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A Real-life Lesson in Health Literacy

Health literacy research focuses on patients’ low health literacy. In medical parlance,
we could call it hypo-health literacy. It leaves individuals unable to understand medical
information, manage their health and build healthy communities. This case suggests a
different health literacy problem—clinicians’ hyper-health literacy.

Dad fell in the driveway Saturday morning. His glasses broke. Nine major lacerations to
the face and mouth, filled with glass and gravel. A neighbor administered first aid. The
driver of the local dial-a-ride van stopped and called 911. My sister met Mom and Dad at
the ER. Two hours of testing ruled out brain damage so they finally could give him
morphine for the pain. Then the on-duty surgeon stitched the wounds – for 90 minutes,
some three layers deep. Several severed arteries. Dissatisfied with Dad’s vital signs, the
surgeon admitted him. I got to the hospital about 8 that night so my sister could take Mom
home. The nurses and other staff were attentive to both Dad and me. Even the cleaning
and kitchen workers were attuned to patient-centered care. By 10 PM, things quieted down,
Dad was asleep; I settled in for the vigil, giving thanks for Medicare.

At 11PM, a guy in black scrubs and a stethoscope burst in to the room. Dad and I were both
suddenly alert. The man said his name was Doctor Jones (not his real name). He glanced at
me and asked Dad, “Who is this and what is your relationship?” Dad, ever gracious, said through
swollen lips, “The good looking one is my daughter.” They exchanged niceties about their
good-looking wives and children. Doctor said “Dr. ____(neither Dad nor I recognized the name)
is worried about you and asked me to check on you.” My calm evaporated. The interrogation
began.

How did you fall? What were you doing ? Dad gamely repeats the story he already has told so
many times today. Dr. Jones is holding the record in his hand but apparently has not read it.
How much do you drink? Have you had your testosterone checked? Do you have prostrate
problems? Do you have problems with erections?  (Am I invisible? I wondered.) I understand
you had surgery recently. What was the procedure? Dad explained he’d broken his back and
they cemented three vertebrae.  Did you have kyphoplasty?  What? Was it open surgery or an
injection? Open surgery.  Who did the surgery? No idea.  Doctor pokes and prods. Does that hurt?
Yes. Does this hurt? Yes.  Looks like you might have some serious damage in your neck, like the
_____might have exploded. What? He sketches  hastily on the back of the unread chart. “I can’t
see it,” Dad said, his eye swollen shut and surrounded by stitching and oozing wounds. Doctor
turns to me for the first time. “Maybe you can explain it to him. I’ll be back tomorrow.” I still
don’t know what he  sketched. He did come back, after 2 pm the next day. He discharged Dad
with no further mention of the exploding neck.

I was impressed with the health literacy in my parents’ small community. The neighbor knew
first aid and applied it well. The bus driver was alert and called 911. Mom had a chart of Dad’s
medications and when he takes them. She’s learned to navigate hospitals and multiple providers
and Medicare. Dad has read widely about back pain and treatments. He knew which vertebrae
had been repaired. He knows his physical therapy exercises and has been doing them faithfully.
With his personal physician’s guidance, he’s weaning himself off oxycodon prescribed for back
pain over the last six months. He’s become adept at giving his medical history.

But what about the mysterious Dr Jones? He did not read the medical record – but that does
not suggest low health literacy any more than patients not reading information provided to them.
He seemed not to have had the in-service on patient-centered care. I was dismayed that his
training did not suggest that he may not get clear answers to technical questions about an
emergency surgery from an elderly patient woken from deep sleep, on a pain cocktail, after a
day of trauma, without his glasses or hearing aid. What was the point of telling us another doctor
is worried and that something unexplainable in Dad’s neck might have exploded? I believe this
doctor is a skilled physician. And his behavior demonstrates hyper-health literacy, extremely high
levels of background knowledge and ability to understand medical information and healthcare
documents. It can leave clinicians unable to communicate effectively with most patients.

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