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Help Patients Understand [from AMA Health Literacy Tool Kit]

Checklist for patient-friendly Office Procedures [1]

  1. Exhibit a general attitude of helpfulness.

  2. When scheduling appointments:
    a. Have a person, not a machine, answer the phone.
    b. Collect only necessary information.
    c. Give directions to the office.
    d. Help patients prepare for the visit: Ask them to bring all their medications and a list of questions.

  3. Use clear and easy-to-follow signage.

  4. Ask staff to welcome patients with a general attitude of helpfulness.

  5. During office check-in procedures:
    a. Provide assistance with completing forms.
    b. Collect only essential information. Provide forms in patients' languages.
    c. Provide forms in an easy-to-read format [eg, large print, uncrowded on the page].

  6. When referring patients for tests, procedures, or consultations:
    a. Review the instructions.
    b. Provide directions to the site of referral.
    c. Provide assistance with insurance issues.

  7. When providing patients with information:
    a. Routinely review important instructions.
    b. Provide handouts in an easy-to-read format.
    c. Use nonwritten modalities.

Six Steps to Improving Interpersonal Communication with Patients [1]

  1. Slow down. Communication can be improved by speaking slowly and by spending just a small amount of additional time with each patient. This will help foster a patient-centered approach to clinician-patient interaction.
  2. Use plain, nonmedical language. Explain things to patients as you would explain them to a family member.
  3. Show or draw pictures. Visual images can improve the patient’s recall of ideas.
  4. Limit the amount of information provided, and repeat it. Information is best remembered when it is given in small pieces that are pertinent to the tasks at hand. Repetition further enhances recall.
  5. Use the teach-back or show-me technique. Confirm that patients understand by asking them to repeat back your instructions.
  6. Create a shame-free environment. Make patients feel comfortable asking questions. Enlist the aid of others (patient’s family, friends) to promote understanding.

1. References are for the above 2 lists (Checklist and Six Steps). See “Adapted from….” link below.
These National Adult Literacy Survey results were cited in: American Medical Association Foundation and American Medical Association. Health Literacy: A Manual for Clinicians. Chicago: AMA Foundation and AMA; 2003:8. All information and statistics in this article come from Health Literacy: A Manual for Clinicians in which original sources for the data can be found.

For more information about the AMA Foundation and AMA health literacy program, or to order a health literacy kit, go to the American Medical Association Foundation health literacy Web site at http://www.ama-assn.org/ama/pub/category/8115.html.

Adapted from: http://www.ama-assn.org/ama1/pub/upload/mm/384/june03cp.doc (MS Word - 3 pages)

©2003 American Medical Association
This publication may be downloaded and reproduced for educational purposes. Sale or distribution for non-educational purposes is prohibited.

Behaviors that improve communication [2]

  • Use orienting statements: “First I will ask you some questions, and then I will listen to your heart.”
  • Ask patients if they have any concerns that have not been addressed.
  • Ask patients to explain their understanding of their medical problems or treatments.
  • Encourage patients to ask questions.
  • Sit rather than stand.
  • Listen rather than speak.

The teach-back technique [2]

  • Do not ask a patient, “Do you understand?”
  • Instead, ask patients to explain or demonstrate how they will undertake a recommended treatment or intervention.
  • If the patient does not explain correctly, assume that you have not provided adequate teaching. Reteach the information using alternate approaches.

Formatting checklist for easy-to-read written materials [2]

General content

  • Limit content to one or two key objectives. Don’t provide too much information or try to cover everything at once.
  • Limit content to what patients really need to know. Avoid information overload.
  • Use only words that are well known to individuals without medical training.
  • Make certain content is appropriate for age and culture of the target audience.

Text construction

  • Write at or below the 6th-grade level.
  • Use one- or two-syllable words.
  • Use short paragraphs.
  • Use active voice.
  • Avoid all but the most simple tables and graphs. Clear explanations (legends) should be placed adjacent to the table or graph, and also in the text.

Fonts and typestyle

  • Use large font (minimum 12 point) with serifs. (Serif text has the little horizontal lines that you see in this text at the bottoms of letters like f, x, n, and others. This text, on the other hand, is non-serif.)
  • Don’t use more than two or three font styles on a page. Consistency in appearance is important.
  • Use upper- and lower-case text. ALL UPPER-CASE TEXT IS HARD TO READ.

Layout

  • Ensure a good amount of empty space on the page. Don’t clutter page with text or pictures.
  • Use headings and subheadings to separate blocks of text.
  • Bulleted lists are preferable to blocks of text in paragraphs.
  • Illustrations are useful if they depict common, easy-to-recognize objects. Images of people, places, and things should be age appropriate and culturally appropriate to the target audience. Avoid complex anatomical diagrams.

2. Adapted from American Medical Association Foundation and American Medical Association. Health Literacy: A Manual for Clinicians. Chicago: AMA Foundation and AMA; 2003:8. (in which original sources for the data can be found.): http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf (PDF - 60 pages)

For more information about the AMA Foundation and AMA health literacy program, or to order a health literacy kit, go to the American Medical Association Foundation health literacy Web site at http://www.ama-assn.org/ama/pub/category/8115.html.

http://www.ama-assn.org/ama/pub/category/9913.html

©2003 American Medical Association
This publication may be downloaded and reproduced for educational purposes. Sale or distribution for non-educational purposes is prohibited.

When talking with your patients [3]

  1. Ask your patient if he/she has any questions or concerns.
    • Talk to your patients respectfully.
    • Provide them the opportunity to ask questions and make sure they understand your answers.
    • Be a doctor they feel comfortable talking to.
    • Suggest the patient could bring a relative or friend with them to help ask questions and understand the answers.

  2. Remind your patients to keep and bring a list of ALL the medicines they take.
    • Your patients should give you and the pharmacist a list of all the medicines that they take, including non-prescription medicines.
    • Ask about any drug allergies they have.
    • Tell them about side effects and what to avoid while taking the medicine.
    • Remind them to:
    • Read the label when they get their medicine, including all warnings.
    • Make sure the medicine is what the doctor ordered and know how to use it.
    • Ask the pharmacist about the medicine if it looks different than expected.

3. Adapted from: http://www.ahrq.gov/consumer/5steps.htm

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