Saturday, October 5, 2019

Confessions of a Low Health Literate Woman

This week I was reading a thread on the IHA Health Literacy Discussion List and once again,  contributors were talking about what tools they would use to assess a person's health literacy in clinical settings.  Should it be the  NVS, TOFHLA, REALM and BRIEF.  

My reaction, and thankfully some of the contributors as well, was - OH NO. Are we still there! The 1990s when we naively believed that health literacy was a competency someone had or didn't have - static.  And that these crude reading and computation tasks could point us somewhere useful. 

Careening to 2020 we should be well on our way to accepting that these early notions of what health literacy is were based solely on deficit models - what people COULDN'T DO.  Not about what real people are capable of, what they negotiate and get done in their lives.  What we call a person's health literacy is far more changeable and interesting than any computing about how many calories a serving of ice cream has. 

But I didn't want to be mean spirited and say just that.  So I pondered it and finally decided the best thing I knew to do was talk about me and my own flawed understandings of health.  Full disclosure - I'm a fairly smart lady, good credentials in the field of public understanding of health and science - but, well.... you decide if I am low health literate. 

Last June I went to a dermatologist because I had some occasional redness on one side of my face and sometimes it felt a bit numb.  Quite frankly, after all my teen years with acne, I think I should be rewarded with the clear skin my age group is entitled, sans makeup.  For some reason he skipped over possible allergies and went straight to the big stuff – auto immune disease and my “asymmetrical face”.  Didn’t use the “L” word but I could see it in his beady eyes. 

A week later, through an alert from my patient EMR, I read that “all my tests came back negative/in the normal range.” By then it was start of summer and I figured a tan would take care of that little problem. I didn’t make a follow up appointment in spite of reminders. I didn’t have Lupus and as for the facial symmetry, I just had to accept Wikipedia’s little jab - “facial symmetry has been shown to have an effect on ratings of attractiveness in human faces.”  It’s all good.

Unrelated in every way to the discovery that I had an asymmetrical face, I had a recent run-in with a change of medication dosage. Full disclosure - I’ve been bad with numbers, percentages, fractions, computation, all my life.  My parents even had to hire a math tutor so that I could pass the math section of NY State high school Regent’s exam and graduate. 

So, my doctor, not the beady eyed one, and I talked over increasing my anxiety meds just a skosh.  You know - tariffs, the stock market, impeachment talk and the clear devolution of civility abounding, it seemed good evasive action.  She explained I would add a second pill – 37.5 mg. along with the first.  That would be a total 187.5 mg.  I asked her why I couldn’t just take one bigger pill. She said that the next dose up would be 225 mg.  “Oh, I see.  Of course,” I said looking straight at her. I pondered the math all the way home but it wasn’t until I sat with pad and paper that I could figure out why I had to take two pills.

Oh, and as for medical forms - I haven’t met one that liked me.  

“Excuse me. When it says “recent surgeries” is that in the last 10 years – I am 70 and 2010 seems recent to me. “

“Excuse me. Should I check where it says “emphesyma, shortness of breath, sarcoidosis” because I really can’t breath well with this cold.

“Here in smoking history do I pick “smokeless tobacco” I use e-Cigs.

“Excuse me. When it says “I consent to pay any reasonable costs related to this procedure” how do I know what that means?  What the costs are?”

“I didn’t check off “paresthesias”  - not sure what that is.  I don’t think I have that.”

“I had some spots on my skin that the doctor took off.  Should I check where it says “history of cancer”.

--> In closing - the Big Lots near me got a shipment of Italian wafer cookies - vanilla.  The price too low to advertise here.  I bought many of the prettily wrapped packages – foil lined – so old word civilized.  The nutrition label says 4 wafers = 150 calories.  But when you break off the wafers it looks like there are two stuck together. My unfortunate dilemma – am I eating 2 wafers / 75 calories, 4 wafer/150 calories or really 8 wafers @ ________well I can’t do the math!

