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Low health literacy is costing the health care system more than $300 billion annually, according to the
Untreated chronic diseases, unnecessary repeat hospitalizations and doctors' visits, and the costs of improperly taken medications all contribute to the price tag. The additional costs incurred by patients who can't process basic health information — whether from a language barrier, limited education, or problems associated with aging — amount to a significant percentage of the $1.3 trillion spent annually on hospital care and physician services, as reported in 2010 by the Kaiser Family Foundation.
To attack the problem at its root, the AMA has given out millions of dollars in resource materials to promote health literacy in areas with demonstrated need. Williamsburg and
Alerting doctors' offices
A former pharmaceutical rep, literacy tutor Sandy Menaquale uses her sales background to motivate the staff at physicians' offices to identify patients who may need help navigating their health care. "Health literacy" refers to how well people understand and process health information, she explained. She cited the National Assessment for Adult Literacy, conducted by the
Addressing the staff at
Pediatrician Maurice E. Graham first encountered the problem 30 years ago, when a Filipino woman, whose husband was deployed, brought in their severely dehydrated baby for its two-week-old checkup. She had been feeding the baby concentrated formula since birth, putting it at risk of life-threatening convulsions. He likened the barriers to care for her to Americans abroad. "Say you were in Russia, trying desperately to get medical help. It causes a lot of anxiety. It's quite frightening," he said. "Someone didn't understand that that mother didn't understand."
The pediatric practice has multiple patients for whom English is not their first language. "As small as Williamsburg is it's an international city — we have a lot of Middle Eastern patients, from
Patients often ask for medical assistant Emily Carrillo, whose family is from Mexico. "I use my language skills every day. I will write down instructions in Spanish. Often they don't understand insurance, how to take a prescription to a pharmacy, or the concept of refills," she said, noting that medical customs differ from country to country.
Failure to understand
The HEAL program is not just for non-English speakers, but for all with low health literacy, or difficulty following doctors' instructions. Menaquale told of an elderly patient who revealed to his physician, after seven years, that he only took his
Graham has encountered cases in which young parents administered the thrice-daily oral antibiotic amoxycillin, prescribed for
To conclude her presentation, Menaquale invited staff members to wear a button, "Ask me if I can help?" as a way to encourage patients to self-identify. "Many times people go to the ER because it's all verbal," she said, as she advised office staff to watch for those struggling with paperwork. She identified trigger responses, such as "I don't have my glasses," "I don't know," or "I'll talk to my family." She urged them to give out a "prescription" for the free health literacy classes being offered by Literacy for Life. Further, she said, starting in 2013, there will be new billing codes so that physicians can charge for spending time on patient education, such as for diabetes care.
In the classroom
Students in the pilot health literacy classes in Williamsburg reflect a typical cross-section of those who are daunted by the health care system. They're from a dozen countries, mostly in Asia, along with a few native English speakers.
"There are a lot of English speakers who don't feel comfortable asking doctors questions," said Joan Peterson, executive director of Literacy for Life. "Others will put off going until it's a crisis, knowing that they'll have to fill out forms."
Instructor Tisha Sawyer, who speaks some French, Arabic, Spanish and Italian, understands the problems they face. With a Moroccan husband, she's seen the problems firsthand on doctor visits where she translated for him. "I understand the processes and barriers," she said. Her presentation mixed lecture, demonstration, pictures and interactive games as she introduced basic health vocabulary with all its nuances — the differences between aches and pains, fatigue and drowsiness, nausea and vomiting. She talked about duration and intensity of symptoms, when to go to the doctor and when to wait — and just as importantly, where to go.
The students read and discussed and played interactive Body bingo to label body parts. For some, the information helped to relieve anxiety. "I have a lot of pronunciation problems," said Falguni Patel from India, who cared for her mother-in-law through
For Charles Brooks of Williamsburg, the class was an opportunity to learn more about what contributes to general good health. He learned how stress can produce physical symptoms. "I was surprised how it can hurt you. I didn't realize that," he said.
Free health literacy classes
What: Classes on health education and health literacy, HEAL, for English and foreign language speakers
Where: Literacy for Life, William & Mary School of Education, 301 Monticello Ave., Williamsburg
When: 9:30 a.m. to 11:30 a.m. Thursdays through Dec. 13; new 8-week session starts in January. Take one class or all. They're free but registration is requested in advance.