Sometimes
iPhone helps too much; so we
inadvertently retweeted this, and then the retweet was favorited: Health Illiteracy-- a disease that also
afflicts doctors... I would not intentionally repeat this
phrase. I hope you won’t either. Here’s six reasons why:
1. The term “health illiteracy” focuses on patients’
deficits and places patients in a position of failure and incompetence. This
approach generates anxiety and resistance in patients and calls up their
defenses. It disempowers patients while requiring that they be active
decision-makers and participants in their care.
2. The term “health illiteracy” equates lack of
medical and healthcare vocabulary -jargon- and disease knowledge with illiteracy and all the stigma
that goes with it. It situates in the patient systemic problems in
healthcare (indecipherable &
conflicting information, inefficiency, high costs, poor outcomes); so that when
treatment is successful doctors get credit, and when it’s not, patients get the
blame.
3. “Health illiteracy” is neither a disease nor an
affliction. This metaphor further
tips the power imbalance. it implies health illiteracy is a problem that
patients have and doctors need to treat or manage. It cements the notion that
patients cannot grasp doctors’ specialized knowledge or use it for their
personal benefit; so that an “appropriate health decision” is equated to
compliance. And non-compliance is framed as cognitive deficit or
irresponsibility.
4. Here is the first definition of “disease” produced
by a Google search: “a
disordered or incorrectly functioning organ, part, structure, or system of the
body resulting
from the effect of genetic or developmental errors.... The metaphor adds stigma to stigma
implying cognitive deficits and disabilities, rather than underdeveloped
skills, poor quality education, inexperience with the healthcare system, or
poor communication and complex, concept dense, jargon laden, overly technical
information.
5. An “affliction” is defined as a condition of pain, suffering, or
distress. Most adults who scored in the Basic or Below
Basic levels on the 2003 National Assessment of Adult
Literacy reported that they read well. They are not “afflicted”until the enter
the healthcare system.
6. The
tweeted blog is titled “Screening-illiterate physicians may do more harm than
good”, which a tweeter translated to
the comment that health illiteracy afflicts doctors as well as patients.
The
blog bemoans that many doctors are “functionally
illiterate regarding
basic screening
concepts” This language conflates functional literacy
with knowledge. Functional literacy
(the 3Rs) refers to skills used to
gain
knowledge. Lack of a particular
set of knowledge,
does not indicate inability
to read
or to learn.
Conversely,
“functionally illiterate” means having reading
and writing skills insufficient for ordinary practical
needs. Any one who got into medical school can
read and write. If they do not
understand screening
concepts, that says more about their educators
than about their cognitive ability.
Further,framing
lack of knowledge as functional illiteracy -inability
to gain knowledge - is as disempowering
to doctors
as it is to patients.
I agree with the
blog authors’ conclusion that more attention needs to be paid to improving
physicians knowledge (not their literacy) about screening tests in order to
reduce use of ineffective tests that expose patients to potential harm --
especially health literacy tests.
More attention also
needs to be paid to increasing understanding of literacy and health literacy.
Here’s the blog:
