Health Literacy

Lisa Fitzpatrick begins to speak to the audience.

This is my dad.

He’s actually one of the smartest people I know.

As you can see, he’s a Cardinals fan.

That’s because we’re from St. Louis, Missouri, which is where I grew up.

I was there a few months ago.

We were having breakfast.

We were having a conversation.

“Dad, how’s your health?”

“I’m doing great!

Next week, I’m going to see my gynecologist.”

(Laughter)

“Your urologist!”

“Oh, yeah, yeah.”

(Laughter)

Dad is not alone, though.

He got a little mixed up.

Raise your hand if you’ve ever been confused by a medical term or something your doctor said.

In my 20 years of experience in public health and medical epidemiology and medicine, this confusion transcends race, gender, age, income, and geography.

That means we have a problem with health literacy.

Health literacy is the ability to understand and utilize health information.

But what’s interesting is we’re bombarded by health information almost 24 hours a day.

But people are still confused.

They don’t know what to eat, how much to drink, who to see for what.

We have low health literacy.

And low health literacy can get expensive.

Latest cost estimates of health literacy, low health literacy, are up to $238 billion a year.

That’s because people who have low health literacy are more likely to enter our health care system when they’re sicker, so they show up in the ER.

They’re hospitalized.

They may even have surgery.

These are our most expensive forms of healthcare.

Now, I’ve been thinking about this for a long time.

I’ve been trying to figure out, how do I use my interest and my skills to teach people about basic health information?

So one day I was in a bike shop, and I met a videographer named Francis Tatum, and I told him about my desire to educate people.

So together, we created Dr. Lisa on The Street.

Take a look.

(Video) Lisa Fitzpatrick: Doctors often speak in a language that people don’t understand.

Has this ever happened to you?

Man: Pretty much all the time.

Text displays on screen: Define exacerbate.

Man: Exacerbate, I don’t know that word.

Woman: Hold on, you can’t extend?

Text displays on screen: How does the flu spread?

LF: How does the flu spread?

Man 1: Not cooking your food properly.

Man 2: That’s salmonella.

Man 1: Well, that’s –

Text displays on screen: Have you ever gotten a flu shot?

Man: No, don’t want one. I see everyone pushing it. They keep pushing it; everyone keep pushing it. I’m sick of corporate America pushing stuff on me.

LF: Shawn, got some Pop-Tarts?

Shawn: Yeah.

LF: Okay, didn’t you just tell me that we have to cut down on sugar?

Shawn: I did.

LF: And you’re a diabetic. And you have Pop-Tarts and Froot Loops.

Text displays on screen: Where are the kidneys?

Man: These are the kidneys or lungs.

LF: You said kidneys or lungs?

Man: The kidneys or the lungs.

LF: So, that’s the kidney. This is the lung.

Text displays on screen: Why do people use the ER?

Woman: [Went to] the hospital with her one day, and she wanted to see if she was pregnant, but she said, “Oh, I got a stomachache,” or something like that, so it depends.

LF: You go to the emergency room, get a physical? So do you have a –

Man: sometimes, it depends.

LF: How do you think we can get the message out to them?

Man: The way you talkin’ to me now. Each one, teach one. That’s the way to spread the news.

LF: I’m Dr. Lisa. I’ll see you on the street.

(Applause)

So what have I learned from walking the streets?

(Laughter)

I learned a couple of important things.

The first one is the grapevine is a powerful educator.

Now, I suspect most of us are getting some of our information from the grapevine, whether it’s through casual conversation or the media.

It’s like the game of telephone.

You tell the first person, and then by the time it gets to the end of the line, the message is all garbled.

But the grapevine’s not all bad.

It’s actually pretty effective at transmitting information.

The problem is a lot of the information just is not true.

(Laughter)

And when bad information gets on the grapevine, it creates chaos.

A fantastic example of this is the recent Ebola scare.

Remember that?

There wasn’t enough information reaching the public, so the grapevine took over, and what happened?

We closed schools.

We quarantined people in hospitals.

We barred people from airplanes.

We even kept a cruise ship from docking.

That’s because there wasn’t enough good information on the grapevine to counteract all the misinformation.

This is a great example of why we need better information on the grapevine.

