NPR ‘Morning Edition’ Focuses on Asian Immigrants’ Barriers to Care, While Op-Ed Discusses ‘Health Illiteracy’

In the first of a two-part series, NPR's "Morning Edition" reported on Aug. 28 that language and culture present barriers to accessing health care for California's Asian immigrants. Researchers at the University of California - San Francisco found that "politeness" and cultural taboos prevent many Asians from acknowledging illness and seeking treatment. In much of Asia, chronic diseases are frequently considered causes of shame -- the result of a curse or "bad things" done in earlier life. To keep their families from "losing face," many Asians do not seek preventive care, "which can raise embarrassing questions," but only go to a doctor when they have symptoms or "something really obviously happening." To facilitate physician-patient communication, researchers recommend that Western doctors take a "milder" approach to addressing medical problems by avoiding "direct" or "forceful" words that "trigger hopelessness," focusing instead on the commitment to future patient treatment. UCSF's Tung Nguyen said that "effective care" also requires physicians to understand that in Asian culture, vital health decisions are often made by the entire family, rather than the individual patient. Nguyen said, "You would make a mistake, I think, if you pushed through the Western agenda, in other words, 'I have to tell the patient. I have to get informed consent.' Because if you did that, what would happen is that you discover that the decision-making unit is not the patient, it is the family. It may end up that even though the patient may appreciate what you are doing for them, the family may take them away from you, because they don't trust you to do the right thing for the patient, and then the patient ends up not getting the right care at all." The second segment, airing tomorrow, will focus on how fear and tradition cause patients to seek treatment in the underground drug markets of Los Angeles. The report will available in Real Audio online after noon EST (Browning, "Morning Edition," NPR, 8/28).

Addressing 'Health Illiteracy'
Also addressing health communication issues, Mimi Davis, former president of Kentucky's Daviess County Medical Society Alliance, writes in an Owensboro Messenger-Inquirer opinion piece that since roughly 90 million adult Americans are "health illiterate," doctors and patients need to work harder to make sure that medical instructions are understood. Physicians may not realize that their patients do not understand information such as prescription directions, medical education brochures and discharge instructions if patients "don't take the initiative to ask questions," Davis writes. Davis points to a 1997 study that found that one-third of English-speaking patients at two public hospitals could not understand "basic health-related materials." In the study, 42% of patients did not understand instructions for taking medication on an empty stomach, 26% could not understand information on an appointment slip and 60% could not understand a "standard" consent form. Because health illiteracy rates are highest among the elderly and those with "poor overall health," those with the "greatest need" for health care services are often the "least able" to comprehend medical instructions, Davis writes. Health illiteracy costs the health care system $73 billion each year in "avoidable" expenses, such as longer hospital stays and "unnecessary doctor visits," Davis notes. Davis writes that a program run by the American Medical Association Foundation, called "Partnership in Health -- Improving the Patient-Physician Relationship Through Health Literacy" -- is attempting to address the problem. She concludes that "awareness will lead to better communication between physicians and their patients and result in a more effective health care system" (Davis, Owensboro Messenger-Inquirer, 8/28).