Recently I was caring for an older male who clearly did not understand his health. He has been hospitalized four times in the past year for COPD (chronic obstructive pulmonary disease) exacerbations and/or pneumonia. He smoked for a couple of decades and had a 35-pack per year smoking history. Fortunately, he quit smoking years ago but now suffers from COPD and stage 1 lung cancer.
Fortunately, his lung cancer mass was removed and his last scan was clear of any new lung mass. But the last CT scan of his chest was more than two years ago. He told me on my visit with him that, “I know I was supposed to see the doctor again but I hadn’t yet.” I explained to him the importance of a follow-up scan as his medical oncologist had recommended one for six months after his last scan.
He politely refused to have that scan during this admission and shared that he already talked with his main family doctor about ordering the CT scan. I reminded him to have his doctor alert us when the scan was completed.
He went on to say, “I know it’s the cancer causing me to be in the hospital all the time.” I was quietly shocked to learn that he did not realize it was more than likely his COPD that was causing the issues. Or, at least I had hoped so. I asked him if he knew he had another lung condition and he said he did not. I was really shocked then.
I explained the COPD disease process to him and how it was likely caused by his history of smoking; I explained what it meant to his lungs and health. I could tell by his expression this was the first time he had heard all of this. Wow. I wonder if he is experiencing health illiteracy or if we failed, as a health care community, to properly educate him. It is likely both.
Health literacy is defined by the United States Department of Health and Human Services as the degree to which each person has the capacity to obtain, retain, process, and understand basic health information, situations, and services needed to make appropriate health decisions. Please realize that health literacy is much different than the ability to read or write.
In addition, limited health literacy (or what I referred to here as health illiteracy) is often associated with an increase in preventable hospital visits and admissions. Numerous studies have demonstrated a higher rate of hospitalization and use of emergency services among people with limited health literacy skills.
I hope for his sake and for the sake of his family, he now understood more about his overall health, and understood the importance of surveillance and follow-up for his lung cancer. Only time will tell.
Have you seen this phenomenon with your patients?
- Quick Guide to Health Literacy
- U.S. Department of Health and Human Services. 2000. Healthy People 2010. Washington, DC: U.S. Government Printing Office. Originally developed for Ratzan SC, Parker RM. 2000. Introduction. In National Library of Medicine Current Bibliographies in Medicine: Health Literacy. Selden CR, Zorn M, Ratzan SC, Parker RM, Editors. NLM Pub. No. CBM 2000-1. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services.
- Baker DW, et al. (1997). The relationship of patient reading ability to self-reported health and use of health services. American Journal of Public Health. 87(6): 1027-1030.
- Baker DW, et al. (1998). Health literacy and the risk of hospital admission. Journal of General Internal Medicine. 13(12): 791-798.
- Baker DW, et al. (2002). Functional Health Literacy and the Risk of Hospital Admission Among Medicare Managed Care Enrollees. American Journal of Public Health. 92(8): 1278-1283.