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From: Jeri Levesque <levesqjr@webster.edu>
To: Multiple recipients of list <nifl-health@literacy.nifl.gov>
Subject: [NIFL-HEALTH:3442] Re: On the credibility of health literacy efforts
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Deborah, (Warning LONG post)
Thank you for underscoring my position that regardless of literacy
level, patients have the right to self determine treatment options. In
response to your question,
How far can we reasonably expect health care providers to extend,
change, or initiate efforts to communicate with low literacy patients?
The literacy issue involves access to information that the patient can
understand and use for decision making. The multi-media (print, posters
with drawings,, videos, Internet sites, interactive CD roms, face to
face conversation) is complex and needs to be coordinated by someone
fluent in health literacy. I've watched such a project evolve at a major
medical center here. They established a special room for patients to sit
and read (no,, not outdated issues of People magazine - pamphlets and
brochures), listen to audio tapes, do Internet searches, and view a
video. The project is lead by a nurse who joined our Health Literacy
Collaborative over five years ago. The shortcoming is that I've never
seen anyone in the room. Patients sign in for the doctor down another
hallway, the mammograms are down yet another corridor. I know Rima Rudd
at Harvard did a Pfizer study on "reading hospitals" - navigating one's
way to the information center often requires a tour guide. She is right
on the mark . Once a patient finds the right room, (here the information
center) he/she may well need a health literacy guide.
Time is another factor to consider which also supports the need for a
facilitator. At the major medical center, everyone I encountered was in
a rush. After my initial diagnosis, I left my surgeon in a state of
shock, not really sure about his message. I'd waited over an hour and a
half for "my turn" and was on the street 15 minutes after he walked in
the examining room. I sought a second option (recommended) and once
outside the university center, into a private practice, I was
stumfounded at the pace of my initial visit. The plastic surgeon showed
me photographs, drew pictures of the procedure, had "hands on" demos,
used plain English and actually paused for me to think before responding
or asking questions. I could've been at Level I on NALS and made a
rational decision based on the communication skills that transacted
between us. Deborah, this supports your key thesis - practitioners
should not usurp a patient's independence - but must be open to either
directly providing support for communication or have access to a health
literacy facilitator.
It is reasonable for a health practitioner to use a variety of
communication strategies to transmit information and then confirm that
the patient has made meaning that approximates the original message
("We're on the same page.") It is encumbant on the practitioner to make
regular use of auxillary information materials - in all fairness -
unless the effort is coordinated we can't expect the practitioner know
what is available for patients. This is much easier to manage in a
private practice than in a large medical center. My son is a second year
med student. Over 90% of med schools particiapte in the Robert Woods
Johnson Foundation program to "humanize" medicine. (It was ironic that I
had to explain the significance of the lapel pin worn by a third year
med student who tried to take my case history shortly after a 13 hour
surgery!) The use of language is one of the most critical attibutes of
human beings. The effort to use language and communicate effectively is
now a core of medical school training. We can conclude that if one lacks
here as a practitioner - the team approach to diagnosis, treatment and
well care mandates the inclusion of a communications specialist.
In short, the medical center and the private practitioner made concerted
attempts to enhance provider-patient communication. Multi-modality
delivery of the message, a team approach to communication, and time for
the patient to process and respond to the information were the key
elements of my successful health literacy experience.
It puts a spin on the way we sign off by saing, "Take Care"--
Jeri Levesque, Ed.D.
Associate Professor, Webster University
Director, Webster University Literacy Center
St. Louis, MO 63119
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