Wednesday, March 30, 2011

Don't Use That Kind of Language Here

The other day, I was glancing at a new report from AHRQ announcing that 75 million Americans have limited health literacy, when I stopped abruptly. Unsurprisingly, the report found that low health literacy is linked with high risk of mortality and more visits to the ED, and recommended increased communication and education for all patients. But what piqued my interest the most was a line buried at the end of the report, which describes the National Action Plan to Improve Health Literacy, developed by HHS last year.

"The plan calls for improving the jargon-filled language, dense writing, and complex explanations that often fill patient handouts, medical forms, health web sites and recommendations to the public."

It made me wonder—how much of improving health literacy comes down to producing easily understood signs and pamphlets that ordinary patients can understand and act on?

As it happens, I read the report the same day I interviewed Spencer Hamons, a corporate project manager for Yukon-Kuskokwim Health Corporation in Alaska and formerly CIO at San Luis Valley Regional Medical Center in Colorado, for a podcast running Friday on the challenges and opportunities of rural health IT. During a conversation about ACOs, Hamons argued that successful providers in the accountable care age will need to see their facilities through the eyes of an average patient—and communicate accordingly.

"The terms that we use—we take those for granted, and…they create apprehension for the patient," Hamons told me. "Think about what goes through the mind of a 75-year-old patient, who's spent his entire life as a longshoreman. He goes into a room with a sign on the door that says nuclear medicine and has warning signs plastered everywhere. We expect that patient to give up a certain amount of control while they're in the hospital, but we don't do a very good job of explaining why."

Of course, effective signage is precisely the sort of low-tech solution that good hospitals already do every day. I've been in hospitals as a patient where the signs and pamphlets are written in clean, simple language that most patients and visitors, regardless of their familiarity with the health care system, can understand—and I've been in facilities where a medical degree is seemingly necessary to decipher the myriad warnings and protocols on the walls.

I'm not discounting the difficulty of reaching patients with limited understanding of the health care field and the challenges they face when interacting with doctors, nurses and other hospital staff. But communication is a two-way street, and effective signage and reading materials can go a long way in educating patients and making an often bewildering experience a little less so.

E-mail your thoughts and suggestions to


Steve said...


Health literacy is just the tip of the iceberg when it comes to the range of barriers to effective provider-patient communications. Factor in the costs associated with non-compliance due to poor physician instruction on medication-taking, the fact that physicians and patient disagree up to 50% about on their diagnosis and treatment, malpractice claims associated poor physician communication and poor communications turns out to be the biggest yet most "fixable" problem facing the health industry today.

For more details check out my blog Mind the Gap at:

Dan said...

Hayden, you are so right to call attention to the language barrier that often gets in the way of good patient communication. As a longtime health care writer, I face this issue every time I write for my clients. Establishing the appropriate context (Why should I care?), choosing accessible words, presenting the information in the right order and being concise are all factors in good health care writing.

I've also learned that the other essential aspect of written communication is the design of the materials. Colors, typography, illustrations, information architecture all go into lowering the barriers to reading, learning and complying with important patient instruction.

Hospitals are used to designing space that heals. Working with experienced graphic designers, I've seen the healing power of good graphic design, as well.

Spencer said...

A challenge to healthcare providers whether that be a physician, a nurse, a radiology tech, or a paramedic, is that we become jaded against the most basic yet scary aspects of healthcare.

When I was doing the podcast with Hayden, I mentioned that even the smell of a hospital, which many of us don't even notice anymore, can illicit fear for patients. Walking down the hallway next to the MRI and the sound that comes out of that room doesn't bother us. There is a whole myriad of activities, smells, and sounds in a hospital that make communication difficult.

Imagine if you were to go to a haunted house for the very first time at Halloween, and your accountant wanting to talk to you while lights were flashing and people were jumping out in strange outfits...people's screams are heard all around you. Would you feel comfortable making decisions at that very moment about how to invest your retirement funds?

Those of us in healthcare must learn to be considerate of the patients that are in our care. Not just physicians, not just clinicians, but everyone that interacts with patients, even when someone may consider their specific task in the care of that patient insignificant. I can promise you, the patient doesn't think you have an insignificant task.

Spencer Hamons

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