?sdrawkcab daer ot drah ti t'nsI ?siht daer uoy naC

There's a lot to learn during medical school. As a society, we know a lot more about the human body, mechanisms of disease, and evidence-based medicine than we did 100 years ago. there are thousands of medications being prescribed with mechanisms of action and clearance, indications, adverse reactions, and drug interactions to memorize, and they each have several names. There's a lot to learn, and medical school has not become longer in the last 100 years.

I'm still learning, and once in a while, there's a lecture that makes something really click for me--a new way of looking at a problem or organizing it in my head. The last one for me was on health literacy, and I hope I never forget it.

Can you read the subject line of this post? My professor handed out a whole paragraph of instructions for us to read but the words written backwards. His point? That process is what it is like to read with marginal literacy skills. If reading is difficult for people, so much effort goes into individual letters and words that the meaning of the whole sentence or paragraph might get lost in the process. That was a pretty dramatic example for me, but how many of patients would this apply to? Here are some stats:

• 48% of Americans (53% of Bostonians) cannot consistently read a bus schedule or identify information from a bar graph


• 21% cannot enter information on a Social Security application


• Patients will low literacy are 4 times more likely to be non-compliant with Anti-HIV meds


• Low literacy patients are more likely to be hospitalized, to have poorer glycemic control, to have late stage prostate cancer at presentation.


• 68% of low literacy patients have never told their spouse about their reading problems

This lecture absolutely blew me away. In a busy office, we rely heavily on the written word. Primary care doctors do many things, but patient education is usually a large portion of the visit. Well, it should be, but often the office is busy. Instead, I just hand the patient a print out on their disease and the medication side effects and send them on their way. After being in the medical world for long, I forget that my patients might not know what "inflammation" or "contraception" mean. I thought I would never use medical jargon when talking to patients, but I catch myself doing it all the time.

What's the solution? Unfortunately, all the solutions require time, which is usually short. However, being aware of the problem is the first step. I set two goals for myself:

• Be aware of medical jargon use.


• Ask patients to repeat back instructions to me.

I made these changes to my education practices in ophthalmology clinic, and so far, I have caught some communication errors (e.g. one drop four times a day vs four drops once a day)!