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Misunderstood medical instructions can be proved deadly  

Copywright 2008, Idiomorf infographics  

Pay attention when following instruction
This is one of a serial illustrations which has been made for articles for Nursing Magazine. It shows two persons verifying their medical data. This medical image is made to show what can go wrong when the instructions are mixed up by using different date notification.

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Plenty of evidence suggests that having trouble understanding medical information is bad for your health. Now new research says it could even be deadly.
A study of patients 65 and older found that those who couldn't understand basic written medical instructions were much more likely to die within six years than those who had no problems grasping the information.
The difference in the death rates remained substantial even when researchers considered differences in the patients' health at the outset.
Inability to understand medical information and instructions makes it hard to manage chronic illnesses from asthma to diabetes to heart disease, said the author of general internal School of Medicine.
That in turn can lead to declining health, frequent hospitalizations and ultimately death, especially in older patients whose health may be more precarious to begin with, he said.
One-fourth of the 3,260 patients in the study were considered medically illiterate. That was based on tests of their ability to read common medical information, including prescription labels, appointment slips and instructions on how to prepare for an X-ray.
Almost 40 percent of those deemed medically illiterate died during the study, compared with 19 percent of those who were literate. Factoring in health at the outset and other variables, medically illiterate patients were 50 percent more likely to die than the others.
The difference in death rates ``was much higher than we expected,'' he said.
The results appear in Monday's Archives of Internal Medicine.
Evidence suggests that as many as 90 million Americans have trouble with medical literacy, said a specialist in aging and community health at the American Medical Association. She was not involved in the study.
While patients of all ages are affected, ``the elderly are the most highly challenged because they're on the most drugs and have the most chronic illnesses,'' she said.
Other studies have suggested poor literacy might be linked with higher death rates, but this is the most comprehensive to date.
A recent small study suggested intensive education to help patients understand medical information can reduce hospitalization and death, she said.

Medical instructions often complicated
According to the most recent federal statistics, 29 percent of adults 65 and older have health literacy - the ability to understand medical information - below a basic level. The result can be more emergency-room visits and more hospitalization.
Some hospitals, medical schools and pharmacies are taking steps to improve health literacy. They're training new doctors to use clear language and avoid jargon, getting hospitals to improve communication with older patients, and making prescription labels easier to read.
Target stores, for example, in recent years increased the type size on its labels and created a flat-faced bottle that eases reading.
A methodist Hospital in Omaha lends small amplifiers to patients with hearing trouble, so they can understand instructions from doctors and nurses. And more Methodist nurses are getting training that earns them a national certification in caring for older patients.
A Health Cerner in Omaha asks permission to contact the family members of elderly patients who are scheduled for surgery or medical procedures. The hospital then talks to the kin to make sure the patient understands the diet and medication changes necessary before surgery.
A geriatric physician at a Medical Center said older people face greater health-literacy challenges simply because they tend to go to the doctor more often. Older patients also are more likely to be taking multiple medications.
One of our reseach laborants spends plenty of time with doctors. The 67-year-old has had breast cancer, heart problems and diabetes.
She has lots of medical instructions to juggle. She takes at least 12 medications a day. Along with her family doctor, she sees a cardiologist and a kidney specialist.
She has taken multiple medications so long that she knows the pills by sight and touch. She keeps track of her doctor's appointments on a calendar. Doctors sometimes use jargon, she said, but she doesn't let them get away with it. She gives them her own instructions: "Tell me in plain English."
A study reported this year by researchers of Medicine illustrated the dangers of poor health literacy.
The study, involving patients 65 and older, found that those who couldn't understand basic written medical instructions were much more likely to die within six years than those who could understand the information.
Of the 3,260 patients in the study, one-fourth were considered medically illiterate, based on tests of their ability to read common medical information such as prescription labels and appointment slips.
Nearly 40 percent of those deemed medically illiterate died during the study, compared with 19 percent of the literate.
Patients who aren't able to understand medical instructions have a harder time managing chronic illnesses such as diabetes and heart disease, said one of these doctors. Such illnesses worsen if they aren't managed.
Even seemingly simple dosage instructions can be confusing. "Take two tablets twice daily" might be interpreted as "Take two tablets per day," he said.
Another problem, he said, is that doctors use too much jargon.

An assistant professor at a Medical Center, said doctors sometimes use jargon because they are trying to be specific.
"The tradeoff is most people don't understand what those fancy terms are, and it causes problems," he said. Instead of saying hypertension, doctors should call it high blood pressure. Rather than referring to blood glucose, they should call it blood sugar. And hyperlipidemia? That's high cholesterol.
At the UNMC College of Medicine, students practice their explanations on people posing as patients. The "patients" give feedback on whether the information was clear or confusing.
Medical students learn that a good way to ensure understanding is to ask a patient to explain the information back to the doctor.
It's also effective for patients to ask doctors to show them an illustration or make a simple sketch. A doctor trying to determine whether a gallbladder problem is causing a patient's stomach pain can use a drawing to show where that organ is.
In 2003, Methodist Hospital adopted a national program called Acute Care for Elders, designed to improve the treatment of older patients.
Nurses are reminded, for example, to turn down the TV and close the door when talking to older patients. And when such patients are discharged, they are given a card with any new medications written on it, in large type.