Do You Know What I’m Talking About?

In virtual care, a quick assessment of health literacy can be essential.


  • Jeanine Feirer RN MSN 1
  • David A Thompson MD FACEP 2

1 Marshfield Clinic Health System, Marshfield, WI

2  Northwestern University, Northwestern University Feinberg School of Medicine, Chicago, IL


Current data suggest that about a third (89 million people) of all American adults have insufficient health literacy skills to effectively seek and obtain the medical and preventive care they need. Poor health literacy can result in medication errors, decreased compliance with treatment advice, worse clinical outcomes, and increased malpractice risk Effective communication skills are essential for telemedicine providers – an understanding of health literacy and plain language should be part of your communication skill set.


Health literacy, according to the Institute of Medicine (2004), is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Those of us who work in health care often think of health literacy as a “patient problem.” However, we contribute to issues with health literacy if we do not communicate clearly with patients. With the increasing prevalence of virtual care, with its opportunities for dropped connections and limited point of view, the need for a quick assessment of health literacy has never been greater.

It’s an obvious but underappreciated fact that low health literacy can lead to poor health outcomes and even unnecessary patient deaths. Patients with limited health literacy might take the wrong medicine or the wrong dosage. They might fail to recognize serious complications or symptoms or struggle with managing complex medical problems. Limited health literacy also contributes to poor patient satisfaction and increased health care costs as patients miss appointments, avoid asking important questions and generally feel frustrated with their physician encounter.

In a virtual care visit, assessing health literacy starts with recognizing at-risk groups. Elderly patients and those who have limited income or education can be at risk, as can people who have difficulty speaking English. But there are other, more nuanced factors that can lead to a patient misunderstanding healthcare instructions. These factors include a lack of sleep, fear or anxiety about a new diagnosis and the presence of separating, complicating medical ailments.

One strategy for quickly assessing health literacy at the beginning of a virtual care visit is to use the Universal Health Literacy Precautions. Step one, take time at the beginning of an interaction to develop rapport and trust. Speak in a slow, calm manner in short sentences. Use shorter words when possible. For example, use “get” instead of “obtain,” “help” instead of “facilitate,” and “decrease” instead of “mitigate.” By a similar token, avoid medical jargon by using patient-friendly words. For example, use “heart attack” instead of “myocardial infarction” and “rinse” or “wash” instead of “irrigate.” When in doubt, talk to the patient like you would talk to a family member sitting in your living room. And always verify patient understanding during and at the end of an encounter.

Thinking of starting a telemedicine program at your institution? Make sure that health literacy is part of your strategy. This can be accomplished by including health literacy training in your orientation for all new telemedicine providers (doctors, PAs, NPs), your nursing team, and front-end staff. Also, assess health literacy skills (listed above) when reviewing taped calls. You will find certain problem words (medical jargon) that could be replaced with more patient-friendly language. Share these terms with clinicians and other staff. Use this as a learning opportunity for all. Include health literacy topics and exercises in your ongoing staff education. Finally, make sure the materials you send to patients electronically or by mail are patient-friendly and easy to understand.  Aim for a 6th grade reading level. Resources for creating patient-friendly written materials can be found at:

A plain language exercise

Consider this list of common terms and concepts that telemedicine providers use during patient interactions. Suggested plain language answers are provided to the right of each medical term. Using plain language terms can help improve patient understanding and satisfaction.

Medical Term A Better Plain Language Term
1 Abdomen 1 Belly, stomach area
2 Anxiety 2 Feeling stressed, nervous
3 Bacteria 3 Germs
4 Cardiac disease 4 Heart problem
5 Contraception 5 Birth control
6 Feces 6 Stool, bowel movement, poop
7 Hypertension 7 High blood pressure
8 Insomnia 8 Trouble or problems with sleeping
9 Menses 9 Monthly period
10 Primary care provider 10 Regular doctor



  1. Health Literacy. Accessed 2/19/2017 at
  2. Plain Language Thesaurus for Health Communications (February, 2009)
  3. Committee on Health Literacy, Institute of Medicine (2004). Health Literacy, A Prescription to End Confusion. 2004.

Citation: Feirer J, Thompson DA. Does that make sense? Telemedicine. 2017:10:10-11. Telemedicine Magazine and Full Text.

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