Do your patients understand what you are telling them?

Ashwin Patel: ©Pyx Health

Lack of patient engagement, including poor adherence to treatment plans, medications, and appointments, is a key pain point for many physicians. If you’ve been practicing medicine for a while, you know that patient engagement is one of the main factors that can make or break a patient’s health journey.

Contributing to this lack of patient engagement is poor health literacy (i.e. when patients lack the information, context, or perspective necessary to make optimal health care choices). Unfortunately, according to the National Library of Medicine, a staggering 9 out of 10 adults struggle with health literacy.

Indeed, without effective engagement with their physicians, patients may not follow through on key actions in between doctor visits. Therefore, this health literacy deficit directly drives poor engagement and the subsequent worsening of health outcomes over time. In fact, research shows that health literacy can be a more important predictor of health than race, socioeconomic status, or educational attainment.

So, how can physicians begin to tackle health literacy?

Bridging this health literacy gap is not trivial. More educational materials or just spending more time with each patient is not enough. The problem is deeper and broader, thus the solution needs to similarly be more encompassing.

Social health + health literacy connection

Poor health literacy creates a ‘social’ distance between us and our patients. Maybe you’ve experienced this? The feeling of being in a foreign country where you do not speak the language. You may be surrounded by people, but because of your illiteracy, you would still be lost.

In this same vein, even patients who come to visit their physician regularly may not have the tools or background knowledge necessary to understand their care plan. When patients cannot fully grasp what we are sharing – education about their condition, their medication regimen, etc. – this can lead patients to feel inadequate, confused, and even threatened.

This distance contributes to the perverse feeling of ‘loneliness’, which, as we know, is already pervasive among our most vulnerable, elderly, and marginalized patients.

For this reason, we need to check for patient understanding during the visit and follow through after the visit. Importantly, patients often need people in their lives who can help them better process important medical decisions, understand the lifestyle changes they need to make, and then support them in developing those healthy habits to better self-manage their chronic conditions. In addition, these critical people can assist patients in advocating for themselves at the pharmacy, asking the right questions about their chronic condition, reminding them to take their medications at home, or even helping them get to their appointments. This can be anyone who the patient trusts: a relative, a neighbor, a friend, or a peer mentor. Developing these connections can help improve social health.

What is social health? It’s the complete network of connections a patient has with their family, community, physicians, health plans, pharmacies, etc. These supportive connections help increase health literacy, improve health, and build resiliency to withstand future challenges to one’s health. These connections can also help overcome barriers related to the social determinants of health (SDoH), as well as help to ‘translate’ complex medical concepts into both knowledge and then action. These connections can help the patient connect the often siloed parts of our health system.

How can physicians help?

There are many ways that physicians can help improve health literacy: sharing success habits between patients, checking for understanding, and highlighting the importance of social health are a few great places to start.

Sharing success habits: Begin identifying patients who successfully follow through on their care plans and explore the reasons behind their success. To do this, physicians can integrate these discussions about successful adherence and lifestyle changes into their practice by having nurses or medical assistants play a role. Then, during the latter part of the appointment, the physician can delve deeper into what specific factors contributed to positive changes in diet, exercise, or medication adherence. Understanding what motivated these patients can provide valuable insights to share with other patients who are in a similar boat, but still struggling.

Checking for understanding (in the office):Incorporating “teachbacks” can also be a great way to gauge if a patient fully understands what was shared. Research shows that asking a patient to explain back to you their condition, or how they think their medication works, can increase knowledge retention, reduce hospital admissions, and even improve patient satisfaction. Teachbacks take time but can be incorporated into not just the physician’s workflow, but also the workflow of nurses and MAs. Interestingly, these are often win-win. Ideally, the patient expresses full understanding, but if they do not – it’s an opportunity to remediate with that patient before they leave the office. And, perhaps even more important, this can provide critical feedback to the physician on how they can better teach all future patients.

Checking for understanding and action (out of the office):Physicians’ offices should also engage with patients outside of their regular appointment times, too. Oftentimes, patients don't realize they lack understanding until they attempt to follow their treatment plan at home. Connecting patients with peer mentors can be one way to help answer those in-the-moment questions between appointments. Online resources can also provide helpful context at home. In addition, physicians can emphasize the importance of the patient engaging their family, friends, and community in their health. Building these social connections can build a helpful personal support network with immediate and far-reaching benefits. Helping patients build social health can reduce health literacy, and pave the pathway toward better health.

Tackling poor health literacy takes a village -- a lot of time, energy, and effort. However, it’s worth it since the benefits to one patient end up accruing to the entire village! By building mutual trust and respect with patients, doctors can help them feel more comfortable, better understand their care plans, and ultimately achieve better health outcomes – a win-win for everyone involved.

Ashwin Patel, MD, PhD, is the Chief Medical Officer at Pyx Health