Let’s play a game:
1. Grab any bottle of your prescription medicine.
2. Read the label.
3. Now try to interpret the information there
Do you have a clear understanding of the medications instructions? Do you know what that medication is for? What are the potential risks or side effects of that medication? If a recall is issued on that medicine, how do you know if you have the affected batch? What is the expiration date on your medicine?
Could you answer all of those questions? If not, don’t worry! You are probably like a lot of other Americans. The activity with your prescription bottle is a health literacy task. Health literacy is a patient’s ability to understand and interpret the instructions given by a health care provider related to their treatment. This can cover a wide range of things including reading medication labels, understanding your treatment options, or properly performing your home physical therapy exercises. Health illiteracy is a growing issue in the United States because medical technology is continually increasing in complexity, and patient education from health care providers has become somewhat stagnate.
Most of the time this may work out okay for all parties involved, but there are many incidents that occur, that may be preventable by an increase in the level of health literacy of our population. A 1995 study showed that only 52% of adults could understand 80% or more of the information given them by a healthcare provider. 15% of adults did not understand instructions on a prescription bottle, to take one pill, four times daily, 37% did not understand instructions to take medications on an empty stomach, and 48% were unable to determine if they were eligible for free care. While this study focused mostly on patient’s abilities to interpret medication instructions, it exposes a significant problem in our medical system. Even when instructions are clearly written on paper, or on the side of a bottle, many patients still have difficulty understanding what they are supposed to do (or not do).
This is particularly concerning to me, because I daily give out home exercise sheets, or give instructions for activity modifications. I wonder, are my patients doing these exercises correctly? Do they understand the instructions on the page? Do they understand what these exercises are for? Do they understand the frequency that they are supposed to perform the exercises? Do they know the risks or warning signs of “over doing it” with their exercises? I think I am explaining things well, and I think my patients understand, but how can I know for sure.
The answer to that question is not necessarily clear, but I think the key to success here is empowering our patients as health care consumers. Patients need to make informed choices about their treatment. The fundamental change in thinking comes about when we think of patients as customers. This forces us to provide greater levels of information and customer service.
Patients need to change their mindset as well. If you were going to buy a car, you would ask a lot of questions, kick the tires, take it for a test drive and choose an option that is financially good for you. Why wouldn’t you do the same as a consumer of healthcare services? After all, many of the healthcare decisions you make could be crucial to your survival, and your quality of life. Expect the highest level of customer service from your clinicians, and expect results. If your health or quality of life does not improve with treatment, seek other options. Ultimately you are responsible for your own well-being.
Once you decide to become an informed customer and consumer of health care services, you are presented with the difficult task of researching your condition, your treatment, and the providers you seek help from. There are multiple sources of information available, but selecting reliable information can be a challenge. Recent studies have shown that many patients use the internet to do research, which raises the question: How reliable is the internet? A 2001 study in the Journal of the American Medical Association found that only 20% of the initial search results returned by a search engine were relevant to the condition being searched. Of those that were relevant, only 45% provided at least minimal quality evidence, and all required at least high school level reading ability. There have been many studies reviewing the quality of internet information, and all have shown relatively low levels of good information. I am sure this is no surprise to anyone, but why do we continue to use the internet for this purpose when we know that the information we retrieve is typically bad?
I think the answer lies in convenience. So we as health care providers need to give our patients access to quality information that is also convenient. When looking for information related to your health and wellness you should look for peer-reviewed journals. In case you don’t know what those are, they are typically publications released by professional associations with the sole intent of informing practitioners and guiding practice. Some examples include:
The Journal of the American Medical Association (JAMA)
The Physical Therapy Journal (PTJ)
The Journal of Athletic Training (JAT)
The Annals of Internal Medicine (AIM)
The Journal of Orthopedic and Sports Physical Therapy (JOSPT)
The New England Journal of Medicine
These journals are published only after thorough peer review. This means that researchers study a subject and write a detailed report, and other researchers, scientists, and professionals in that field review the study to ensure that it is of the highest quality. Everything from placebo, to blinding, to statistics is assessed, and only if everything is of good quality will the study be published. While the process is not perfect, and the occasional bad study will get through, in general you can trust the quality of the information in these resources. So where do you find these journals or other high quality evidence?
The best source for you to access is http://www.pubmed.gov. This is a government-run website aimed at making quality health research more accessible. There is a lot of great info here, and you will be able to see your tax dollars at work. I have cited some articles below which support some of my previous statements, and I have included the links for you to try. There are other good sources of information out there, but you should be careful and perform a quality review before considering the information.
When you become an informed health care consumer, you only stand to benefit. When you have this newfound knowledge you can more actively participate in your care and will see better quality of care, and better results. Moral of the story is:
1. Don’t be afraid to ask questions of your doctor or therapist
2. Understand your treatment
a. Make sure you are doing it right
b. Make sure you know the risks and rewards
3. Research your treatment, and all your other options using quality sources of information
Check out the articles below and enjoy becoming an empowered health care consumer!
Parker et al. (1995). The test of functional health literacy in adults: a new instrument measuring patients health literacy skills. Journal of General Internal Medicine.
Bergland et al. (2001). Health information on the internet: accessibility, quality and readability in English and Spanish. JAMA