He doesn’t want to read the list: Illiteracy, patient compliance, and the electronic medical record

Dr. Erin Marcus’ story

Last year, the community clinic where I work began requiring patients to go elsewhere for their blood and urine tests. For some patients, this has posed insurmountable obstacles, for shameful reasons.

One patient, compulsive about keeping his appointments with me, consistently fails to see specialists I recommend, and to have tests performed elsewhere. He always has an excuse.

And so I am stuck with a pleasant, complicated patient and no way to monitor the effects of the medicines I have prescribed.

Why is he non-compliant? Probably because he can’t read the map or directions I gave him, though he’ll never admit it – like many patients. In fact, one in seven adults in the U.S. has "below basic" prose literacy, i.e., they cannot read simple text. It is particularly hard for these patients to navigate the healthcare system, and their doctors are left without basic diagnostic information they need to provide good treatment.

Our comment:
Too bad they didn’t have Dr. Kalow. My son’s former pediatrician was Dr. Bruce Kalow, the doctor you wish you had. On his own initiative, during evenings at home after seeing young patients in his working class Somerville, Massachusetts community, Bruce developed a medical software program. His program improves communication with his patients and their families, many of whom primarily speak Spanish and Portugese, often with low literacy in English. At the end of the visit, he types briefly into his personal computer, which prints a sheet for the parent (and the doctor’s office) about the diagnosis, treatment, prescription, and follow-up instructions. When needed, the program readily provides the information in Spanish or Portugese.

Advice: Tell your foreign-born friends with little English literacy to look for a nearby doctor who routinely provides written summaries to patients in their primary language.

Read the source story by Dr. Erin Marcus in the July 24 New York Times.