Report cites Americans' lack of health literacy'

WASHINGTON -- Nearly half of American adults face higher risks of health problems because of trouble understanding medical terms and directions, specialists said yesterday in a report that calls for a national effort to improve health literacy.

Comprehending medicine's arcane jargon can be difficult for even the most educated of laypeople. It's almost impossible for millions who can't read well, aren't fluent in English, or have vision or cognitive problems caused by aging.

Now the prestigious Institute of Medicine has put a number on just how many people have "limited health literacy" -- a surprising 90 million adults.

They have problems following instructions on drug labels, interpreting hospital consent forms, even understanding a doctor's diagnosis and instructions, the report said.

"It's a shocking figure," said Dr. Carolyn Clancy, director of the government's Agency for Healthcare Research and Quality. Her agency released a second health literacy report yesterday that suggested ways to help, such as with easy-to-read health guides.

Low health literacy, exacerbated by the increasing complexity of the nation's health care system, contributes to health disparities among the poor and minorities -- and may cost billions of dollars, the Institute of Medicine report concludes.

"It's a public health problem, a societal problem," said Dr. David Kindig of the University of Wisconsin, who was chairman of the institute's two-year probe.

Numerous studies show patients with limited health literacy are more likely to need hospital care, have poorer health habits, and are less likely to use preventive services. That in turn increases costs. One study found hospital spending is $993 higher, on average, for a patient with inadequate health literacy.

Shame and stigma play a big role, the report found. Patients are embarrassed about difficulty reading or worried that the doctor will think they're stupid if they ask questions.

Even the college-educated can have a hard time with examples like this one from the institute: "Patients should be monitored for extraocular CMV infections and retinitis in the opposite eye." That instruction wasn't written for doctors -- it was on an information sheet for patients.

Another example cited: One mother poured an oral antibiotic into a 2-year-old's infected ear -- because the prescription label didn't say to swallow the liquid.

In videotaped sessions with patients, the institute documented worrisome misunderstandings: A mother misread how much medicine to give her child. A woman didn't realize she was signing a consent form for a hysterectomy. A man thought his doctor considered him "hyper, can't sit still" because she diagnosed him with hypertension, the medical term for high blood pressure.

"This goes across all social strata, even people who can read well," cautioned Dr. John C. Nelson, president-elect of the American Medical Association.

Health literacy isn't a new problem. US Surgeon General Richard Carmona has made the issue his cornerstone; the AMA has long sponsored efforts to improve doctors' communication; and pilot programs to help Medicaid patients or people in adult reading classes better understand health instructions are under way in several states.

But if doctors actually quizzed patients about what they understood after a visit, they'd be stunned, said Dr. Harvey Fineberg, president of the Institute of Medicine, which advises the nation on health.

Among the report's recommendations:

The government should pay for research on ways to improve health literacy.

Health organizations and medical schools should teach health literacy and how to communicate with patients.

Medicare, insurers, and other health groups should develop creative ways to communicate clear health information.