Person:

Rudd, Rima

Objective  Doctors often use medical language with their patients despite findings from a variety of studies that have shown that patients frequently misunderstand medical terminology. Little is known about the patterns of medical word use by doctors and patients during clinical encounters.

Methods  A content analysis of 16 verbatim transcripts of first clinical encounters between rheumatologists and newly referred patients was conducted to assess how doctors and patients introduced medical words. Medical words were identified via a computer program using a defined list.

Results  Doctors did not introduce or use more medical words than patients, but the types of words that doctors and patients introduced did differ. The majority of patient‐initiated medical words occurred during the history taking (94%). Doctors did not explain, or use as part of an explanation, the majority (79%) of the medical words they introduced, and patients seldom responded in a way that would indicate whether or not they had correctly interpreted those terms. There was relatively little repetition of medical words within or even across encounters.

Conclusions  This study provides insights into how the use of medical terminology could contribute to misunderstanding. Findings suggest that steps already promoted in the literature to improve doctor–patient communication may also ameliorate potential problems arising from the use of medical terminology.

The health literacy demands of the healthcare system often exceed the health literacy skills of Americans. This article reviews the development of the Health Literacy Universal Precautions (HLUP) Toolkit, commissioned by the Agency for Healthcare Research and Quality and designed to help primary care practices structure the delivery of care as if every patient may have limited health literacy. The development of the toolkit spanned 2 years and consisted of 3 major tasks: (1) developing individual tools (modules explaining how to use or implement a strategy to minimize the effects of low health literacy), using existing health literacy resources when possible, (2) testing individual tools in clinical practice and assembling them into a prototype toolkit, and (3) testing the prototype toolkit in clinical practice. Testing revealed that practices will use tools that are concise and actionable and are not perceived as being resource intensive. Conducting practice self-assessments and generating enthusiasm among staff were key elements for successful implementation. Implementing practice changes required more time than anticipated and some knowledge of quality improvement techniques. In sum, the HLUP Toolkit holds promise as a means of improving primary care for people with limited health literacy, but further testing is needed.