Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

Former AHRQ Director Carolyn Clancy, M.D., prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan.

With final exam season upon us, I'm offering a pop quiz on a topic many of us—health professionals included—need to learn more about. (Don't worry: grades won't be posted!)

What do the following scenarios have in common?

  • A middle-aged lawyer with diabetes trying to figure out her medication schedule during a business trip.
  • A man who speaks mostly Spanish wondering if he can have coffee before a lab test that requires fasting.
  • A busy single mom searching at the local drug store for the right medicine to reduce her 5-year-old child's fever.

If you answered that all of these examples relate to taking care of ourselves and our families, you're partially correct. The full answer is that these scenarios all describe situations in which health literacy is the key to getting or staying healthy.

Health literacy reflects how well a person can find and understand information about the health care services they need. It plays a big role in how well a person can take information and use it to make good decisions about their care, such as following directions for treatment.

Given all of the health information we get each day, you might think we'd score fairly high on the literacy scale. But the facts tell a different story.

Nearly 90 million Americans have only basic or below-basic health literacy skills. Limited literacy affects people from all income, age, ethnic, and education groups. Studies show it plays a major role in whether you have a good result from the treatment you get for a disease or an illness.

Health literacy means understanding your disease or condition and how to live with it day to day. For example, the lawyer with diabetes needs to know that she must eat on a regular schedule to control her blood glucose levels. If she skips lunch and then gets on an airplane without food, she could end up feeling dizzy, or even worse, having a seizure.

Health literacy also means knowing how to follow directions for treatment. The Hispanic man about to have a blood test would not have had to wonder if he could drink coffee if he had been told clearly and in Spanish that he could drink only water for 12 hours before the test. This confusion is not uncommon, but it is unfortunate.

Not reading labels carefully can be a dangerous result of low health literacy. The busy single mom might pick up a bottle of aspirin to bring down her child's fever, but I hope she quickly puts it back on the shelf. That's because aspirin—a safe and inexpensive medicine for adults—is generally not safe for children.

Since 1986, the Food and Drug Administration has required that all aspirin products include a warning label about the risks of giving it to children. Since then, fewer children have died because they were given aspirin. But the bigger lesson still holds: Make sure you read medicine labels before you take or give them.

Of course, reading labels on medicine bottles or instructions before a medical test doesn't mean that you, I, or millions of other Americans will know exactly what to do. That's because medicine is far more complex today than it was even a decade ago. Drugs are more plentiful and powerful, and there are new, more involved medical tests that can detect illness and disease early.

Doctors, nurses, and hospitals need to help patients better understand and use health information. My Agency, the Agency for Healthcare Research and Quality, has developed tools to help pharmacists talk to patients about how to use drugs safely. The American Medical Association recently put together a kit to help doctors realize why health literacy is so important.

As a patient, the very best way to boost your health literacy is by asking questions. I know this is not always easy to do. But having the right information—and putting it to good use—can make the difference in the results you get from your health care. To help you, my Agency has also developed suggested questions that you can take with you when you visit your doctor, your pharmacist, or the hospital.

Working together, patients and health professionals can work to improve our health literacy. Better health is the reward.

I'm Dr. Carolyn Clancy, and that's my opinion on how to navigate the health care system.

More Information

AHRQ Podcast
Health Literacy and Understanding Health Information  (Transcript)

Questions are the Answer
Build Your Question List
http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/index.html

Is Our Pharmacy Meeting Patients' Needs?
A Pharmacy Health Literacy Assessment Tool User's Guide

Food and Drug Administration
Consumer Education: Over-the-Counter Medicine
Tips for Parents
http://www.fda.gov/cder/consumerinfo/otc_text.htm#Tips

Current as of May 2008
Internet Citation: What's Your Health Literacy Score?. May 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/052008.html