By Dina Golbin, Med Stud. IV, RPSGT
Illiteracy regarding health issues is very surprising this country, where health concerns seem such an important public issue. Health illiteracy is so dramatic that many journals have devoted central articles about it. According to the National Adult Literacy survey (NALS) report by the National Center for Education Statistics and the Division of Adult Education Science, health illiteracy is intimately related to the basic illiteracy of adults who either cannot read or misread instructions and thus do not understand doctors explanations.
Current strategies to deal with health illiteracy target physicians, nurses, and allied health professionals, but are clearly not enough for the general public which is most likely to obtain medical information from TV, radio talk shows and newspapers that dramatize and twist stories. All tend to present physicians as careless pill pushers who damage patients with poisonous medications. This orientation is part of the reason for medication phobias and the flourishing of anti medicine movements such as scientology and “alternative” treatments.
Health literacy about sleep and its disorders should start with the health professionals. For example, many pediatricians do not know that bedwetting, night terrors and head banging and body rocking in children are disorders of sleep mechanisms, rather than “bad habits”. Professional journals are also not exempt. For example, the Sleep Review journal for sleep technicians presented several examples of poor phrasing that might scare patients, including: ”I will have leads glued to your scalp” or “This machine I’m testing you on will splint your upper airways” (1). Theresa Shumard, Editor-in Chief of APT’s magazine stated: “The best practices in medicine are useless if patients do not understand how to follow the care regimes needed to address their health problems. Even well educated patients may not understand medical jargon and often are unlikely to admit that they need clarification”.
The mission of Sleep and Health is to provide credible medical information about sleep and its disorders in a clear, reader-friendly and entertaining manner. As many practicing physicians have noticed, doctor-patient interactions are recently being reversed in many ways.
In the past, when the doctor recommended a medication, patients were unlikely to question it. Nowadays, however, the patient immediately goes on the Internet and enteres into a long discussion with the doctor about potential side effects and about the other medications advertised on TV. As soon as the patient warns the doctor about consequences of side effects, the doctor immediately is placed in the “defensive mode” and has little choice but to let the patient try the medication of his or her choice.
The practice of “defensive medicine” is partly the result of a litigious attitude of society, partly stems from mistrust of medical professionals, and partly stems from misuse or misinterpretation of complicated medical information obtained on the Internet. Emotionally charged selection of the ”bread slices” of information without the ability to put it into prospective is the worst type of literacy, although promoted by the media as real education.
Real health education should start with changes of the societal attitude to its medical science and doctors, who devoted their life to the public health. Physicians must carefully and clearly explain options and the logic behind each to their patients. If the public wants their doctors to be creative, not perform just a “standard of practice”, the public should decrease its urges for litigation. On the other hand, physicians should be more open and willing to hear the alternative logics and methods from the patient’s experiences.
All this sounds like wishful thinking, but the dramatic miscommunication and opposition between medical community and the patients has come to an impasse. There is no other solution except revision of attitudes for benefits to all.
Citation: Theresa Shumard. “Raising the bar on health literacy”.
Sleep Review, July/August, 2004, 44-51