By: Elizabeth Oh
Doctor: "Why haven't you been taking your medications properly?"
Patient: "I don't know"
Doctor: "It says right on the paper work - Take twice a day."
Doctor: "Do you understand?"
Patient *nods yes
A far too common scenario.
A plea from a doctor to a patient about taking the proper steps for healing.
Frustrations and tensions are in the room.
Too many assumptions made on both ends.
Looming emotions shooting across both minds.
...Did you catch it? A possible reason?
Answer: The patient could not read and was ashamed to share.
To assume that in our "day and age" and with the "internet at our finger tips", that the rates of illiteracy may be low is a heavy understatement. During my time volunteering in local clinics abroad and in the states, I've noticed on a personal account that there are many individuals out there that simply can not read. Turns out, the research also supports this observation...
According to an NPR article, one in six adults in the United States have reading skills below a 4th grade level. Among this group, 66% adults were born in the United States while 34% were born abroad.
In a recent study published in July 2018, illiteracy was one of the death predictors in a Brazilian cohort (Inuzuka, et al)
According to the United Nations Educational, Scientific, and Cultural Organizations (UNESCO), there is Globally at least 750 million youth and adultsthat still cannot read and write while 250 million children are failingto acquire basic literacy skills.
So now that you, the global warrior that you are, are now more aware of illiteracy, you want to ask:
Are there tools developed yet to establish a bridge for illiterate patients?
Sadly, I have to say- It is in the works.
But... I do have personal recommendations for those that are not comfortable at all.
Disclaimer: My recommendations stem from my personal adjustments after seeing my immigrant parents do the silent nod during their primary care visits and is in no way a well-studied approach (since there is none at this moment).
Approaching a suspicion of illiteracy:
1. Be attentive to your patient's reactions and body language
are they nodding more than asking questions?
2. Ask them if they can read or if they have trouble reading the given material.
Usually when addressed, it is easier to say no.
3. Be open to using different visual aids as materials to communicate properly to your patient.
If you can, try to draw out something and explain what is going on and why their medication will help them.
4. Have them repeat back what you'd like them to do.
This is important. Don't forget this step as this affirms that the message is interpreted properly or poorly to the patient.
As a technologically advanced society, I believe we've relied too much on the printed document given at the end of each visit. As a team member that plays any role with someone's care,
we must be aware of the silent nods that exist and the potential chasm of communication that could be reduced between doctor and patient- abroad and in our Westernized clinics.
I hope this read was helpful and if you have any questions, please send them my way!
About the Author: Elizabeth Oh is a member of the Class of 2020 at Western University of Health Sciences College of Podiatric Medicine. She is also the the APMSA Alternate Delegate for the Class of 2020 and the student liaison to the American Board of Podiatric Medicine.