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Work With Me, Doc

Maureen Larkin, for HealthLeaders Media, August 28, 2008

Have you seen the report that says "illiterate" healthcare consumers cost the United States more than $100 billion each year? It's a frightening number, and even scarier when you consider this figure doesn't include the costs of poor outcomes resulting from a patient's lack of a basic understanding of their health and treatment options.

So I guess it shouldn't surprise me to hear the industry talking about the need to increase the health literacy rate of consumers. Patients have to be "trained" to talk to their clinicians, some say. They must educate themselves about common medical terms and think ahead about the questions they want to ask about their diagnosis and treatment options. A "literate" patient will go a long way to solving the quality issues that plague our healthcare system, they say.

But I've got to ask: Why is it my responsibility as a patient to educate myself on something that my doctor already knows? Why can't my doctor—who is already well educated in the subject—take the time to explain my condition to me in a way that I will understand?

Don't get me wrong. I'm not saying patients should sit back and let the doctor make all of their healthcare decisions. I'm all for patients being involved in their care. In fact, I like to think that I'm one of these engaged patients. When I or someone in my family receives a diagnosis, I'm immediately online looking for information that will help me understand it. But I don't believe my 30 minutes of Internet research will make me an expert. I use what I find online as a guide to help me ask the right questions. When there's a healthcare decision to be made, I want an educated, experienced healthcare professional to help me make the right choice.

Physicians have years of classroom and on-the-job training. They're put through the rigors of residencies and fellowships and have worked in various parts of the hospital to gain a complete understanding of the conditions that I and other patients may present. In my mind, this experience has made them experts in their field. So the idea of "training" patients to talk to their physicians seems a bit absurd. Why does making the right decision in healthcare fall strictly on the shoulders of the patient? Don't doctors already have the knowledge needed to help patients make the right decision?

The problem isn't just that patients lack an understanding of basic medical terms. It goes deeper than that. Our healthcare system isn't designed to give physicians the time to sit down, educate, and counsel patients about their illnesses and treatment options. Patients often complain that their doctor spoke a lot of "medicalese" and left the room before they had a chance to digest the given information. This situation is all too common, and one that, when repeated time and time again, does little to help patients become more interested and involved in their own care.

Improving patient engagement and understanding isn't just a job for the patient—but one for the entire healthcare industry. Physicians need to be encouraged to spend time with patients and translate these medical terms that members of the general public just don't understand. In short, doctors need to speak the language of the patient. Doing so will eliminate the fear and intimidation that many patients face during an office visit and encourage them to get more involved in their own care.

The secret to giving patients a higher quality healthcare experience doesn't fall on just the patient. Quality healthcare requires a partnership between patients and providers. All of us—patients and providers—have some work to do.

Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
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1 comments on "Work With Me, Doc"


denmar (8/28/2008 at 2:24 PM)
Maureen, Thank you for your article: "Work With Me Doc" in today's HealthLeaders Media Quality Leaders e-zine. Although I appreciated your comments and read the article with interest, I'd like to offer another perspective on things. I have been in the health care industry since 1964, am an RN, and have been a CEO of two different organizations, including a large regional hospital. I formally retired in 2001, but quickly became bored and jumped back into the frying pan, albeit at a slower pace with less stress. My current position is as Chief, Performance Improvement and Risk Management for a large ambulatory care facility. In 1998, while I was the CEO of a hospital in Louisiana, my wife discovered a very small, but concerning lump in her right breast. Although she has polycystic breast disease, she wanted it checked out. The chief surgeon, who was also my chief of the medical staff, felt it was nothing to worry about and didn't feel a biopsy or removal was necessary. We sought a second opinion from a surgical oncologist, who basically agreed with the first surgeon, but because it was of concern to my wife, performed a lumpectomy. To his surprise, and our distress, the pathology report came back positive for Breast Cancer. The oncologist felt the lumpectomy would be the end of any necessary treatment because the lump was so small, approximately 2mm. My wife is also a very experienced RN, so we consider ourselves to be very well versed and "literate." Like you, when your family is faced with a diagnosis, we immediately hit the internet looking for information. We found more information than we were prepared to deal with.some of it absolute voodoo, but some of it very useful. When we talked with the oncologist about follow on care and treatment after the lumpectomy, we brought up the many things we found in our internet search. In an attempt to allay our fears and concerns, he stated that "no other treatment was necessary and that he could basically wave a set of beads over my wife and she would be considered cured." Not only did that disappoint us, it angered us. Something so personal and so important to us was basically dismissed by his innocent, but inappropriate comments. We pursued our concerns and he agreed to do a sample node biopsy (which turned out negative) followed by a course of radiation therapy. My wife remains cancer free at this time, but every day is a gift for us, and the unthinkable is always present and is always a threat. Had he understood that better, I'm sure he would never have made the remark he did, but just like pounding a nail through a piece of wood, then removing it, the hole remains long after the nail is removed. While I agree that there is a mutual responsibility for health literacy between the provider and patient, I think the provider must be able to not only explain health care issues in a language their patients will understand, but must also be able to place themselves in the shoes of their patients and think about the impact of the comments they are about to make. All the years of classroom and on-the-job training for this physician may have gained him a complete understanding of medical conditions, but didn't fully prepare him to relate to us as one human being to another. and that is an area where we most certainly "have some work to do." Thank you again for a great article. Dennis Marquardt