Literacy challenges extend to health care

In Healthy People 2010, a 10-year set of objectives developed by the U.S. Department of Health and Human Services, improving the general population's health literacy is seen as integral to ensuring patient safety.

Among other things, health literacy is defined as the ability to understand instructions on prescription drug bottles, appointment slips, educational brochures, doctor directions and consent forms, and the ability to negotiate complex health care systems. It requires sophisticated reading, listening, analytical and decisionmaking skills applied to health care situations.

But it will be difficult for individuals who lack basic literacy skills to achieve these goals.

The other day while driving, I noticed a sign on an area strip mall marquee greeting passers-by with the proclamation, “Happy Holiday's.” By putting an apostrophe between the “y” and “s,” the signmaker made it possessive, not plural. As a person who writes for a living, such misuse of the English language, especially in public displays, annoys me.

It is a perfect example of the functional illiteracy we're dealing with as a society. It's becoming acutely apparent to me that the emphasis educators have placed on math and science in recent years has served only to enhance serious deficiencies in other academic areas, such as basic communication skills.

The Institute of Medicine reports that 90 million people—nearly one-third of the U.S. population—have difficulty understanding and using health information. As a result, patients often take medicines on erratic schedules, miss follow-up appointments and do not understand instructions such as “take on an empty stomach.”

I recently received a letter from my health insurer's pharmacy benefit manager addressed to “Joanne Wojchick.” If the letter had come from almost any other source, I might not have been too concerned. But the PBM, which is part of my health insurer, should have the proper spelling of my name on file, particularly because the PBM issued me an insurance card with my name—spelled correctly—printed on it. What was even more amazing was that it had the wrong house number. It's a wonder it ever got to me.

At first I was going to mark it “addressee unknown” and return it to the PBM. But on second thought, I decided to open it to see what was inside. The envelope contained a folded plastic bag and a return postage label, also inscribed with the butchered version of my last name, and a note explaining how to return a mail-order prescription.

Because I don't use the PBM's mail-order service, I called my health plan. The customer service representative transferred me to the PBM's “merchandise return department,” where a recording asked that I leave a detailed message, which I did. That was three weeks ago.

A lot of people stumble over my last name. But even a slight transposition of letters in a person's name could have serious consequences.

A few years ago, after receiving several prescriptions from a local pharmacy in which my name was spelled “Wojick” instead of “Wojcik,” I insisted that the pharmacist correct the spelling in her computer. Afterwards, my drug copayments all increased. When I asked why, she explained to me that my prescriptions had been erroneously processed under the insurance terms of someone whose name was spelled “Wojick” and whose copayments were lower.

That got me to wondering what this “Joanne Wojick” might have thought when she received an explanation of benefits from her insurer after I filled a prescription for a colonoscopy prep kit. Then again, maybe she was one of those 90 million people who don't know how to interpret an EOB.

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