Health Literacy, a Critical Component of Humanism in Medicine

October 31, 2014 at 8:00 am | Posted in Uncategorized | 1 Comment

Haider Javed Warraich’s “Humanism in Medicine” presentation at NAHSL’s annual conference included thought-provoking patient-experience anecdotes. One account was particularly moving to me. It was the story of the late Arnold Relman, internal medicine physician and longtime editor of The New England Journal of Medicine. In June of this year, Dr. Relman fell down a flight of stairs in his home, cracking his skull, fracturing several vertebrae, and breaking bones in his face. He spent weeks in the intensive care unit at Massachusetts General Hospital and subsequently in a nearby rehabilitation facility. After Dr. Relman’s recovery, he wrote “On Breaking One’s Neck,” a description of his time in those facilities. Dr Warraich recounted some of Dr Relman’s experiences as a patient as some examples of the lack of humanism in medicine.

I have been reflecting on some of the quotes from Dr Relman’s article, some of which were used by Dr. Warraich during his talk. I have had health literacy on the brain, as October is Health Literacy Month, and I am on my hospital’s health literacy committee. Literacy is the ability to read, write, compute, and comprehend written information. Health literacy is the ability to use these skills in health-related situations. Nearly half of all American adults lack adequate literacy skills and those numbers dwindle in the 65+ age group.

To me, Dr Relman’s first notable quote from “On Breaking One’s Neck” was “Conversations with my physicians were infrequent, brief, and hardly ever reported.” Exchanges like this are not uncommon. Unfortunately they set up a miserable foundation to determine whether a patient truly understands the ramifications of an outpatient visit or hospitalization.

Quote two, “What is important is that someone who knows the patient oversees their care, ensures that the many specialized services work together in the patient’s interest, and that the patient is kept fully involved and informed” indicates that an advocate is critical. Who would be this advocate? Anyone taught health literacy skills –ALL clinicians need apply.

Relman’s last quote was “(his rehab hospital) illustrated how patients, even when they are physicians, can feel adrift and confused when their care lacks firm, identifiable coordination by a physician in charge, to whom the patient can look for guidance and information.” This highly educated man experienced “infrequent, brief” exchanges with his doctors, lacked information on the particulars of his care, and consequently felt “adrift and confused.” A patient with less education and familiarity with the healthcare field would likely feel the same. In spades.

Health literacy training is crucial for patients’ successful navigation and use of healthcare services and their self-maintenance of health and wellness. Prominent national players such as the Joint Commission, the Institute of Medicine, the AMA, and other professional associations have all recognized this. Classes in plain language and teach-back improve patient care, and yes, help put humanism – compassion, respect and open communication non-“doctor speak,” as Dr Warraich describes it) — back in medicine. If these terms mean nothing, you have work to do. Here are some places to start:

PlainLanguage.gov
Health Literacy and Communication
Plain Language Association International
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Relman A. On breaking one’s neck. New York Rev Books. 2014;61(2):26-29. http://www.nybooks.com/articles/archives/2014/feb/06/on-breaking-ones-neck/

Submitted by:
Susan A. Bloomfield, MLS, AHIP
Health Sciences Librarian
Southern Maine Health Care
Biddeford, Maine

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1 Comment »

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  1. Thank you for this post, Susan, and for the link to Dr. Relman’s article. I look forward to reading it. Health literacy (and science literacy) is a HUGE area of opportunity for us and I like how you tied it to Dr. Warraich’s plenary.

    As a plug for NAHSL 2015, literacy will be a key focus of the talks and a theme running throughout the program. Your post gives a nice perspective that we can share with our invited speakers, as a way for them to keep the topic and discussion going.

    Thanks again!

    ~ Sally


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