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Keynote Speaker, Annual Banquet Health Literacy in America: What the Health Community is Doing Good evening. Thank you, Tom, for that kind introduction. On behalf of the American Medical Association, I want to thank you for letting me join you today. The work you do - teaching people to read and helping to unlock minds - is crucial to helping me do the work I do. And not only are you teaching people to read - you may be helping them save their own lives. A lack of literacy regarding health matters is a steep obstacle standing between millions of America's patients and the health care they need. So today, I'd like to tell you about what physicians are doing to give our patients a leg up as they surmount this obstacle. I'll admit straight off that the medical community has had some catching up to do. America's physicians for years gave short shrift to health literacy. We were guilty of some of the same faulty assumptions many have made in a society facing information overload. Some call it a "data fog." And not everyone can find their way through it, particularly those with limited - or no - reading skills. And now, it's even more important that people are able to comprehend medical advice and opinion that is sometimes quite complicated. As for everyone else, the last five weeks have been a time of emotional difficulty for physicians. We're human, too. But we've also had professional challenges. Our job is to preserve human life, and all physicians are trying to comprehend what motivates those who have so little respect for human lives - including their own - that they would do what they did on September 11. When physicians find out they have to brush up on diagnoses of almost-forgotten diseases like anthrax and smallpox, you can imagine the confusion and concern that tugs at our patients. But despite this turmoil, these are times in which I am prouder than ever that I became a physician. The response of physicians and other health professionals in the New York and Washington, DC areas - and throughout the country - is something of which my profession can be proud. It reminds us that physicians are individuals who make a critical difference. We have helped our injured fellow citizens and the survivors of those who were lost begin the healing process. And now we're preparing for potential acts of bioterrorism where physicians form the first line of defense. And this is something we must prepare our patients for. And for which our patients must be prepared. Those patients who can read, but especially those who can't. They are the most vulnerable among us. After years of benign neglect, the AMA now works to change the way people think about literacy and health. We now see low health literacy for the serious problem it is. And the AMA is taking concrete steps to change not only our own response and the ability of our patients to cope - but the perspective of the health care system itself. Let me tell you what I mean. As you know, some 90 million Americans have limited literacy skills. For them, it's tough to read the front page of a newspaper or a bus schedule, much less the complicated documentation that goes along with being a patient in this country today. And the implications of that are obviously enormous. It certainly is for me, as a surgeon. Such as when I ask a patient to sign a document of informed consent before undergoing a procedure. Essentially, it's a piece of paper that says you - the patient - understand what I'm about to do, and you agree to have it done. You know that I may have to take alternative measures, if your condition during the operation turns out to be different from what we expect before we begin. And that you trust me to do what is necessary for your good health, based on my best medical judgment. For instance, that if an imaging scan has shown what seems to be a cyst ... I may plan microscopic surgery to explore more closely what the scan has told us. But what if we find that the cyst is actually a growing tumor? There may be a need to act quickly - to determine, right there in the operating room, whether that tumor is malignant, and if we need to remove it. That's what a document of informed consent is all about - to assure that doctor and patient work together, that I follow your wishes, even when you're the operating table. Informed consent. But if you can't read that document in the first place - if you sign it just because someone tells you to - then it's not really informed. And it's not really consent. How can physicians and patients be true partners - when one lacks the basic tools of understanding? It's as though they are wearing a blindfold, unable to see where the health care system is taking them. Take for example one woman I know. She had high blood pressure, and it stayed high even after her doctor adjusted her medication. She was checked into the hospital. And she responded right away. Why? Because, on her own, she couldn't read the prescription dosage information and couldn't do the math to adjust the dosage, even after the doctor had told her how much to take. But patients with low literacy don't just have prescription problems. They also tend to have a lower estimation of their own health status. And in many cases, their perceptions are true. Studies say people with low health literacy are less healthy - physically and psychologically. They also tend to be hospitalized longer than patients who have stronger literacy skills. And they are more at risk from complications due to chronic illness. Low health literacy, by at least one estimate, costs our health care system $73 billion dollars a year in excess hospital stays, multiple doctors' visits, and expenses incurred by misunderstanding and miscommunications. These all create costs that all of us must bear through higher premiums, higher taxes, and the higher inefficiencies illiteracy brings to the process. That is why the AMA is doing something about health literacy, and I'd like to tell you about that today. In fact, health literacy was the very first signature campaign of our AMA