Perhaps you can't read your doctor's handwriting on your prescription, but do you understand what is said to you during your office visit? Are you clear on your doctor's instructions for using medication and understand what you need to do to prepare for a test?

For many Americans, the answer is "not really." Many Americans have complex medical issues, take several medications, and some have reading disabilities or limited literacy. That can add up to poor understanding and confusion.

Raising the bar for patients' health literacy

The health care culture demands more and more literacy from patients. There are more and more medications and many of them involve a very complex regimen according to the American Medical Association (AMA). In recent years, the AMA has worked to raise patients' health literacy.

Patients now have more responsibility. A generation ago, if you had a heart attack, they'd put you to bed afterward and give you aspirin. Now, you're supposed to quit smoking, watch your cholesterol, watch your body fat in addition to taking all these drugs.

The gap in health care knowledge is even greater when a patient has poor reading skills. The Center for Health Care Strategies and the National Academy on an Aging Society reports many elderly patients, who tend to have fewer years of schooling than younger adults, are among the 90 million Americans who have either inadequate or marginal literacy skills. The elderly also tend to have perceptual problems, such as low vision or poor hearing, which can also affect their understanding. About 66 percent of adults in the United States 60 and older have poor reading skills.

The Council on Scientific Affairs of the American Medical Association (AMA) found that patients with low health literacy often have trouble understanding directions for taking medication on an empty stomach or information on an appointment slip or on a standard consent form.

The AMA recommended strategies that doctors and other health care providers can use to make sure patients do understand medical advice or instruction. One strategy, Davis says, is for doctors to "teach back" - give information and then have the patient repeat it to make sure the patient truly understands.

Getting the most out of your doctor visit

If you are unclear about what a doctor says, the National Institutes of Health offers these pointers.

Before you go:

• Write down your concerns.
• Keep a diary of your symptoms, so you can describe them accurately.
• Note any past treatments.
• Gather any drugs you are taking, and bring them or a list of them to the office visit.

During your office visit:

• Be open with your doctor about concerns or complaints.
• Briefly describe all symptoms. Tell when each started, how often it happens and if it has been getting worse.
• Note any causes of stress in your life.
• Ask questions. Be sure you understand what the doctor says. Ask for an explanation of any term you do not understand. Be sure you know the instructions for any medication - when to take it, what to do if you forget and skip a dose; what other drug, food or activity to avoid while taking it; and what side effects may occur.
• Write notes. This will help you remember what the doctor says.
• Bring a friend or relative if you are worried about understanding what the doctor says or have trouble hearing.
• If something bothers you, say so. The doctor needs to know if something is working or if you're having trouble following a treatment.

If a diagnostic test is ordered:

• Ask the reason, and find out what will be learned from the test.
• Ask if there are any risks to the test.
• Ask when results are ready.
• Know what the test involves and how to prepare.
• Ask who will do the test.
• Find out if you will need help getting home after the test.

If you need a special procedure:

• Find out if the test has any dangers or side effects.
• Find out the benefits and risks of the procedure.
• Ask what kind of doctor you need for it and get a referral.
• Ask if you will need to be hospitalized and for how long.
• Ask what kind of pain or discomfort you may feel.
• Ask about the recovery period, how long it will last and what it will involve.

If you take a medication, use our Drug Guide to check side effects and drug interactions.

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External Sources Terry Davis, Ph.D., professor of medicine and pediatrics and head of the Behavioral Science Unit of the Center for Excellence in Cancer Research, Treatment and Prevention at Louisiana State University Medical Center in Shreveport American Medical Association (AMA) National Academy on Aging Society

This article was reviewed and updated June 2007.