Are You (Health) Literate?

13 02 2013

plainenglishHow’s your health literacy? Literacy, in this instance, doesn’t only mean can you read and write—are you literate. It means can you read instructions on a bottle of medicine, can you listen to a healthcare professional tell you about your health problem and walk away fully understanding what she said, and can you then figure out how to get the care you need for that particular problem?

The IOM defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”

Po-tay-to, po-tah-to.

By any definition, I suspect that most of us fall short of acing the health literacy quiz.

I went in to see my dermatologist last week. Every year I go to her office, she looks at my rosacea, and renews my prescriptions.

And every year I learn something new about my meds.

I’m not sure if she’s not offering all the information or if I’m not retaining it.

This year, I learned that I have to take Oracea® at the same time every day because it lasts 24 hours. If I take it at 6:00 p.m. one day and 7:00 a.m. the next day, that’s too often, and if I take it at 7:00 a.m. one day and 6:00 p.m. the next day, that’s not often enough.

I could swear that she did not tell me this basic piece of information at any time in the past. (I’ve been taking this pill for three years.) She could swear that I’m not paying attention and that she did tell me at some point.

I looked at the bottle when I got home and directions were to take one capsule by mouth one time daily (didn’t mention the same time of day thing).

I don’t know. It’s hard to say where the communication fell down. The point is, it did.

So what can we as patients do about our health literacy?

There’s a lot of info on the web for clinicians and others on how to communicate with those who have low health literacy. In other words, putting the onus of improvement on the provider.

That’s good. Many providers don’t talk the talk of the non-scientist. But what can we do to keep up our end of the relationship?

It’s harder than you’d think. Because we’re not medically trained, we don’t always know to ask certain questions. We rely on the provider to tell us what we need to know (and then some).

One provider I saw recently wanted to prescribe a medicine that I’ve not used before. What are the side effects, I wanted to know.

He snorted impatiently and pulled out his smartphone and showed me a list and said he didn’t have time to go through them all, but if I wanted to sit there and read them I could.

Hmmmm.

On the other side of that coin, I don’t write down everything a provider tells me about a new medicine. I trust to memory and the directions on the bottle. Not always the way to go, apparently.

Here’s a starting place, if you want to create a checklist for yourself: http://www.ahrq.gov/questions/ 

Share any other ideas you have in the comments. Maybe we can chip away at this wall from our side while the providers do the same on their side.

One day, the wall will be gone.

By Trish Parnell





Healthcare Professionals: Thanks for Vaccinating Yourselves!

3 12 2012

nurseI like nurses and doctors and technicians and assistants and all the folks who, one way or another, try to keep me healthy.

That needed to be said because, in a second, it’s going to seem like I don’t much care for them.

Every year, a few healthcare professionals complain when the order comes down to get a flu shot or wear a mask when seeing patients.

They don’t wanna. Not only don’t they wanna, but their excuses sound, well, uninformed is the most polite way I can think of to say it.

The vaccine isn’t necessary.
The masks scare people.
Nobody can tell them what to do.
The vaccine doesn’t prevent flu.
The vaccine is more dangerous than the flu.
The masks are stuffy.
They don’t wanna.

Kids are required to get certain vaccines to attend public school, and if they don’t, they can’t attend.

The CDC recommends everyone over the age of six months get an annual flu shot.

You can’t get influenza from the flu shot.

It’s puzzling to know what to say to people who are supposed to be more educated than you are about disease prevention.

Granted, there are people at work or shopping in the grocery store who didn’t get the flu shot. They are therefore at risk of getting influenza and passing it on to those who couldn’t get the shot. But, the risk we have to take out here in the big old world isn’t the same as the risk we should be expected to encounter in a healthcare setting.

I say yahoo for the hospitals and clinics holding firm on this issue. To the few in healthcare who skipped the classes on disease prevention: follow the science and provide the minimum standard of care by getting vaccinated or wearing a mask around patients.

Please.

