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WASHINGTON (AP) - Millions of Americans are risking their health because they cannot understand medical forms, even prescriptions, and many doctors are too harried to provide simple directions, experts said Saturday.
``This enormous problem has gone largely unrecognized and rarely discussed,'' said Dr. Herman I. Abromowitz, an American Medical Association trustee who participated in a discussion of health literacy at an AMA national leadership conference.
``Take away the fear of your white coat and stethoscope. Let your patients know it's OK not to understand and to ask questions,'' he said, reminding his colleagues they have an ethical responsibility to ensure that patients understand them.
Among the problems cited: the growing number of senior citizens who have problems with vision, hearing and cognitive skills; more and more patients for whom English is not their first language; patients unable to read or with learning disabilities, such as dyslexia.
Also, doctors busier than ever are not taking the time to adequately explain patient consent forms, instructions, prescriptions and other vital information. And when they can take the time, many physicians lapse into ``doctor-speak,'' rather than using plain English.
The AMA estimates about 90 million Americans have difficulty comprehending medical information and acting on it.
That means an inability to follow instructions on pill bottles, understand health advice, complete office forms or insurance applications, or give informed consent to have an operation or office medical procedure.
The results can be devastating - visits to emergency rooms, increased likelihood of complications, even death.
The country's largest organization of physicians estimates that low health literacy costs the health care system $73 billion per year in unnecessary doctor visits, hospitalizations and longer hospital stays, and that estimate does not factor in expenses associated with malpractice lawsuits.
Last year, the AMA, and its philanthropy arm, began a first step toward addressing the problem - educating doctors about how to recognize patients with low health literacy.
The foundation recently started distributing kits to doctors that include an 18-minute video showing patients struggling to keep up with their medications.
On the video, one patient, a fifth-grade dropout who can barely read, admits he has problems following labeling directions for the nine medications he must take each day and the three inhalers he uses. A second patient says, ``You're just like a bird out there, you're lost.''
At the discussion Saturday, Dr. Mark V. Williams, director of the hospital medical unit at the Emory University School of Medicine, told about 35 doctors that his research shows many patients are simply too embarrassed to let the doctor know they do not understand what they are being asked or told.
``There is shame involved. We need to be sensitive,'' he said.
Dr. Patrick E. Brookhouser, an otolaryngologist - or specialist in disorders of the ear, nose, and throat - said patients just told of a cancer diagnosis or other unanticipated news cannot be expected to comprehend the information that comes next.
Dr. Bruce Scott, also an ear, nose and throat specialist, said he changed all of his office forms to make them easier to read after realizing that many patients were giving incorrect answers to such basic questions as whether they had had any previous surgery.
``Here I was wondering, 'Why aren't you cooperating with me?'' he said.
Psychologist Terry C. Davis, a professor at Louisiana State University's School of Medicine, challenged the panel to simplify lengthy consent forms that contain what she described as incomprehensible legal and medical terms.
``What we say to ourselves is legally this is the way it is, and we just throw up our hands,'' said Davis, shaking her head. ``Patients are asked to sign these every day, and they don't understand what they're signing.''
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