Q. How can I tell if one of my patients has a reading or other health literacy problem?

A. You certainly can't evaluate your patients' health literacy based on how they look or talk. Anyone can have trouble understanding what's going on in their health care setting regardless of how educated they are or how well-spoken. And while there are tests available, they're primarily used for research purposes.

But you don't need a test to evaluate your patient's health literacy level. Instead, try to assess your patient's baseline understanding of at least one thing during the visit to provide a brief glimpse into their overall understanding of their health. For instance, if a new diagnosis comes up, like high cholesterol, instead of just launching into an explanation about high cholesterol, pause and say, "What do you already know about high cholesterol?"

Another key opportunity to assess your patient's understanding is through the teach-back method (described in the cover story.) If your patient struggles to teach back something you feel you covered pretty clearly, that's a big red flag that the patient has just been nodding along but didn't really understand what happened in the visit.
-Sunil Kripalani, MD, MSc
Health Literacy Researcher
Assistant Professor of Medicine
Emory University School of Medicine
Atlanta, GA

Q. My mother who doesn't speak English is being treated for breast cancer. What arrangements can I make to be sure procedure information is translated for her and how does not speaking English affect "informed consent" paperwork?

A. The onus for obtaining informed consent is on the health care-provider. Consent obtained with the use of materials that the patient or family don't understand is not considered "informed" and thus is not legally defensible. So health care professionals should make sure adequate translation is available. In theory, this means the health care professional must provide the translator. In bigger, more urban medical centers, this is, obviously, easier to do. In smaller places, family and friends often provide this service on an ad hoc basis.

You should also make sure all your mother's health care professionals know that she is a non-English speaker, and know what her primary language is. Make sure it's documented in her records. Give all health care professionals affiliated with her case phone numbers and any other important contact information for any members of the family or friends who are willing to assist with translation or explanations. Also, assuming your mother is beginning a planned course of treatment, her health care professionals should be able to provide a timeline of treatments and actions.

Those discussions should occur in advance of treatment, in a relaxed setting that allows for questions and truly informs everyone involved, and that allows for the entire family to have some say in the timing of events. If this process occurs, you shouldn't have to worry if you're not available 24/7, because you can anticipate what will occur and when.
-Laurie Scudder, RN-C, PNP
Board Member, Partnership for Clear Health Communication
Pediatric Nurse Practitioner
Columbia, MD