Communication breakdowns stemming from poor health literacy take many shapes. Furthermore, those with literacy impairments come from all walks of life; however, educational level, nativity, socio-economic status, and elderly age are all associated with lower levels of health literacy.
Inability to read
“Everything was happening so fast and everybody was so busy,” and that is why Mitch Winston, 66 years old and suffering from atrial fibrillation, did not ask his doctor to clarify the complex and potentially dangerous medication regimen that had been prescribed for him upon leaving the hospital emergency department. When he returned to the emergency department via ambulance, bleeding internally from an overdose of Coumadin, his doctor was surprised to learn that Mitch had not understood the verbal instructions he had received, and that he had ignored the written instructions and orders for follow-up visits that the doctor had provided. In fact, these had never been retrieved from Mitch’s wallet. Despite their importance, they were useless pieces of paper. Mitch cannot read.
Source: “Internal Bleeding”
Robert M. Wachter and Kaveh G. Shojana
Culture clash
A concerned wife consented to have a ‘percutaneous endoscopic gastrostomy tube’ inserted into her husband, not knowing that it was a ‘feeding tube,’ which was against the family’s wishes.
Source: “Patients as Partners: How to Involve Patients and Families in Their Own Care”
Joint Commission Resources
The Hmong-speaking parents of infant Lia Lee were unable to describe Lia’s epileptic seizures to the English-speaking emergency department doctor who was treating her, which led to her initial misdiagnosis of pneumonia.
Source: “The Spirit that Catches You and You Fall Down”
Anne Fadiman
When a Spanish-speaking interpreter was asked to tell a Mexican mother that her child would die overnight and there was no more hope, the interpreter refused because “you never tell a mother in our culture to give up hope.”
Source: “The Spirit that Catches You and You Fall Down”
Anne Fadiman
Physical impairment
Mr. Garcia needed to have his surgical staples removed. So when a resident entered his room, he asked the man in bed if he was Mr. Garcia. The man smiled and agreeably nodded his head. He then had his staples removed…prematurely. He was not Mr. Garcia. Rather, he was a man who did not hear well and who had the habit of smiling and nodding in response to something he did not understand. Mr. Garcia’s hearing loss contributed to the error.
Source: “Internal Bleeding”
Robert M. Wachter and Kaveh G. Shojana
Overwhelming forms
One woman put it this way: “I’ve had a lot of illnesses, but I preferred to stay home, until I get better by taking anything I can. Because being asked to fill this out, to fill that out, I feel embarrassed to ask for help, to ask them to fill them out for me. They might get upset or they would say, ‘This lazy lady, she never learned to read,’ that’s how I think.”
Source: “The Health Experience of Patients with Low Literacy”
Archives of Family Medicine, Vol. 5, June 1996