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Views And Reviews Taking Stock

Rammya Mathew: Where are we letting our patients down?

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3980 (Published 20 October 2020) Cite this as: BMJ 2020;371:m3980

Rapid Response:

Re: Rammya Mathew: Where are we letting our patients down?

Dear Editor,

Patients with low literacy attend doctors and A and E more and are less compliant with treatment.

The AMA "Health Literacy manual for clinicians" refers to the American Adult Literacy Survey and goes on to say:

"Unfortunately, current data indicate that a large proportion of the US population — perhaps as many as half of American adults — lacks sufficient general literacy to effectively undertake and execute the medical treatments and preventive healthcare it needs. Inadequate health literacy affects all segments of the population, although it is more common in certain demographic groups, such as the elderly, the poor, members of minority groups, and recent immigrants to the United States.

"The economic consequences of limited health literacy are considerable, estimated to cost the United States between $50 billion and $73 billion per year."

It has been my experience that sharing complete medical records with patients creates a learning culture of partnership and trust that engages patients, increases health literacy, reduces complaints and increases compliance.

Whereas a GP for instance, has a high IQ, training and about 8 or 9 years in which to learn about diabetes from medical school to full competence, the GP only has on average about 60 minutes a year with any average patient. Nurses and HCAs may have another 60 or 120 minutes a year. So patients are at an initial disadvantage. Plus, we know that patients only remember 15% to 30% of what they are told in consultations. Patients are not alone and most patients with low literacy have friends, relatives and/or carers of higher health literacy with whom they can share their reading and understanding.

Allowing patients to access their records after consultations has been shown to improve understanding, patient activation and compliance and to reduce attendances at clinics and family practices.

We measured patients' knowledge of their medical history in a small non controlled trial and found that all patients produced a higher score on knowledge of their own health after accessing their records.

Modern technology and COVID19 - a desperate necessity and mother of invention - has accelerated the use of telemedicine, teleconsultations and patient online worldwide. Telemedicine includes access to records and one benefit will likely be an improvement in patient health literacy.

Competing interests: No competing interests

26 October 2020
Richard Fitton
retired gp
Glossop