Now, the second thing I learned – and I knew this to an extent already because everybody I talked to on the street had a doctor.

But I learned we are failing to educate you, our patients.

And I think we’re failing for a couple reasons.

First, because our tools are outdated.

Not just our physical tools, but the strategies we use to communicate with people.

For example, this is a health literacy test.

I ask a person to read the words on this paper.

Then I give them a score, and voila, I’m supposed to know if they’re health literate.

Now, this test might tell me if someone can read,

(Laughter)

but I’m pretty sure it doesn’t tell me the things I really care about, like, “Will she take her medications,” or “Will he keep his appointments?”

And look at this.

I still have a fax machine in my office!

Raise your hand if you have never used one of these.

(Laughter)

Right?

At a time when patients are asking us to communicate with them via text and email, doctors are still communicating via fax, and even my dad has a cell phone.

(Laughter)

But we’re also failing because we use language that’s comfortable for us and not you.

I asked one of my colleagues why he wasn’t testing his patients for HIV, and he said, “Well, I’ve had most of these patients for 20 years. It’s just awkward to bring it up.”

(Laughter)

So I thought for a minute, and I said, “Do you prescribe Viagra?”

He got the message.

(Laughter)

(Applause)

He was denying his patients an opportunity to be as healthy as they could be.

So, why does all this matter?

It matters because research shows that for every $1 spent on health literacy, we can save $25.

That means if we spend $1 million on health literacy, we can save our system $25 million.

That’s impact.

But it also matters because of people like John.

He says things like, “I don’t trust doctors. They’re nothing but drug dealers working for drug companies.”

But then he said something that really struck me.

He said, “Doctors don’t listen. If I go in for a headache, I don’t want you talking to me about my liver. I just want something for my headache.”

I had to explain to him the headache is actually a symptom of a much bigger problem, and it’s our job to figure out what’s causing the headache.

Well, John was diagnosed with diabetes two years ago, but before that, he hadn’t seen a provider in 10 years.

And at that time, the doctor told him he was pre-diabetic.

But he didn’t go back because he felt fine, but also because he didn’t like the way the doctor spoke to him.

Fast forward, he sees another doctor who says, “Guess what? You have diabetes.”

He puts him on medication, but John stops taking the medication without even talking to his doctor.

And almost a year later, he’s rushed to the emergency room in an ambulance in a diabetic coma,

and he spends eight days in the hospital.

He is a great example of why health literacy matters, and our health care system is flooded with patients like John.

So, what can we do about it?

First, we can manage the grapevine.

The grapevine is like ivy.

You know what happens to ivy; you’ve seen it.

If you don’t maintain it and control it, it spreads like wildfire.

And bad information travels very fast on the grapevine because it’s associated with drama, and people usually love drama.

(Laughter)

But we don’t want to destroy the grapevine.

We actually need it.

We need it to help counteract the misinformation.

So, what can you do?

Before spreading information on the grapevine, verify it, and don’t believe things just because they sound true.

Next, I think doctors need to embrace technology, but you have to push for it because the change in our healthcare system comes from demand from you.

And nowadays, almost everybody has a device.

I was riding my bike last week, and I turned down this small road, and there was a group of people standing on the street, and nobody waved.

Nobody even saw me because they were all looking down at their cell phone.

I believe if we are this captivated by devices, we should definitely use them to educate people

with health information, don’t you?

Audience: Yeah.

So you push your health care providers toward technology.

Thank you, please!

Take control of your health.

Your health literacy is up to you.

So, avoid gaps in care.

Remember John?

It took him 10 years to get back to the doctor, but his illness was completely preventable.

Find your health care provider.

John was frustrated because he and his doctors were mismatched, and they didn’t meet his expectations.

Unfortunately, there’s no match.com for doctors and patients.

(Laughter)

But that’s a hint to you entrepreneurs out there.

(Laughter)

He became frustrated and discouraged, and he gave up, but he was the one who suffered in the end.

So don’t be like John.

And finally, be persistent in getting the information you need.

Ask if you don’t understand something, unapologetically.

I know office visits are short, but that’s our problem; it’s not yours.

So speak up and get the information you need to be healthy.

I’m Dr. Lisa, and I’ll see you on the street.

(Applause)