How Do I Explain This?

There is a concept in health care called health literacy. Essentially it is the ability to understand the body, what is happening to it, why it may be sick and how to navigate the health care system.
All of these things require an understanding of Western views of the body and an ability to negotiate these systems, mostly in English.

Many of my patients have what could be described as “low health literacy,” which means a lot of extra explaining about how to properly use medications, that antibiotics must be used until they are gone, not until you are feeling better,   and that when I tell you yes, your pregnancy test is negative today, but that it won’t turn positive from the sex you had three days ago why it needs to be repeated in two weeks.

The patients that I see with low health literacy tend to fall into one of two categories. The first is the young woman, raised in the United States, usually in one of the Small, rural towns that surround the large city I live in. These school districts do not have comprehensive sex education (or really any sex ed at all), which I found out when I made an offhand comment to the health center manager in one town after I had been given quizzical look after quizzical look after discussing emergency contraception, something these teens had never heard of before.

Many of the women and men I serve believe that HIV can be transmitted through sharing cups and glasses, holding hands, or through kissing. Many do not have a basic understanding of anatomy, as I was asked recently that if we needed to get clots out of the uterus maybe the patient should drink a lot of water and pee a lot. Many of my patients use the pull out method for birth control (hey, it’s 70% effective!)

These young women and men have been utterly failed by a school system that has funded abstinence only education for the vast majority of their lives, and that currently values high stakes testing over health education (as well as the arts, sports, and other fulfilling activities).

I am certainly no expert in how to solve the problem of low health literacy in combination with high risk behaviors, but I do know that these folks who ask questions need gentle explaining and a little more time. Sometimes that means drawing diagrams of the human body, or what a birth control pack looks like with arrows of which way to take the pills (across left to right, not down).

Sometimes I overhear patients who don’t understand their bodies being mocked or laughed at, and sometimes when you’re exhausted, running short on time and resources, this is an easy habit to fall in to. As a personal tool, I try to take a step back and imagine how terrifying it must be to sit on a table, covered in a paper gown, having had no real education about sex , sexuality, or my own reproductive organs, as a woman, young, from the Big City, who is not that much older than myself , trying not to look like she’s in a hurry, explains things in slow, careful words, some of which I understand and some of which I do not.

My second group of patients that have a very difficult time navigating the health system are those who are from outside the US, who maybe speak English and maybe don’t. We have interpreter phones and access to a pretty good phone line but it is almost impossible to feel connected through the interpreter line. Suddenly all my banter and few tricks to try and get to know a patient go out the window because my schedule is packed, I’m supposed to have two appointments blocked off for these visits, but that rarely happens, and interpreting takes a long time. I end up having to nearly shout so the interpreter on the other end can hear me. I have never wished so hard that I speak another language (mostly Spanish) than during visits that require the interpreter phones. I just want to be able to relate to my patient, to put her at ease, but the interpreter phones make everyone tense. There seems like such a wide gulf that happens during those visits, that could only be solved if only I spoke the same language.

I find myself needing more time than I am consistently allowed with these visits, but weather it’s the young woman who needs extra time to talk about healthy communication or the Spanish speaking woman that I just downright need more time to use the interpreter phone with, there always seems to be something lost in translation. We all do the best we can with what we’ve got, which has been my mantra as of late and sometimes I’m better at believing that than others. I’m trying to come up with simpler and easier to understand metaphors, and to simplify my language while using the interpreter lines, that way I can get more information out faster.

For those of you who work in high-volume clinics with low health literacy, what are your tips and tricks? Or, conversely, what have other health care providers told you that helped you to understand your body or illness?

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