Health Literacy with Dr Graham Kramer

Realistic Medicine; What?Why?How?

Kate: Welcome to the Realistic Medicine Podcast. We are taking full advantage of Health Literacy Month, and we are delighted to welcome Graham Kramer here to talk to us about about health literacy. So I'll start by introducing myself and Kate Arrow. I'm the clinical lead for realistic medicine in Highland. And then thanks so much for joining us. Graham, can you tell us a little bit about yourself?

Graham: Yeah. Thanks, Kate. And thanks for inviting me to take part in this. I'm a recently retired GP. I retired August last year, having spent most of my career as a GP in Montrose on the East Coast in Tayside. And I suppose I spent a lot of time in general practice with a big interest in people living with long term conditions. And for a few years in the latter half of my career, I was seconded to Scottish government as a clinical lead for self management and health literacy, kind of terms that are slightly confusing and people struggle to think what those might mean. But at the heart of it, it's really enabling and supporting people to be the sort of lead partner in their care, because we know that when people are the lead partners, when they're the active agent in their encounters with healthcare professionals, often health care outcomes are better, people make better decisions relevant to themselves when these sort of things happen. So there's a big political economy around supporting people to self manage, and a key ingredient to that is people being able to understand and engage in their own health and health care. And that's where some of health literacy comes in. And this is very important.

Kate: Grand yeah, because it's a term that we talk about a lot. And it became clear to me recently that not everyone fully understands what health literacy means and how they can improve health literacy. Can you kind of explain to us what it is from a clinician point of view and maybe from a patient's point of view?

Graham: Okay, that's interesting. I think there are sort of a few definitions of health literacy, and I just recently reading a paper, which was a whole paper discussed to sort of teasing out the various definitions of health literacy. It's really complex and I thought it would be disingenuous, but I think some of these are very good definitions. But I would argue that they suck. And I mean suck as a Mnemonic with S standing for skills, u standing for understanding, c for confidence, and K for knowledge. I think fundamentally, health literacy is about people having the skills, the understanding, the confidence and the knowledge to do what? To access and navigate the healthcare system, to be able to collaborate with their health care professionals, and I suppose, finally, to be able to self manage their own health and their health conditions in the way that they would want to necessarily force our treatment, some people. So that's sort of I think a light way of understanding that it's just remember the mnemonic suck skills, understanding, confidence and knowledge. There is a problem with these definitions because they often locate the problem with the person. So we might argue that people have insufficient skills and understanding, confidence and knowledge. And I suppose there's this great temptation to sort of really try and improve that, improve their skills and understanding and give them knowledge and things like that. And that's very important. But it's also a challenge for us to make healthcare much more easier to understand and more accessible and easier to engage with. I guess sort of in the evolution of the development of health prevention, health promotion, particularly in the old days where perhaps the biggest health problems were infectious diseases, communicable diseases, and health education was really important. So health literacy sort of was conflated a bit with health education. Now I think we're moving where people living with long term conditions. It's not really just the responsibility of public health teams. It really impacts us clinicians on how we engage with people and the onus for us to make healthcare much more understandable and engageable. The analogy, just a brief analogy that I've always used often tell this story, is 40 years ago, none of us had any computer literacy. We didn't really understand how computers work. And of course, IBM produced the first computer, which was this massive clunky thing which would have filled half your living room. And you would have had to have been an uber scientist or a geek to really want to be able to engage with one of these. And of course, what the computer industry could have done is they could have educated us all. They could have given us books and pamphlets to read about how to use these computers and how to code. They could have sent us off to evening classes. But in fact, what they did is they made computers a lot more engaging and simpler to use. And now, whether you're five or 85, using an iPad is so instinctive. I guess that analogy is how can we shift health and healthcare and the services we provide to be less like an old IBM computer and a bit more like an iPad, which people can engage with? So that's a useful analogy and hopefully that's sort of helpful overview of what health issues about.

Kate: Yeah, and when you say that, that resonates with me because the mnemonic that you talk about often as healthcare professionals, it's so easy to slip into Jargon and having the confidence and the knowledge on how to explain things in a way that people understand and within the confines of the time that we have to explain them can be incredibly challenging. I wrote all my letters to patients now, and it definitely takes practice and I'm sure I make mistakes in it.

Graham: I think that's a really good point. The thing about Jargon is these are terms that us healthcare professionals are so familiar with. We don't even know their jargon. We don't even know that the other person doesn't understand them. We do have to be very careful and it works some ways because sometimes if you try and oversimplify things for people and avoid jargon completely, some people feel at risk of being patronized. So I think perhaps the safest thing to do is it's okay to use jargon, but as long as you clarify that jargon, I'm just going to go and get my Glucometer. That's the little machine that I use to test your blood sugar and things like that. So use the words and then people pick these things up. And I guess in your case of point, if you are writing a letter, you can use the technical work but then put a bracket in as to explain that or have a little glossary at the end of something like that that explains these things.

Kate: Even translating terms between specialties can often be difficult because having an awareness that acronym in your world of anesthetics can mean something completely different in obstetrics. Yes, there can be a lot of confusion there, too.

Graham: I remember one little story, this is quite a case in point, actually, where people, when they go into hospital, acutely ill, and then they come out of hospital and they used to come and see me and I used to ask them, do you understand what happened to you in hospital? And it was surprising how many people didn't have a clue what happened, particularly of the sort of elderly. And I remember going to visit a nursing home and a little lady and the nursing home got a copy of the discharge letter and the diagnosis on it was non STEMI, which is a non St elevation myocardial infarction a heart attack. I went to see her with the carers and the nursing home and I said, how are you getting on after your heart attack? And none of them knew she had a heart attack. The patient didn't know that she'd been in with a heart attack and the care...