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Officials work to raise public's medical IQ

JANESVILLE — A patient who couldn't read randomly checked "yes" or "no" for questions on a health history form.

When a nurse asked why he had answered questions for women, the man made a joke to hide his shame.

Another patient didn't know he was taking medication for high blood pressure because the doctor had always referred to his condition as hypertension.

Area health educators cited the men as examples of low health literacy, an issue getting more attention because of rising health care costs.

In Rock County, nearly $152 million in unneeded health care expense can be attributed every year to low health literacy, according to a 2009 study by Dr. John A. Vernon, a professor in the Department of Health Policy and Management at the University of North Carolina at Chapel Hill.

In Walworth County, those unneeded costs total nearly $99 million.

The wasted cost for Wisconsin is $3.3 billion to $7.6 billion, according to Vernon's study.

In addition to unneeded expense, low health literacy can lead to inappropriate care, prolonged illness or even death.

A local committee wants to improve the area's health literacy with workshops for patients and better communication with health care providers.

What is health literacy?

Health literacy refers to how well a person can obtain, process and understand basic information and services needed to make proper health decisions.

It's a term a lot of people don't know, said Michele Erikson, executive director of Wisconsin Literacy, the umbrella nonprofit organization of Health Literacy Wisconsin.

"It's a burgeoning field that is connecting health care providers with the world of adult literacy," she said. "The aim is to narrow the gap between how health information is communicated and the capacity of individuals to really understand and act on that information."

A lot of health information is communicated at a very high oral and written level, but 20 percent of the population reads at the fifth- or sixth-grade level, she said.

Only 12 percent of U.S. residents are what researchers call "proficient" in health literacy, she said.

"Eighty-eight percent of us out there, even with higher education, struggle to understand health information and services and how to act on that," she said.

Wisconsin is a leader in creating health literacy awareness, she said. Health Literacy Wisconsin has been working with state organizations and health care providers to raise awareness, and most people are receptive, she said.

Hospitals are starting to address the issue because of mandates from The Joint Commission, which accredits and certifies health care organizations.

Where is it a problem?

Erikson said low health literacy is prevalent in three areas:

-- Improper emergency room use: Patients don't understand how primary care works and often go to the ER for things such as nosebleeds or ear infections, which drives up health care costs.

-- Hospital exit care: Patients leave with directions they don't understand. They might take medications incorrectly or misunderstand a doctor's instructions about how to care for themselves, resulting in reentries to hospitals.

-- Management of chronic illness: People who don't understand how to manage daily life with diabetes, asthma, heart disease or other chronic illnesses can increase health care and emergency room costs.

In their shoes

As an English tutor with The Literacy Connection in Janesville, Linda Wendt often accompanied her student Rosa Perez to doctor appointments during Perez's pregnancy and later for her daughter's early childhood checkups.

They practiced reading medical literature on childhood development and rehearsed questions for the doctor. Wendt said everyone—English and non-English speakers—should practice questions or write a list of questions so they don't forget when they're nervous or upset.

Shame plays a huge role in low health literacy, Erikson said.

Her organization stresses to health care providers that they can't tell by looking at a patient if the patient struggles with literacy. Shame can persuade a well-spoken, well-dressed person to hide low literacy, she said.

For others, a language barrier can prevent them from asking enough questions.

Or culture might be the problem. In many cultures, people don't ask questions of a man, "especially a man wearing a white coat who is well educated," she said.

Dr. Divya Sharma, a family physician at Dean Riverview Clinic in Janesville, focuses on speaking in layman's terms. Most of the time she avoids using terms such as "lipid lowering agents," instead saying "something to lower cholesterol or medication to bring your blood pressure down to normal."

What's being done

The Literacy Connection in Janesville is starting health literacy classes later this summer. The nonprofit organization helps adults increase their English literacy, but tutors have incorporated health literacy, Executive Director Cathy Jennings said.

Board member Silvia Donday will be teaching healthy literacy in Spanish, and other classes will be taught in English. Donday's class will focus on what patients should expect at the doctor's office—from filling out forms to describing symptoms.

"We need to empower the people to know what they could ask and that it's OK to ask," she said. "There's not such a thing like a stupid question."

Many doctors provide a written summary of an appointment, which is a step in the right direction, Sharma said.

"If we give 20 different directions (and) they're not written down, they're going to forget half of them and be overwhelmed and frustrated," she said.

Signs need to be improved, too, Jennings said.

"Does it have to say 'radiology?' Can it say 'X-rays?'" she said.

That's something Mercy Hospital and Trauma Center is looking at as it remodels its lobby, said Kathy Adams, director of education and organizational development for Mercy Health System.

Staff is getting feedback and testing signs to see what patients will understand so it will be "easier for the lay person to understand where things are."