes to ask this question: 

"Is there anything else you wish that I had asked or that you wished to talk about?" 

It gives her patients the chance to bring up any unresolved questions or concerns they have without feeling like they must do it first. Sometimes, she gently suggests that they schedule a follow-up visit to address particular concerns, to give them adequate time. 

5.  Use a medical interpreter.

Sometimes, a person’s limited English proficiency is an obstacle to good communication. In this situation, your best bet is to call in a trained medical interpreter. Experts generally recommend that you should not rely on a family member, especially a child. 

6.  Follow-up with written instructions. 

It’s easy to overload a patient with a lot of information that they may or may not understand, said Smith. Keep that in mind as you interact. Watch your patient’s face for signs of confusion and continue to ask open-ended questions. 

Then provide some handouts written in easy-to-understand language—this is usually called "plain language" by the CDC and others—to send home with them. The written information should clearly spell out what they need to know when they get home, which may include medication instructions and other follow-up care. If you have a patient with limited English proficiency or low literacy, find out if they have someone who can read the information to them.

    It’s easy to overload a patient with a lot of information that they may or may not understand, said Smith. Keep that in mind as you interact. Watch your patient’s face for signs of confusion and continue to ask open-ended questions. 

    Then provide some handouts written in easy-to-understand language—this is usually called "plain language" by the CDC and others—to send home with them. The written information should clearly spell out what they need to know when they get home, which may include medication instructions and other follow-up care. If you have a patient with limited English proficiency or low literacy, find out if they have someone who can read the information to them. 

    Patient communication resources:

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