"Stripping it Down, Mixing it Up, and Bringing it Home: Reducing the e Oral Literacy Burden of Medical Dialogue" was presented at the Center for Health Literacy Conference 2011: Plain Talk in Complex Times by Debra Roter, DrPH, Professor, Johns Hopkins Bloomberg School of Public Health. Description: The presenter will describe a framework for thinking about the oral literacy burden in medical dialogue, discuss the evidence that links oral literacy burden to patients’ satisfaction and comprehension of medical information, and propose practical ways to reduce the oral literacy burden of routine health communication with patients.

1. Stripping it Down, Mixing it Up, and Bringing it Home: Reducing the Oral Literacy Burden of Medical Dialogue Debra Roter Professor Johns Hopkins Schools of Public Health, Medicine and Nursing

3. A typical American patient will see a doctor approximately 320 times over a lifetime --– an average of 4 medical contacts per year. -- more if you suffer from a chronic illness, are a woman, have children, have a spouse or an elderly parent. Almost half of these patients have restricted literacy skills.

7. Medical Jargon Language Complexity Patient –Physician Nonverbal Interaction Patient –Physician Verbal Interaction Satisfaction with information and interpersonal rapport Dialogue Interactivity Adherence with medical recommendations Informational Context What makes it difficult for patients to understand and feel understood? Roter et al, 2007 Learning Recall/comprehension Patient centered communication Stripping it down Mixing it up Bringing it home Engagement in self care and preventive health practices

8. --- because part of medicine’s mystique is that it is written -- and often communicated in code. --- demystification begins with a translation from “Medicalese” to English Why is it important to strip it down?

9. ---Use of medical jargon is common Studies dating back 50 years have established that physicians use technical terms that patients do not understand But , patients rarely challenge their doctors to “speak English”

15. What does high interactivity look like?

16. HIGH INTERACTIVITY VISITS

17. LOW INTERACTIVITY VISITS

21. Communication is regarded as key to any significant improvements in health care quality -- patient-centered care is included alongside the core quality requisites of safety, timeliness, effectiveness, efficiency and equity. IOM reports: Crossing the Quality Chasm; To Err is Human; Health Professions Education. Patient-centered Communication has been linked to Health Care Quality and

22. What was lost in the practice of modern medicine?

26. TIME TO TALK CARDIO www.timetotalkcardio.com

28. TIME TO TALK CARDIO www.timetotalkcardio.com

30. Does this approach work?

31. Yes! In a randomized trial patients using the TTTC website reported a significant increase in targeted communication skills and subsequent medical visit satisfaction.

34. Physicians using the website also reported a significant increase in the use of targeted communication skills.