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Simplifying medical terms

Providing health literature that is easy to understand is a challenge for local organizations.

BY CYNTHIA H. CHO
247-4744
February 11, 2007
In December, the Virginia Health Information commissioned freelance writer Marjolijn Bijlefeld to create brochures on medical procedures. The Richmond-based organization, which publishes consumer friendly health literature, planned to make those documents available on the Internet this spring.

When Bijlefeld, who is based in Fredericksburg, submitted the first drafts a few weeks later, she was asked to revise them - specifically, to make them easier to understand.

While reviewing what she had written about laparoscopy, she considered replacing "is punctured" with "is torn"; "diagnosis and/or treatment" to "to find and treat."

Health-care professionals say it's a constant challenge to provide written material that their audience will understand. Many Americans, they say, have low "health literacy," in part because many people have low basic literacy skills.

On the Peninsula, about 25 percent of adults 25 years of age and older are at or below a fifth-grade reading level, according to the Newport News-based nonprofit Peninsula READS.

Low health literacy often is linked to poor communication between patients and health-care providers - which can lead to mishandling of medication, more hospitalizations and, ultimately, higher health-care costs. According to the Center for Health Care Strategies, Inc., a New Jersey-based nonprofit, low literacy resulted in an estimated $32 to $58 billion in additional health care expenditures in 2001.

Meghan Foster, executive director of Peninsula READS, said someone who is at a fifth-grade reading level would not be able to read a newspaper, balance a check book or fill out an insurance form.

That person would have trouble reading this sentence: "This is the age of the computer. The computer is a machine that works with facts like names and addresses."

Foster said it is not unusual for people who receive tutoring from Peninsula READS - about 450 people each year - to bring medical forms to the center, to ask their tutors for help in filling them out.

"All of these people are going to need medical care at one time or other," Foster said of the people with whom she works. "If you think about someone who is unable to fill out a patient information form or read a label off a prescription bottle - that's scary. Think about how easy it would be to overdose on medication."

According to the Institute of Medicine of the National Academies, 90 million Americans have difficulty understanding and using health information. The Institute defines health literacy as "the degree to which individuals can obtain, process, and understand basic health information and services needed to make appropriate health decisions."

About a year ago, the staff at the Lackey Free Family Medicine Clinic in York County stopped asking first-time visitors to fill out patient information forms. Instead, staff members began to sit down with new patients, ask them questions and jot down the answers.

"Patients were having a great deal of difficult filling them out because of the reading level and low comprehension of health terms," said Kay Bradley, the clinic's executive director. The clinic also recently reviewed all of its written material - "everything that a patient has any interaction with," according to Bradley - to make sure that all medical terms were clearly defined and easily understandable. Changes made include changing "hypertension" to "high blood pressure."

CENTER USES PICTURES

At the Maryview Foundation Healthcare Center, located in Portsmouth, director Dr. Amy Price said the brochures made available to the clients are "mostly pictorial" and have "as few words as possible."

Some of the patients at the center - which serves people who earn less than twice the federal poverty guideline; for a family of four in 2007, that is $41,300 - cannot read much or at all, Price said.

Price said she has considered administering literacy assessments with new patients, as some medical facilities around the country have done. But she decided against it.

"When you test people, you offend them," Price said.

"They think, 'I am here for my medical problems, why are you asking me about reading?' It's a sensitive issue in terms of patient satisfaction. We haven't figured out the best way to handle it."

What seems to be working so far, she said, is that her staff is aware of this problem and pays extra attention to patients' behaviors and responses to written and verbal instructions.