--> .

Monday, September 30, 2019

Kentucky Medicaid - there's no shame in calling it "work"

Federal officials have approved work requirement proposals in seven states — Arizona, Arkansas, Indiana, Kentucky, Michigan, New Hampshire and Wisconsin.

And the more I clicked on the links for the painfully disguised Medicaid work requirement in Kentucky, what they mysteriously obfuscated as the Path Community Engagement Requirement, the more I concluded that this rebranding of a work requirement has 2 big downsides:

#1 As I talked about in the previous post "community engagement" doesn't jump off the page saying "work" requirement. Writing critical health coverage information that is high barrier - hard to read and use, frustrates and demeans consumers and perpetuates the health disparities agenda. 

#2  Not using the word "WORK" diminishes the very value of the work it wants to encourage.  What's so wrong with calling taking care of a relative work!!!

Friday, September 27, 2019

How Kentucky Medicaid Disguised Work Requirement

The Commonwealth Fund reports that nearly Half of Kentucky’s Medicaid Enrollees Don’t Know About the State’s Plans for a Work Requirement.

First #1

Then you have to know to click on the middle box that tells you that you will "have a Path Community Engagement Requirement.

Being preternaturally curious you click on this vague statement. 

What the hell? 

Well the "Path Community Engagement Requirement" is ....EMPLOYMENT!

Either a creative at an Ad agency conjured up the Path Community Engagement name with delusions of Adworld awards, or the Kentucky Health Communications Dept. hasn't gotten the memo - 

Imperative to help people stay as healthy as possible - make health information clear, understandable and usable. 

Sunday, September 8, 2019

Liberal Media Fails to Learn From TrumpSpeak

Over the last two years any number of critics have pounced on the simple stupid of Trump speak. The Atlantic's 2018 piece,  "How to Speak Like Trump: A short guide to speaking the president's dialect" is a fine example. Writer Kurt Andersen says, tongue in cheek, "I spent weeks studying transcripts of his interviews and press conferences and depositions, as well as thousands of his tweets, to assemble a lexicon I could consult as we wrote. This is an abridged version of that Trump style guide." The lexicon features recognizable Trump words like -
big / huge / major / many / massive / numerous / staggering / substantial / tough / vast
          Usage note: These may be spoken once, twice (“major, major”), or three times (“many, many, many”)
Along with utterances such as:
“I mean, we defend everybody. We defend everybody. No matter who it is, we defend everybody. We’re defending the world.”

Yep that all too familiar decimation of the language that we take as an indicator of the Great Western Decline and the encoding of a great existential crisis.  I get how easy it is to equate this type of talk with small minds who oversell inauguration crowds and the return of coal mining jobs.
And yes, a linguist, I get the connection between thought + language.  I've spent many painstaking research hours analyzing transcripts of speech to shed light on a speaker's world view, perceptions and, dare I admit, intellect. I even gave a talk at my college on the language level of Trump's spoken language -  "A linguistic analysis of Trump Speak" showing that most of Trump's utterances were scored at about 5th grade level and lower!

Zarcadoolas/ CUNY/ 9/28/16

But if the liberal and (supposedly) democratizing media is going to help elect someone other than Trump Tuesday November 3 2020 they better learn something from both Trump speak and the popular language of the conservative media ( let's say, FOXNews).

I submit as evidence Example #1 
(CNN and Fox reports of the Alabama was in Dorian's path fiasco - affectionately called "markergate") 

Even when I unpack that ridiculously long CNN sentence I still can’t make it understandable:
1. On Friday NOAA disavowed (said something was not true)something.
2. That something was a tweet.
3. That tweet was from the National Weather Service office in Birmingham Alabama.
4. The tweet from NOAA contradicted said something opposite) to what President Trump said.
5. President Trump said that hurricane Dorian was likely to hit Alabama.
Rule: if you are embedding 5 sentences into one long sentence you really have no interest in people understanding what the heck you’re saying.