Chapter 23: Final Thoughts From Dr. Malpani
We can all be functionally illiterate to some degree or another when we are placed in unfamiliar situations. Even doctors can be health illiterate in areas that they do not specialise in.
At first blush, health literacy seems to be a dry and boring academic topic for most doctors. This is why I feel every doctor should see the film English Vinglish. This is a touching film, and will help all health care professionals to understand what uneducated patients go through when they cannot understand what the doctor is saying.
The protagonist of this film, Sridevi, cannot speak English, and finds herself completely clueless and directionless in New York. Her situation is akin to that of patients who find themselves stranded, lonely and miserable when they fall sick, and are unable to navigate the complex linguistic landscape of healthcare professionals.
Patients naively expect their doctor to act as a friend, philosopher or guide, but if they are poor or uneducated, they will often find that the doctors and other medical staff treat them callously and thoughtlessly. Medical students and residents often make fun of patients who cannot understand what theyre saying; and many get irritated when they have to repeat instructions to patients, who are not able to comprehend a language that is foreign to them.
There are a lot of parallels between Sridevis lack of proficiency in English and a poor patients health illiteracy. Most large hospitals are in the cities, and patients who come here for treatment from villages are often poor and cannot read or write in English. They spend a lot of time, money and energy to come to city hospitals that can provide them high quality specialised medical care, so they naturally come with great hopes and expectations.
However, when they land here they find their hopes dashed in a manner similar to Sridevis experience in New York City. They discover to their horror that most signboards are in English and they get lost very easily. Doctors and medical residents usually come from privileged urban backgrounds and think, read and write in English. Most of their education has been in English; their medical textbooks are in English; and their professors lecture to them in English as well. While this means that their medical knowledge and technical expertise meets global standards, it also means that they have a hard time talking to their uneducated patients from a vernacular background.
After watching this movie, I felt that our doctors can learn a lot from the characters of this movie. Character artist, Amitabh Bachchan, who occupies a seat next to Sridevi on the flight from Mumbai to New York, is supportive and helpfully shows her how to use a call bell to summon the hostess. In sharp contrast, the waitress behind the counter at the coffee shop is loud and obnoxious, because Sridevi cannot place her order in English and is holding up the other customers. She belittles Sridevi, makes fun of her; and causes her to leave the caf‚ in tears. You can watch the trailer on YouTube @https://www.youtube.com/watch?v=AwmFMjv7XE4.
What kind of doctor are you? Do you take the extra time and trouble to learn how to communicate with your patients in terms they can comprehend?
Uneducated patients or those from a linguistically different background then yours are very vulnerable. They maybe impoverished, scared, poorly informed and easily exploited. They are usually treated by doctors and nurses with little respect, because they think of them as being stupid because they cannot speak English. Ive witnessed some doctors take a perverse delight in looking down upon these patients - tragically, the very patients who need our compassion and kindness the most.
In reel life, the story has a predictable happy ending, and Sridevis self-esteem is restored, thanks to the motley bunch of classmates in her English language class, who prove to her that shes competent, and that learning English is a skill she is quite capable of mastering. Similarly, patients also need to learn that they have to take the time and effort to master basic medicalese - they cannot expect to be spoon-fed all the time.
While doctors can take the initiative in simplifying how they talk and write, literate patients also have a lot to offer. Collaborative efforts such as Wikipedia show that its possible to tap into the wisdom of the crowds for creating information for mass consumption. . Thus, if you are fluent in English and Hindi, you can volunteer to create health entries in the Hindi Wikipedia, so everyone can benefit from these. Similarly, if you are a graphic artist, you can use your skills to illustrate medical concepts for laypeople. If you are a Web designer, you can offer to publish a website for your doctor, so he can communicate with his patients. If you are a concerned citizen, you can make videos of your doctor answering common questions in regional languages, and upload them to YouTube. Remember that the best way of helping yourself is to help someone else - and all patients can use their hard earned personal expertise to make the life of other patients easier.
Remember that we can all be functionally illiterate to some degree or another when we are placed in unfamiliar situations. Even doctors can be health illiterate in areas that they do not specialise in. For example, if an orthopaedic surgeon gets cancer, he may feel at a loss with the diagnosis and will need help from an oncologist to make sense of his treatment options.
As each health literacy problem is unique, the solution we need to deal with it also has to be unique! Information material has to be tailored to those unique health needs.
For instance, a nutritionist who is familiar with a patients dietary habits and preferences can offer a better and more realistic solution to her weight problem, than simply handing her out an informational leaflet on Daily Recommended Allowances or giving her vague advice on reducing her caloric intake. You have to know the patients "bigger picture" in order to provide her with effective advice.
This may seem like a lot of work. However, rather than see health literacy as a burden to be borne, it can actually be a wonderful opportunity for medical practitioners to learn the best practices of the healthcare industry. In effect, health literacy presents an opportunity to offer CARE, where:
- C stands for Compassion
- A for Acceptance
- R for Respect, and
- E for Effective care
In order to be able to offer this kind of CARE, we need to make our communication clear, simple, brief, appealing, interesting, believable, and persuasive.
We cant do it alone. We need to work together to make a difference. By highlighting the issue, collaborating and by making effective use of the innovative literacy resources available today, we can help overcome literacy problems and achieve improved health outcomes. Improving health begins with understanding - andhealth literacy is a vital part of this prescription.
Poor literacy and poor health set up a negative vicious cycle. Because the poor cannot afford education, they suffer from poor literacy. This prevents them from receiving good health care, as a result of which they may fall ill more often. This affects the next generation as well, because ill, poorly-nourished mothers in turn have malnourished children, who are often physically stunted and mentally disadvantaged because of poor in-utero nourishment
Can we break this cycle? India has the potential to become a world superpower, but only if we can capitalise on our social capital, by making sure our citizens are healthy and productive. Health literate people live longer and have stronger incentives to invest in developing their skills and their childrens knowledge. Healthier populations have higher productivity and are less of a burden on a countrys fragile health system, thus cutting down on wasteful expenditure.
India has many dubious distinctions, including being the diabetes capital of the world. These chronic illnesses are lifestyle diseases, and all the doctors and hospitals in the world will never be enough to manage these. We need to empower citizens with health literacy, so we remain healthy, happy and productive. Success happens one individual, one company and one community at a time. And thats the challenge and opportunity that stands in front of all of us, starting today.
Low health literacy is a silent epidemic that can cause the health care system to collapse. This is a huge challenge - and a great opportunity as well. Wed encourage you to explore and to contribute. Find people with a passion for health literacy, and work with them to move your program forward. Think big, act small, dare to fail... but PLEASE stop talking and start acting! The Suggestions for Further Reading lists the resources used in the creation of this book, as well as further sources of information on this neglected topic. It is a good starting point and will put you in touch with the main players in this area. You can access the online version of this book @www.thebestmedicalcare.com/healthliteracy ! We would like to hear from you - and would be delighted if this book inspires you to create your own resources that we can add to this expanding list!