Massachusetts Medical Society's Physician Focus

December 2011

Medical Literacy


  • Some 90 million people – nearly half of the adult population in the United State – have low medical or health literacy.

  • Age, educational levels, language barriers, and cultural differences are some of the factors that determine a patient’s medical literacy.

  • Low medical literacy hinders health prevention efforts and leads to poorer health outcomes, more use of emergency rooms, higher health care costs, and higher rates of disease.

  • Improving medical literacy requires the commitment of physicians and patients alike.

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The Institute of Medicine, the health arm of the National Academy of Sciences and an independent nonprofit organization that serves as an advisor to the nation to improve health, defines health or medical 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.”

In simpler terms, says Andrew Morris-Singer, M.D., a leading proponent of medical literacy, “Medical literacy is the ability of patients to read, understand, and act on health information, whether that information is about the human body, certain diseases like high blood pressure, or just our complex health care system, such as how it works and how one gets insurance.”

Dr. Morris-Singer, a primary care physician at Brigham and Women’s Hospital in Boston and co-founder and president of Primary Care Progress, discussed the various aspects of medical literacy – and the consequences of medical illiteracy - on the December edition of Physician Focus with the Massachusetts Medical Society with program host Bruce Karlin, M.D.

The problem of medical illiteracy is widespread throughout the country, with some 90 million adults having low health literacy. Several reasons account for this situation, says Dr. Morris-Singer. Low educational levels, age (people older than 65 especially), language, and cultural issues all play roles in medical illiteracy. Even fear can play a role, he says, in patients not admitting they don’t understand something.

“Patients with low health literacy,” says Dr. Morris-Singer, “have poorer health outcomes, are more prone to medication errors, and are more likely to be hospitalized or re-hospitalized.”

Millions of Americans have difficulty with common tasks such as following directions on a prescription bottle, and the smartest of people can be challenged by serious illnesses or the constant care of chronic conditions such as diabetes or heart disease. The language of medicine, with its big words unfamiliar to most people outside of medicine, also can produce mystery and confusion for many patients.

All of this results in higher rates of disease and mortality, more use of emergency rooms, and higher costs for our health care systems. Tragic results can also occur, through misunderstandings over medical procedures or the use of medications.

Alleviating the problem, says Dr. Morris-Singer, will require efforts from those on both sides of the equation: “Fixing medical illiteracy is not just about what the patient is going to do, it’s also about what the provider needs to do.”

He says more doctors need to become bilingual, not in the sense of being able to speak another language, but being able to use words that patients understand. Physicians could use words like “bleed” instead of “hemorrhage” or “bad” instead of “malignant.” Doctors, he says, with their own complex language, are “not the best at communicating simple information to patients.”

Efforts to improve medical literacy must be a team sport, he says, because “doctors can’t do everything.” That means other members of the health care team - nurses and medical assistants, for example - should be empowered to play key roles in helping patients.

He is also adamant that patients must be a part of that team as well, and his message to them is clear and straightforward.

“Patients need to understand they need to get engaged,” says Dr. Morris-Singer, “to help doctors understand what they need to learn. I ask my patients to come to their appointments ready to teach and learn. It is critical that they understand the basics about their body and the basics about their condition, to help us manage them.”

Watch the accompanying video for the full discussion, including conversation about using interpreters to bridge language barriers, the roles other members of the health care team can play, how medical illiteracy can result in errors, and techniques that physicians can use to improve medical literacy.

MMS/Richard Gulla

Centers for Disease Control

US Department of Health and Human Services

Partnership for Clear Health Communication

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Medical Literacy PSA

Standing, Bruce Karlin, M.D.;
seated Andrew Morris-Singer, M.D.
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