Plaintiffs are sometimes labeled as uncooperative for not following prescription directions, appointment slips and other written instructions. “Health literacy” is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health care decisions. People with low health literacy are less likely to understand written and oral health information and be able to navigate the healthcare system. Superimposed on depression, lost income, pain and other symptoms, low functional health literacy can sabotage the efforts of the plaintiff to obtain medically necessary treatment. Although health literacy affects people from all backgrounds, the problem is more acute in those who are older, non-white, immigrants, and those with low incomes.
Approximately 44 million adults in the United States are functionally illiterate and an additional 54 million have marginally better reading and computation skills. This information suggests that many injured people may have difficulty understanding prescriptions, informed consent documents, insurance forms, and patient education materials, most of which are written at a high school level. The recommended reading level for all health education materials is 5th to 6th grades.
Many individuals with low reading skills are loathe to admit to their deficits and go to great lengths to avoid admitting they have trouble reading. Often they cover this by saying they forgot their glasses. Healthcare providers should set up a climate that is shame free and does not make the person feel embarrassed or stigmatized. Healthcare providers can ask the patient to restate the instructions in his own words to help to determine if the patient understood the information. Simplifying language also helps. Healthcare providers can also limit the amount of information imparted to the patient, slow down, and take the time to talk to the patient.
Modified from President’s Editorial, New Jersey Nurse, May/June 2009
The plaintiff attorney who suspects the plaintiff client has difficulty reading can encourage the client to bring surrogate readers to a healthcare encounter to help with reading difficulties. Providing a videotape to cover key points on being deposed lessens the demand on reading skills. The attorney and legal nurse consultant can effectively communicate with low literacy clients by using the same techniques of slowing down, simplifying, asking for a repeat back of instructions, and providing simple, attractive materials. The client will feels he is being treated in a respectful, nonjudgmental and helpful manner will learn more and be better equipped to cooperate in the medical and legal system.
See The Uncooperative Plaintiff for more information
