Time is an important factor in building trust and collaboration between doctor and patient. For adults with literacy barriers, new skills for self-management are best learned through listening to explanations, watching demonstrations, asking questions, clarifying doubts and practicing self-care over repeated visits. Limited time for direct contact gets in the way of this learning process.

In the past, doctors had access to specialised medical knowledge that was denied to the patients. Patients used to be very impressed with the depth of the doctor's clinical acumen, and were pleased when he made the right diagnosis and provided the correct treatment. Today, thanks to the Internet, patients have access to a glut of health information that was previously only available in medical schools and libraries. This is both a blessing and a curse.

Due to the accessibility of information and limited availability of doctors, patients now rely on the Internet for their health information needs instead of seeking the advice of their doctors. However, the format in which this information is available does not make their job easy.

However, naive readers may not even consult their doctor before following the advice of someone they have never met, because he or she seems to share their symptoms, or understands their concerns. Following the advice may or may not be appropriate, and can be quite dangerous if it involves the use of medications - medications that can easily be bought online at the click of a mouse, without a prescription.

• The medical and nursing education curricula are already crowded and health care professionals are not taught how to communicate effectively with patients who are literacy challenged
• Low health literacy is not considered a priority issue
• A doctor usually has only about 15 minutes to talk to a patient, and this is not enough to ensure clear communication

Patients now live an average of 10 years longer than they did in 1948. Older patients have more chronic medical conditions, which can often be managed for many years thanks to modern technology. However, this management may require multiple medicines, an army of specialists, regular monitoring of side effects and response, as well as adherence to complex treatment regimens.

Older patients are particularly badly hit by poor health literacy. This is a double whammy for them, because even though the complexity of their medical problems increases exponentially as they age, their reading and comprehension abilities decline because of a progressive loss of vision, hearing and cognitive skills. This means that even if they were able to cope when they were younger, they face a much harder time as they age - and this can prove to be a huge burden on them, their caregivers and their doctors. The ageing of developed countries means that the magnitude of these problems will soon become unmanageable.

As our lifestyles progressively deteriorate thanks to urbanisation, the burden of chronic diseases and lifestyle illnesses (such as diabetes, heart disease and obesity) will increase exponentially. When a person with low health literacy has a chronic disease, serious barriers to self-care can arise. People living with chronic disease usually have more than one condition and may have a complex care plan, involving several medications and multiple healthcare providers, many of whom have no idea what the other is doing. There is usually no co-ordination of care, and patients may receive inconsistent messages from different doctors as they make their way through the system, leaving them even more confused.

Getting the right treatment and keeping track of medications and appointments is difficult even for highly educated patients, so we can imagine the plight of uneducated patients. What chance do they have of being able to cope? Many will fall between the cracks, but the bigger tragedy is that rather than fix the system, we will blame them for not seeking medical care at the right time!

Most patients living with chronic diseases are expected to manage their own care, under the supervision of their doctor. This includes using monitoring devices such as glucometers, and knowing how to modify their medication, diet, exercise or other behaviour based on the results. Despite the complexity of their diseases, these patients have limited time with their doctors. A typical physician visit to monitor diabetes takes place every three months, unless there are serious complications, and typically, this visit lasts only about 15 minutes. In that time, the provider must carry out an assessment, order any tests required, answer questions and provide instructions for self-care. Under the best of circumstances, this can be challenging for both the doctor and the patient. To be able to expect patients with low literacy to learn everything they need to in these 15 minutes is a tall order.

Time is an important factor in building trust and collaboration between doctor and patient. For adults with literacy barriers, new skills for self-management are best learned through listening to explanations, watching demonstrations, asking questions, clarifying doubts and practicing self-care over repeated visits. Limited time for direct contact gets in the way of this learning process.

1. News stories, press releases and commercials are often misleading because they exaggerate the benefits of interventions and minimise the harms. For example, you read an article that claims that a new drug reduces the risk of a heart attack by 50%. Your loving wife promptly takes you to the doctor and pressurizes him into prescribing that drug to you, not realising that the 50% mentioned in the article refers to relative risk not absolute risk. Relative risk means that there could be a reduction from two heart attacks in 100 untreated patients to one heart attack in treated patients. This implies just 1% absolute risk reduction. In other words, the remaining 99 patients would be spending money on buying the drug and risk attracting its side effects, without getting any medical benefit, whatsoever. These are not easy concepts to explain to anyone, much less to low-literate people.
2. News stories seem to equate "association" with "causation". There may be an association between A and B, but this does not mean that A causes B. For example, NBC News once reported that eating chocolate may decrease heart disease by as much as 37%, and MSNBC reported that drinking coffee may protect against breast cancer. What's worse is that subsequent stories contradict earlier ones, leading to a lot of confusion and scepticism among viewers.
3. The third problem is the promotion and overuse of "screening" tests even for people with no symptoms of a disease. These are often heavily promoted for everyone, which leads to unnecessary testing, anxiety, and harm due to excessive testing.

Thus rather than help doctors dispel myths and misconceptions, media channels often make a bad situation worse by misinforming patients. To counter this, we need to tap alternative options to deliver trustworthy information to patients. These may include: expert patients and self-help groups; curated websites; and consumer alth libraries, to name a few.