It is not only in developing countries that we see the phenomenon of illiterate or uninformed patients. I have practiced in the poorest barrios and in one of the most educated and affluent communities in the U.S. with patients from all over the world. Regardless of the patient education level or language skills there is a considerable task before the clinician to inform the patient before performing the treatment.
We speak a specialized language specific to our field and must translate it to understandable terms for our patients to be informed as well as possible. It is no secret that often the most challenging aspect of clinical paractice is making tests, diagnosis, prognosis, treatment options, and costs understandable to patients. One colleague said, "This would be so much easier without patients." Though she said it with humorous intent, we all know the frustration of patients who refuse the best treatment, perhaps because we were unable to communicate effectively.
The inclusion of patient preferences and values in the intersection of key components for effective practice of evidence-based health care is for the very purpose of keeping patients engaged in their health care. Ultimately, health is the responsibility of the patient and we are, at best, only facilitators. Educating patients is perhaps our greatest contribution to patient care.
According to David Sackett, "By patient values we mean the unique preferences, concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinical decisions if [we] are to serve the patient." ("Evidence-based Medicine - How to Practice and Teach EBM" second edition, 2000 D.L. Sackett, S.E. Straus, W.S. Richardson, W. Rosenberg, R.B. Haynes; Churchill Lifingstone, p1.) In order to have preferences, concerns, and expectations the patient needs first to be informed.
I don't know if this helps, but information barriers impact patient care in every clinical parctice.
Part-time student in EBHC Oxford
Volunteer clinical faculty, dept of surgery, dental residency program, University of New Mexico, School of Medicine - Albuquerque, New Mexico.
General dental practice in Los Alamos, New Mexico, USA.