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‘Does your patient really understand?’

‘Research shows that more than 80 percent of patients have poor health literacy. Cutting the jargon, asking direct questions and simplifying signage are among the ways hospitals are working to improve communication – and care.’

This is an abstract from an article with the same title, written by C Huff and published in the journal Hospital Health Network. I was moved to add these comments.

I haven’t read the full text of this article, but the topic is one that has been exercising doctors for some time here in the UK.

It has several strands, but most of them come back to money. Hospitals and medical facilities are coping with more patients than ever, but doing so with less money; and what money there is is being invested as much in layers of management as in better healthcare provision. One result is that patient “face time” is being cut to the minimum, and practitioners (some of whom, although they are no doubt admirable doctors, for a variety of reasons lack communication skills) often are unable to tell their clients what they need to know.

It is the same in the primary care setting. My own GP said to me last year that his best treatment tool was time – time to deal adequately with his patients’ needs, and to make certain that they both understood one another – but it was a tool that was missing from his toolkit.

In fact, he has introduced a simple method of reassuring himself that at least some of what he tells his patients has sunk in. I wrote about it in my blog, Oliver’s Twists, a couple of months ago (https://martynoliver.wordpress.com/2011/09/21/what-did-i-say/).

… And the next day:

I’ve just re-read my original comment, and I realise now that I appear to have responded to only part of the whole issue (the issue around which this LinkedIn group has presumably coalesced). There are of course other factors in play than the direct lack of understanding between healthcare professionals and their clients, and I should have recognised this in my first remarks.

For example, it is not only patients who suffer from poor health literacy; I work with the written output of clinicians and medical academics/researchers on a regular and frequent basis, and it is often very difficult to unravel what is really meant from what is actually said.

A further example might be the normally quite articulate and educated patient who is anxious to the point of stress at the realisation of illness and the consequences of treatment, and who fails to grasp what the practitioner tells them. (This is where the patient education programmes run by Emmi Solutions in the USA can be so valuable.)

And of course there has to be the will on the part of the healthcare practitioner to communicate as part of caring, no matter how “literate” the patient may be. Today is the day the Francis Inquiry into the failure of patient care at the UK’s Mid-Staffordshire Hospital officially concludes, and the National Health Service claims that there has already been a huge change in the way that patient care has been prioritised in UK hospitals. Bruce Keogh, the NHS’s Medical Director, declares that today’s NHS is “a much safer place than it was three years ago”. “What is different now,” he says, “is that the focus is not just on finance. We’ve put Quality right at the centre of our NHS, and all Trust boards are expected to focus on each and every service they provide in terms of effectiveness, safety and patient experience.” [“Today”, BBC Radio 4, 1 December 2011.] One has to ask where Quality was three years ago, if not at the centre, and why; and in light of Keogh’s claim, one has also to ask why there are still frequent reports of breakdown in care at ward level, where it counts the most. Often such breakdowns are failures of communication between staff and patient in the most basic of services, and the only conclusion can be that in such instances there is either not enough time, or not enough will, for staff to fulfill their prime duty of care.

The abstract was posted on the Health Literacy bulletin board at LinkedIn.

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