By Trish Parnell

Image courtesy of Lower Columbia College (whose students and staff are all vaccinated, as far as I know)





Mandatory HCW Vaccination. Good idea?

11 08 2010

During 2003-2004, 54% of Virginia Mason Medical Center employees were vaccinated against flu. Six years later, that rate more than doubled (to 98.9%) due to the first mandatory healthcare worker vaccination program in the U.S.

Despite increasing healthcare worker flu vaccination rates, these programs remain controversial. The unionized nurses at Virginia Mason successfully filed a complaint against the hospital, claiming the mandatory program should have been included in the bargaining agreement.

Last October, New York State Judge Thomas MacNamara issued a restraining order which halted implementation of a mandatory vaccination program for healthcare workers in the state. 

To many people, healthcare workers resisting flu vaccination makes as much sense as doctors refusing to wash hands between patients. “Low healthcare worker influenza vaccination rates can no longer be tolerated, because our patients and our coworkers are at risk,” declare Dr. Thomas Talbot and Dr. William Schaffner of Vanderbilt University, describing the need for mandatory vaccination programs.

And Arthur Caplan opines, “If you can get close to 100 percent vaccination rates you can cut patient death rates from flu by 40 percent.”

For those against mandatory vaccination programs for healthcare workers, the primary concerns are worker rights and civil rights. To those in support of these programs, saving patient lives is paramount.

If Virginia Mason’s program is any indication, there is little question that mandatory healthcare worker vaccination programs can be successful if implemented correctly.  What is in question is whether these programs will remain hamstrung by legal challenges indefinitely.





Child Mortality – Make a Difference

7 06 2010

“A nation’s greatness is measured by how it treats its weakest members.” Mahatma Ghandi

If child mortality rates are the canary in the coal mine of a nation’s ability to care for its people, then Ghandi had it right. Even with its advantages, the United States struggles to care for the most vulnerable among the population.

Over the past 20 years, the U.S. has seen a 42 percent decline in child mortality. This sounds good, until we realize that Kazakhstan, Sierra Leone and Angola all saw the same rate of decline. Given our resources, it seems that we should be doing better than that.

Despite spending a boatload of money on healthcare, the U.S. continues to have frustratingly high rates of preventable disease.

The link between preventable disease and child mortality is part of the clarion call of healthcare reformers, who hope that new legislation will expand coverage for preventive care and make healthcare more affordable.

Whether the recent overhaul can fix this country’s uneven and expensive healthcare system is not yet known.

It’s just not acceptable for children in this or any country to die before they’ve had a chance to live. Here’s what can be done to reduce child mortality rates around the world. We must ensure that everyone in need has access to:

  • Vaccines
  • Soap
  • Basic health education – hygiene, nutrition, prevention
  • Safe water
  • Sanitation/toilets
  • Breastfeeding
  • Improved pre/neo/postneonatal care
  • Antibiotics
  • Insecticide-treated bed nets
  • Micronutrient supplementation

Buy a net for someone, educate your neighbor on immunizations, encourage new moms to breastfeed. We can all do one thing and by doing it, we’ll help kids have a chance at life.

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Kids’ Care

14 12 2007

The New England Journal of Medicine published a study not long ago about kids and the medical care they receive.  The results are not good.

Children in the United States get appropriate medical care only 47 percent of the time when visiting healthcare professionals.

The study followed 1,536 children over a four-year period.  Researchers found that even basic care was suboptimal for kids visiting pediatricians or hospitals.

  • Only 19 percent of seriously ill infants with fevers had correct lab work done
  • Only 46 percent of kids with asthma were taking the correct meds
  • Only 31 percent of kids ages 3-6 had their weight measured at annual checkups
  • Only 68 percent of the time do kids with acute illnesses get the correct care
  • Only 53 percent of the time do kids with chronic conditions receive correct care

The kids in the study were from middle-income families with health insurance.  The kids most likely to receive good care…or so we thought.  What’s happening to kids with little or no insurance?

This study unearthed a huge problem.  Now what are we going to do about it?