If patients don’t understand what you’re saying, don’t expect them to heed what you’re saying.

Oklahoma’s State Department of Education publishes its students’ vocabulary lists for each grade level. Youngsters in the eighth grade, for example, are expected to know words like inertia, allusion and utopian.¹ If these words are representative of eighth-grade vocabularies countrywide, then at least half of adult Americans would struggle to define them correctly on a test.^2,3

Considering this information, how can ophthalmologists expect their patients to understand excision, astigmatism myopia, dilate or even pupils? Take this one step further, and it’s obvious why their comprehension of physician instruction and adherence to those instructions are limited, if not nonexistent.

Physicians have little time to explain why, for example, glaucoma drops are critical, or for that matter, what glaucoma really is. As a result, much of the patient education is delegated to technicians or to teaching models such as animated videos of disease states. Physicians, who have been trained with “medicalese,” incorporate words into their discussion that patients may not comprehend but are too embarrassed to ask for clarification. Since the average reading level in the US is around seventh or eighth grade, and since most patients only retain a small percentage of what was shared with them, treatment instructions are perceived as confusing and adherence to them frequently fails.

But, if we want our patients to improve, we need to enter into their world. (More on that aspect of health literacy next month.)

MORE RESEARCH, INSIGHTS

There are bright spots: the number of peer-reviewed articles on health literacy, even specific to ophthalmology, seem to be on the rise. None should come as a surprise to you, but together, these studies illustrate a serious problem that all of health care needs to address.

A sampling of what I found:

• A look at nearly 93,000 veterans from 2007 to 2009 found that those with inadequate or marginal health literacy cost the Veterans Administration $143 million more than those with adequate health literacy. The marginal and inadequate group comprised 17% of the total population.⁴
• A review of 160 patient-oriented ophthalmic web pages — 10 patient websites, 16 ophthalmic diagnoses — found that the reading levels were all above what the Department of Health and Human Services recommends, which is at or below a sixth-grade reading level. Anything above ninth grade is considered difficult. German researchers, who looked at 32 ophthalmology departments in university hospitals, had similar findings.^5,6

NOT ALL IS DISMAL

In another study, physicians incorporating education into visits for chronic disease patients found that patients fared better in their health outcomes as they became more proactive in their own care.⁷ This is what we do in our practice: incorporate education into the clinical visit.

Next month, practical help on staff training, products to invest in as well as outcomes. OM

REFERENCES

1. Building academic vocabulary. Oklahoma State Department of Education. http://sde.ok.gov/sde/building-academic-vocabulary#6 . Last accessed July 21, 2017.
2. Yamamoto, K, Khorramdel, L, von Davier, M. Survey of Adult Skills Technical Support. Chap. 17. Table 17.4, p. 15.
3. Crane Cutilli, C, Bennett, IM. Understanding the health aiteracy of America results of the National Assessment of Adult Literacy. HHS Public Access. Orthop Nurs. 2009; 28(1): 27–34.
4. Haun, JN, Patel, NR, French, DD, et al. Association between health literacy and medic]al care costs in an integrated healthcare system: a regional population based study. Last accessed Jun 3 27
5. Edmunds, MR, Barry RJ, Denniston, SK. Readability Assessment of Online Ophthalmic Patient Information.kJAMA Ophthalmology. Dec. 2013. ]http://jamanetwork.com/journals/jamaophthalmology/fullarticle/1763220%20 . Last accessed July 21, 2017.
6. Heim, N, Faron A, Fuch, et al. Comprehensibiity of online based patient education material in ophthalmology. Ophthalmologe. 2017 May;114(5):450-456.
7. Eckman, MH, Wise, R, Leonard AC, et al. Impact of health literacy on outcomes and effectiveness of an educational intervention in patients with chronic diseases. Patient Educ Couns. May 2012. 87; 2:143-151.

Cynthia Matossian, MD, FACS, is the founder of Matossian Eye Associates. Her e-mail is cmatossian@matossianeye.com