Foundation. It is a multi-year effort to determine how physicians and others are addressing low health literacy, and to give them the tools to turn the tide. It reflects our belief that quality health care depends on patients who are active participants in all aspects of their own health care - and that low literacy robs them of that opportunity. Our goal is better health for all Americans through better health literacy. To get there, we're educating physicians, and bringing physicians and patients together to identify problems. We've surveyed with physicians to learn their awareness of the issue. We've provided our educational kit to state medical societies, and to residents and medical fellows to share with their fellow physicians in training. The AMA itself is even offering Continuing Medical Education credit to physicians who commit to reading and learning these materials. We think it's that important. We're developing new resources for the future as well - like a literacy website. And a toll-free 1-800 literacy hotline. We're also working in partnerships with hospitals, clinics, literacy programs - and voluntary health organizations - nationwide. We're working on ways to make health literacy part of the curriculum for medical schools, because future generations of physicians need to be aware of this problem right from the start. We've launched an outreach campaign to bring speakers to physicians in the hospitals and clinics where they practice, and in their medical societies, to increase their involvement, too. And we've been getting the word out to the media and to the general public - because this is a patient and a public health issue, not just a professional concern for physicians. All of this is just the beginning. Because after that, the real work will begin - finding ways to actually begin to solve the problem. A little bit of education goes a long way. In the time we've been talking to AMA members about health literacy, nearly 80 percent of our delegates now understand that health literacy is a major problem in this country. And our physicians are tuning in to the specific problems faced by their patients. Thousands of them now have a better idea of making medical information more understandable for their patients who need that help. First, they're following the conventional wisdom in adult education and general literacy efforts - to make sure that the right message is being communicated.
It's something I wish I'd done with a patient I once had. He came in with a lesion on the tip of his nose. I'd hoped to reduce the inflammation and clear it - without resorting to surgery, and leaving him with a prominent scar. So I gave him a steroid cream to apply, three times a day. And because I didn't know as much about health literacy then as I do now, I wrote the prescription and sent him on his way. Two weeks later, he was back in my office - and the lesion didn't look any better. In fact, it was worse. Something made me ask him about how he had been using the cream I'd given him And that's when I learned he'd been putting it inside his nose, not on the skin. Which meant he'd been taking those steroids into his system, thinning the membranes in his nose - and doing nothing for the lesion on the tip. I learned a big lesson that day. Now - I ask. And I don't worry about what the health plan will say about the extra minutes it takes to make sure my patients understand what they need to do. We're making progress. But sometimes, it's not what you do - it's how you do it. We know that those who face literacy challenges - also live lives of secret shame. Most of them don't tell anyone about their problem - not even their spouses. And I'm proud of how our physicians are responding. Through our surveys, we've learned our physicians do understand how important it is to create a non-threatening environment. Not to judge. And to make it clear that patients are equal partners in the healing process - and that their feelings and needs come first. To keep them from being embarrassed in front of others. Taking the time to understand their world. More and more today, physicians are taking the time to talk and to demonstrate their compassion with low literacy patients - and they're using a lot of other tools to get the message across, too. One doctor draws pictures of faces, and lets the patient choose the one that best reflects his or her pain level. Others use numbered lists, and models or pictures of the body areas in question - with diagrams of the steps that should be taken. Other physicians are expanding the visual approach by using videos - something that resonates with many patients in an MTV era. Other physicians now are hiring multi-lingual staffers for their offices. And - they're bringing family members into the treatment room to help the communication process along. Some have even set up literacy programs right in their offices. But even with all the resources doctors are using - some are still in short supply. Volunteers. Community resources. And simple, published material written at a readable level. And as all of you work to help millions of Americans to read, keep their health in mind, also. You can be a big help to America's physicians as we try to improve the health literacy of our patients I know that today I'm preaching to the choir. And I commend you for helping teach our fellow citizens to read. The work you do directly impacts the people we, as physicians, treat. It's making a life-or-death difference to the half of all Americans who are having trouble with the skills those of us here taken for granted: The ability to read, understand - and then act - for the sake of our good health. And, like you, the AMA and America's physicians want this someday to be something everyone can take for granted. Thank you.
For general information call Peggy May at 843/671-2008 or E-mail to [email protected] For exhibit information call Kathy Freeman at 803/794-5370 or E-mail to [email protected] For sponsorship information call Anu R. Ailawadhi at 914/838-4624 or E-mail to [email protected]
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