Hi Laurie, Julie et all:
   
  I just have to make a comment about the suggestions that have been made about Archie's email description of a doctor's appt. he experienced recently.
   
  I am a literacy council administrator/practitioner who knows Archie, what I'd say, well.  First of all, Julie -- you are right about putting the burden on not just the patient, but the doctor as well.  I feel that the current physicians and other healthcare practitioners in the marketplace need an attitude adjustment about providing accessible healthcare to every *one* of their patients - not to just those patients who carry in a medical dictionary or look up their disease and/or malfunctioning body part on the internet because they *can*.  
   
  Laurie - focusing on the new doctors being trained better and improving their "bedside manner" as you put it, punishes a whole lot of men and women with poor healthcare.  There are, we are told by statisticians who keep such data, an estimated 1 of every 5 adults in the nation who have a functional literacy problem.  Who is going to serve these adults well until there are new doctors who understand?
   
  In my opinion, the suggestions that have been made for the *patients* to do are not very realistic.  We are talking about people who lack basic reading and writing skills, who will take the word of an authority figure at the same level as God's word, and perhaps they lack *self-confidence* to question "The Authority".  This does not describe Archie Willard, I might add, but a lot of the folks it does.
   
  Let me give you an example:  Suggested is to write a list of questions to ask ....  Really.  I am tutoring a gentleman, hurt on the job and living with a serious back injury, whose literacy goal is to write a *short* love note to his wife.  He's unable to spell *those* words.  So is it realistic for this particular beginning reader, who is a patient with a legion of doctors, to write a list of questions?  No, I don't believe so.  
   
  Secondly -- let's say his *wife* writes the questions for him.  Will the doctor take the time to wait patiently until this 50-year old gentleman falteringly *asks* the questions that his wife would coach him to ask?  How about responding slowly and in plain English, giving an answer so this man so he can understand? I don't believe he'd get that cooperation. Do *I* feel this man is getting adequate healthcare?  Probably not.  
   
  For people like my learner to *wait* until another legion of doctors is *trained* is an inadequate answer.  Archie has done a terrific job of educating healthcare providers - giving a *face* to the need - yet even *Archie* wasn't heard by his own new personal physician.  
   
  Should he change doctors?  He did the research, I'll bet, into which doctor would be the best for him when he had to set an appt. with someone new.  Write a letter of complaint?  Now *Archie* could *do* that .... if given a *lot* of time to write, re-write and write again, but a whole lot of *my* learners would never be able to figure out the words to say - much less *spell* them correctly!  So what do *you* think?
   
  How many healthcare providers does it take to make an impact for *every* adult who deserves more than mediocre healthcare -- whether they are slow learners, elderly or someone from another nation?  This should *not* be happening to any of us.  Having a doctor fly out of an examining room has even happened to me.  Do I grab my doctor's sleeve?  Are you kidding?
   
  Nancy Hansen
  Executive Director
  Sioux Falls Area Literacy Council
   
  
Laurie Sheridan <laurie_sheridan at worlded.org> wrote:
  Hi, Julie--

I just wanted to comment that your questions are exactly the right ones
("But why is it that they all put the
burden on the patient? . . . How can we work with doctors and other
providers, as well as the systems
themselves, to promote improvement in communication? How should we
train
our doctors differently?") I and others automatically tended towards
individualistic, patient-burdening solutions, when clearly the system
and training need improvement.

I don't know all the answers to these questions. Some of them have to
do directly with overall health policy that increasingly limits doctors'
time with patients. But others can and should be addressed through
changes in the training of doctors, emphasizing in their training the
health benefits of clear and accessible communication with patients, and
better use of non-physician medical personnel and of accessible written
materials. I have heard of physician training programs that help
doctors improve their "bedside manner" through supervised communication
with actual patients, and requiring that some practicing physicians
enroll in training to improve their communication skills. But these are
both remedial, not built into how they are trained originally. These
are all probably steps in the right direction, but much more is
certainly needed. I hope you get some good answers from the health
care experts. 

Laurie Sheridan 



>>> julie_mcKinney at worlded.org 7/21/2006 9:46 AM >>>

Thanks for the support and suggestions. So far, we have: putting one's
hand on the Dr.'s sleeve, writing questions down before the visit,
asking questions early in the visit, bringing someone with you, and
writing a note or other formal complaint if needs are unmet. 

These are all great suggestions. But why is it that they all put the
burden on the patient? It's true that patients (all of us) have to be
bold, know that we have the right to clarify everything, and use
techniques like these. But there should be some burden on the health
providers as well. 

How can we work with doctors and other providers, as well as the
systems
themselves, to promote improvement in communication? How should we
train
our doctors differently? What can we do with the 10-minute appointment
problem? What other system improvements can we advocate for?

Vera, it sounds like you are from a school of medicine, and Ruth, your
title is "director of navigation services" (sounds like something all
health communitites should have!). Can either of you elaborate on how
the training of doctors, and policy affecting health care delivery
systems can be improved?

Is anyone else out there who is involved with medical training or
policy?

Thanks,

Julie

Julie McKinney
Discussion List Moderator
World Education/NCSALL
jmckinney at worlded.org 

----------------------------------------------------
National Institute for Literacy
Health and Literacy mailing list
HealthLiteracy at nifl.gov 
To unsubscribe or change your subscription settings, please go to
http://www.nifl.gov/mailman/listinfo/healthliteracy
----------------------------------------------------
National Institute for Literacy
Health and Literacy mailing list
HealthLiteracy at nifl.gov
To unsubscribe or change your subscription settings, please go to http://www.nifl.gov/mailman/listinfo/healthliteracy


 		
---------------------------------
Do you Yahoo!?
 Everyone is raving about the  all-new Yahoo! Mail Beta.
-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://www.nifl.gov/pipermail/healthliteracy/attachments/20060721/726fc233/attachment.html