The role of clear communication in health equity
About 6 months ago, I sent a press release out to the MOHEC listserv describing the results of a study examining why black men often avoid going to the doctor. This summary started off a week long virtual dialogue highlighting the important intersection between health literacy and health disparities. For those of you who may have missed it, here is the story. For those who are interested in more details about the study, see the full article, “Social and Cultural Factors Influence African American Men’s Medical Help Seeking.”
This and other studies are beginning to highlight how important clear and complete communication is improving health. They also show how addressing health literacy is a potential solution to help fill in some of these gaps. Health literacy is often defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” This definition however is far too limited. It places the blame on the patient because it fails to recognize how that information is provided by the health system. Health literacy is about how we process information from our health system, and more importantly, how it communicates with us.
As many of you pointed out in our virtual discussion back in February, the experiences that black men described in the study were very similar to rural residents, Hispanic females, those in the LBGTQ community, and even for whites.
Before I continue, I want to be clear. I am not blaming the doctors. Many of them are overworked and underappreciated. A large part of the problem is the current reimbursement system or how we pay for health care. We currently have what we call a “fee-for-service” system. This means that we (either the patient or the insurer) pay a fee for each service we receive from a physician. This has some basic implications for health literacy and health equity. First, the doctor gets paid regardless of what happens, so there is not much incentive for the doctor to talk to the patients to make sure they will be able to act upon the health information they are providing. Second, ask yourself this: How much time do you get to talk to your doctor when you see them? According to the Kaiser Family Foundation, data show that on average, most Americans now see their doctor for 20 minutes, about six minutes more than they did 15 years ago.
From the Kaiser Family Foundation - http://facts.kff.org/chart.aspx?ch=201
But an increase in quantity hasn’t meant an increase in quality. Because patient-provider communication and understanding isn’t as valued by our system, not as much time is spent truly communicating. For example, very few insurance plans (public or private) will reimburse a doctor for getting to know their patients; yet, it can be vital to providing practical health advice.
And this type of communication is especially important when the patient and the physician are from different identities and cultures. Without understanding where a patient works, plays, and lives it is very easy to fall back on stereotypes. Instead of trying to understand their challenges they may label the patient as lacking motivation or just being lazy.
As reimbursement moves towards a focus on the quality, and not just the quantity of care, health literacy and health equity should play a larger role in the American health system. Who knows, perhaps one day, doctors will get paid to sit down over a cup of coffee and really get to know their patients. Other countries with more diverse cultural histories have seen the value of this and their systems are better for it.
Stan Hudson is the associate director of the MU Center for Health Policy and leads the Center’s health literacy projects. Among these projects is the unique Clinical Simulation Program which gives doctors and other healthcare providers hands-on experience on how to effectively communicate, engage, and empower patients for better health.
The opinions and views expressed in this blog and/or comments are those of the author(s) and do not reflect any position of the Center or the University.
