Clinicians must meet patients where they are. Determining their health literacy levels is a critical part of care that sometimes gets overlooked.
During a recent initial assessment with a patient in the ICU, I asked how he manages his medications, as chart notes indicated he wasn’t taking his medications as prescribed.
He told me, “I usually use the purple inhaler, but they gave me a red one at the pharmacy last time.”
When asked the name of his inhaler medication, he said he didn’t know. For a while, I thought maybe he just forgot, but later learned that he never knew it in the first place.
One of the guiding principles of social work is meeting patients where they are. In the healthcare setting, that includes talking to patients and their loved ones about their care and treatment in a way they understand. Being aware of patients’ and families’ health literacy levels is a big part of care that sometimes gets overlooked.
As a social worker, part of my job is to do an assessment that helps identify discharge barriers and readmission risks for each patient. While I often learn that factors like lack of reliable transportation or financial limitations keep patients from fully engaging in their treatment, I can’t tell you how many times I hear from patients that they weren’t clear on how to take their medications or why it’s important to take them as prescribed.
The health system often calls this “noncompliance,” which could imply that patients are choosing not to take their medications as directed. I’ve noticed that many patients truly don’t understand that their hospitalization is due to missing or incorrectly taking their prescribed medications. Furthermore, some can’t even explain what their chronic health issues are or what effects they have on their bodies and lives.
We often explain this to patients and families in person, in chart notes, and in discharge summaries. And of course, we’re all strapped for time, being asked to do more with less. But we’re asking patients to take on more and more responsibility for their healthcare with little to no extra support or resources; if they’re already struggling to understand their health, we’re just digging them a deeper hole.
How can you identify when the patient or loved one in front of you may not fully grasp what you’re telling them? To get a sense of someone’s health literacy without asking outright—which could stir up shame, embarrassment and anger—look for the following:
Frequently missing appointments, rarely/never following through with referrals or tests, asking few or no questions, only partially completing registration forms, taking medications incorrectly or not at all, have trouble naming their medications or explaining what they’re for or the dose they should be taking, identifying pills by shape and/or color instead of by name on the label, trouble giving a clear and sequential medical history.
Even if you’re not sure, it’s best to err on the side of overcommunicating. Try the following:
1. Briefly tell the patient what’s wrong.
2. Explain what they need to do and why, as well as what the benefits are of the medication/treatment/procedure.
For example, if you’re discussing a new medication with patients, tell them what it’s for, exactly how to take it, why they should take it and what to expect, including both side effects and benefits.
If you think patients and families might have lower health literacy, consider a few approaches:
1. Focus on what they need to know and do. Focus on only a few key points.
2. Use the teach-back method, asking them to explain what they heard in their own words.
3. Show, don’t just tell. Draw a picture, demonstrate, and/or use models.
4. Provide them with clear and concise educational materials.
5. Repeat and summarize. People often need to hear something multiple times for it to stick.
By spending a bit more time with those who show signs of lower health literacy, we can help patients and families feel less anxious and more included in their care. This can keep more patients out of the hospital.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.