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A Silent Epidemic

"You still have physicians who use medical jargon too much," Davis added, citing the use of "hypertension" instead of "high blood pressure" and "febrile" rather than "fever." Because doctors are rushed, he noted, they tend to lapse into medical jargon because it is what they are used to.

O'Leary said that the Joint Commission's interest in the issue should serve as a signal to hospitals to ramp up their efforts to communicate better with patients. Literacy improvements might be included in future standards hospitals must meet, he said, because they are inextricably linked to patient safety. At the Washington Hospital Center, the largest hospital in the District and health-care provider for many low-income and elderly patients, spokeswoman Paula Faria said administrators are aware of the problem and are examining admission forms and other documents to see whether they are intelligible as well as culturally sensitive. "We want to make sure that people understand what they're reading and, if they can't read, what they're hearing," she said.

Faria said that some departments are using a technique endorsed by the Joint Commission known as "teach back." Instead of asking a patient, "Do you have any questions?" -- which will probably elicit little in the way of a useful response and puts the patient on the spot -- doctors are taught to ask, "What is the most important thing you learned from our visit today?"

"You never want to put a patient in a situation where they feel like they're dense," Davis said.

Another effort regarded as promising, underwritten by drug manufacturer Pfizer, is called Ask Me 3. Designed by the Partnership for Clear Health Communication, a coalition of national health and literacy groups, the program encourages patients to ask three simple questions and to be sure they understand the answers: What is my main problem? What do I need to do? Why is that important?

Cordell, who has worked with the Ask Me 3 program as a patient advocate, said she also advises patients never to go to a doctor or to a hospital alone. Having another person present makes it more likely that necessary questions will be asked, she said.

Anyone who doesn't understand what a doctor or other health-care worker has said should speak up, Cordell said. "You can say, 'Look, you're giving me stuff I can't manage,' " she advised.

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