hospital impact

Guest post by Dr. Marc D. Rothman

A sobering article this summer in Archive of Internal Medicine highlighted yet another way in which, despite all the good intentions of high-tech folks like us and our reliance and devotion to our digital tools, some of the most basic differences between groups of people continue to predict who does well and who does not when it comes to health care for older people.

As if income, insurance coverage, and race weren’t enough… enter ‘health literacy;’ the ability to read, understand, and utilize basic health-related information like prescription bottle labels and appointment slips. The authors looked at more than 3500 people over 65 years, tested their initial health literacy and followed them for 6 years. The results were eye-opening:

A quarter of the folks had inadequate health literacy, meaning they misread prescription bottles and appointment slips. This group had a greater chance of dying over the next 6 years (40% chance vs. 18% for those with good literacy), even when adjusting for everything else under the sun (race, income, smoking, diseases, meds, etc.).

The difference in death rates was most pronounced for cardiovascular deaths (as compared to, say, cancer), possibly because managing heart disease takes lots of appointments, medications, tests, etc.? And what’s most upsetting is that the magnitude of this association between inadequate health literacy and mortality is about the same as the association between low income and mortality.

Though the study was well done and interesting, it doesn’t come as much of a surprise to me. As a geriatrician it’s astounding to see the complexity of a patient’s diseases and management.

Six or eight chronic diseases, ten to twenty pills taken four times a day to treat them, five other docs each managing only one ailment, and so on.

In the future it’s not only the pill box label that will need to be read. It’s a maze of competing interests and trade-offs, decisions about how or whether to treat, possible complications and side-effects which sometimes resemble the diseases themselves. And harder still, the fact that so much is uncertain: the physician cannot always be sure, and neither can the patient. This last concept is the most complex, but ALL of it is complicated to a degree that is difficult to appreciate.

If you think I’m nuts, go to your grandparents house and ask them to show you and explain what pills they take, what they’re for, how that disease is doing, and what their system is for managing it all. They you’ll know what it’s like on a good day. Just imagine putting it all together the first day back from the hospital after a two week stay, when three pills were stopped and two new ones added.

I’m not saying it takes a PhD to understand one’s own health and health care, but it wouldn’t hurt either!

Dr. Rothman is a specialist in geriatrics and long-term care. He is finishing up his fellowship at Yale University School of Medicine.