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January 2013 Bulletin: Malpractice

Good Communication = Healthy Patients

Susan Sperzel

— Susan Sperzel, Director of Medical Loss Prevention, CMIC

Did you know that only about 50% of all patients take medications as directed?1 Most health care materials are written above the reading level of patients. When meeting with doctors, patients feel rushed and are embarrassed to ask the doctor to further explain something they do not understand. As a result, patients with low literacy average more hospital visits and stay in the hospital longer. What can you do to help mitigate the risk of medical communication errors? Implement the "Ask Me 3" program.

The Partnership for Clear Health Communications at the National Patient Safety Foundation developed the "Ask Me 3" program to promote awareness and solutions around the issues of low health literacy and its effect on health outcomes. The ability to read, understand and act upon health information is essential for patients to have a positive health outcome. Every time a patient meets with a doctor they should use the "Ask Me 3" questions so they will better understand their health. Follow the steps below to implement the "Ask Me 3" program at your practice.

1. Assess your overall practice demographics. 93 Million people in the United States may have difficulty understanding health information. Use the prevalence calculator at to help determine the percent of your patients that may have low health literacy. Especially vulnerable groups are racial/ethnic minorities and the elderly.

2. Review how the doctors, nurses and office staff communicate with patients. Examine:
• How information is provided to patients
• The reading levels of written materials, especially medication instructions
• Protocols for patients' follow-up and questions

3. Inform patients that the practice supports the "Ask Me 3" program.
• Provide patients with the "Ask Me 3" brochure. You may download or order them in six different languages at
• Hang posters in the office to stimulate curiosity.

4. Encourage patients to "Ask Me 3." Allowing more time at the initial appointment may help the patient prepare for medical tests and take medications the right way with less follow-up calls and visits. The three questions every patient should ask and understand the answers to are:
• What is my main problem?
• What do I need to do?
• Why is it important for me to do this?

Medical terminology can be difficult to understand even for your highly literate patients. Patients may be familiar with or recognize a word, but be afraid to ask it to be defined or translated into everyday terminology. While answering the "Ask Me 3" questions, have the doctor explain what the word means as it relates to the patient's everyday life. The patient may understand the concept but may need more information about how it will affect them. For example, if the order is to "keep glucose in a normal range" the patient will need to know the normal range. Also consider using simpler words such as illness for ailment or enough for adequate. For additional "Words to Watch" go to:

It may be helpful to use visual examples when defining medical terms or giving instructions. It may also be helpful to suggest the patient bring along a family member or close friend to the appointment.

Studies show that if a patient understands their healthcare, they will make fewer mistakes taking their medicines or preparing for a medical procedure. Communication is crucial when it comes to enhancing health outcomes. For more information about the "Ask Me 3" program visit the National Patient Safety Foundation's website:

1Center for Health Care Strategies, Inc. Health Literacy and Understanding Medical Information Fact Sheet. 1997.

CMIC is a mutual member owned insurance company created to address the professional liability insurance needs of doctors and healthcare facilities throughout New England.  For more information visit CMIC’s website at

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