High health literacy does not necessarily directly correlate with a person’s level of education, said Jean Anderson Eloy, MD, director of rhinology and sinus surgery, assistant professor and vice chair of otolaryngology at the New Jersey Medical School in Newark and author of several studies on health literacy. “You’d be surprised,” he said. “Because of their education level, a lot of people who you’d think would understand things may not. A lawyer is educated in the law, not in medicine. I can’t give him the same material I would give a colleague.”
Explore this issue:September 2012
But fewer years in school does inversely affect health literacy, said Amy Y. Chen, MD, MPH, professor in the department of otolaryngology and head and neck surgery and in the department of hematology and medical oncology at Emory University School of Medicine and the Winship Cancer Institute of Emory University in Atlanta and a co-author of Dr. Beitler’s laryngectomy and health literacy report. “A lower level of health literacy is related to a lower level of compliance [and] taking medications, as well as adhering to treatments,” she said.
Health literacy also involves understanding numeracy and percentages, said Dr. Chen. “It’s very important to understand what a treatment will entail. If I say a treatment will yield an 80 percent chance of a cure versus treatment B, which will entail an 85 percent chance of cure, the patient needs to understand that.”
Identifying Patients with Low Health Literacy
Patients seek an otolaryngologist’s care for a variety of reasons. As a result, there can be several different reasons health literacy might be compromised.
“For ear, nose and throat doctors, they are dealing with people who might not hear clearly, because the patients have ringing in the ears,” explained Osborne. “What do allergy medications do? They make you sleepy. For people facing head and neck cancers, their whole life is being turned upside down.” In every patient interaction, physicians should “consider all the life factors someone is going through,” she added, because it isn’t always obvious that people are having trouble understanding what is happening at the doctor’s office.
Poverty can also play a role, said Dr. Beitler, who added that poorer people often have a greater distrust of the medical system, and perhaps with good reason. “A heritage of family members being hounded about healthcare bills trains the next generation to avoid health care,” he said. But for those with head and neck cancers, that avoidance can be fatal. “Health literacy is particularly important for otolaryngology patients, because drinkers and smokers who suffer these cancers tend to be in poor socioeconomic groups and have fewer resources,” he added. Such patients, who don’t always understand the need for rehabilitation post surgery, may not follow through with it, suffering poorer health outcomes as a result. And for some patients, the outcome is literal silence. “When some patients are illiterate and can’t read or write, if we eliminate their tongue or larynx, it’s particularly devastating,” said Dr. Chen.