Screening for health literacy is not the answer

Bureaucracy does not make good Medicine.

Engaging patients in treatment decisions is a fundamental component of patient centered care, and is essential to the therapeutic success, but as Vanessa Kronzer states (BMJ 2016;354:i3699), “screening for health literacy is not the answer”, since this bureaucratic task not only steals precious and scarce time from health staff and, more importantly, from the patient-physician relationship, which is very important not only for the diagnosis, but also to the understanding of patients psychology and problems, and a good dialogue with the patient also detects discreetly its literacy, without stigmatization.

As Vanessa Kronzer stresses, “testing for health literacy risks stigmatizing people who score poorly. People with low health literacy dislike taking tests and might even shun healthcare to avoid testing and the accompanying labels and shame”. This is very important, since literacy screening may jeopardize the patient-physician relationship, which is essential to stablish confidence on the physician, which is essential to guarantee adherence and success for the therapeutics. We should remember that as Galen said about medicines “He cures most successfully those people that have the greatest confidence.” Some years ago, Kaptchuk et al. stressed in this journal (BMJ 2008; 336:999-1003), “physicians must know that patient/practitioner relationship is the most robust factor contributing to the placebo effect, and very likely the tight timed consultation may reduce physician effectiveness”.

Bureaucratic literacy screening very likely was not conceived by people involved with patients, who usually know what is useful for patient’s care, and it will only contribute to the degradation of Medicine and Health care.