Gettysburg Medical News
 The Clinical View
 by P.E. Hoffsten, MD
 12 October 2005

THE PROBLEM OF MEDICAL ILLITERACY

            I like to keep things simple but it is an oxymoron to put simple and medicine together.  In medicine, nothing is ever simple but here goes my effort in that regard.

            There are two basic ways to approach health.  One is to maintain health through various preventive measures.  The other method is to wait until something goes wrong and then try to fix it.  The majority of healthcare efforts and expense in our country is devoted to fixing medical problems once they occur.  But a far more effective method of dealing with health problems is to prevent them all together.  As an example in the 1940’s, polio was causing substantial death and disability.  The government considered funding 1000’s of iron lungs to help polio victims breath to keep them alive.  Fortunately, the resources available at that time were devoted to finding a vaccine that prevented polio from ever occurring and today, the disease is no longer a significant issue in our country.  We don’t need iron lungs to treat a disease that never comes anymore.

            The steps in medical prevention are by far the most important in regard to our health.  And yet repeated surveys show that hypertension is not effectively prevented in more than half of our population and high blood cholesterols are not effectively treated in more than half of our population.  Our diets with all of the fast food restaurants promote high blood pressure and high blood cholesterols and overweight.  Cigarette abuse is still a leading cause of death and disability in the United States.  So what is our problem in trying to prevent disease as opposed to treating it once it occurs?

            The first problem one might consider is that the medications that are available are ineffective or have unacceptable side effects.  This certainly is not the case.  Our medications today to prevent high blood pressure, high blood cholesterols, and diabetes are very effective with a very low side effect profile.  We do not need better medications at this point.  Granted they could be a lot cheaper than they are but the medications we have are effective.

            The second problem that might interfere with preventive medicine has to do with a concept of personal freedom.  South Dakota has resisted having a helmet law for motorcyclists.  This isn’t because helmets don’t save lives and prevent injuries; it has to do with the motorcyclists demand to be free to wear a helmet or not if they want.  But they will be darned if they are going to have a law that says they have to wear one.  This same mentality permeates all of healthcare.  People don’t like to be told what they have to do.  I have kind of given up on this approach.  Patients often ask, “Do I have to take this medicine?”  Now, I answer, “Of course not. You can have the disease instead.  But you certainly don’t have to take the medicine.”  Does a person have to change their diet, stop smoking, get more exercise, drive carefully, etc. etc.?  The answer to all of these questions is no.  The person does not have to do any of them and the person can thereby maintain their personal freedom to do what they want.  Those personal choices are sometimes very expensive and disabling but they are personal choices a person can make.

            The third reason that preventive measures seem to be ineffective has to do with the topic of this column.  That is the concept of medical illiteracy.  How much does the general public know about disease processes, how to prevent them and how to treat them?  Is there any evidence that knowing and understanding medical considerations really prevents disease or instead is it really true that “What I don’t know won’t hurt me.”?

            This past week an article appeared in The Archives of Internal Medicine addressing the question of medical illiteracy and whether knowledge of medical considerations really helps preserve a person’s health.  Three thousand new medicare enrollees in four major metropolitan areas were tested in regard to their medical knowledge.  These enrollees were then classified into those that were informed, marginally understanding, or relatively uninformed.  The health status of each group was then assessed in regard to diabetes, hypertension, heart disease, cancer, emphysema and arthritis.  The very clear answer was that being informed regarding the person’s health and preventive health measures prevented disability, maintained physical health and maintained mental health.  Those more informed medical considerations were able to live independently as opposed to requiring nursing home placement or supportive services at home.  The study clearly showed that “What you don’t know is really bad for your health”.  What you don’t know has a long term impairment on both your physical and your mental capabilities.  Next week’s column will be devoted to suggestions on how to improve medical illiteracy and thereby maintain mental and physical health.