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!



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