Viewpoint: Poor communication deepens health inequities, systemic racism

Effective, compassionate communication from health care professionals can improve patient outcomes and help address health inequities, and should be a requirement for students and medical residents, Oregon Health & Science University staff argue in a new viewpoint. (Getty Images)

Unclear communication deepens health inequities and continues the systemic racism upon which American health systems have been built, according to a trio of Oregon Health & Science University staff in a viewpoint published this week in JAMA Internal Medicine.

Their viewpoint notes failing “to communicate health information in its simplest and easiest-to-understand form unjustly favors people who have more education and higher health literacy” — and disadvantages historically underserved communities, including Native American, Black and Latino/a/x people. Further, the authors write, not training clinicians to improve communications with patients and not holding health systems accountable for clear communications “promotes injustice.”

To address this, the authors recommend medical and other health professional schools require students and medical residents to demonstrate clear communication skills in order to graduate, and that accrediting bodies require health literacy practices be a part of their hospital accreditation process.

Cliff Coleman, M.D., M.P.H. (OHSU)

“Studies have shown it’s hard for health professionals to change the way they communicate with patients,” said the viewpoint’s corresponding author, Cliff Coleman, M.D., M.P.H., an associate professor of family medicine in the OHSU School of Medicine and the Doris and Mark Storms Chair in Compassionate Communication with the OHSU Center for Ethics in Health Care.

“Even when doctors are trained in health literacy and clear communication, it can be a struggle to put those lessons into practice during a hectic day in the clinic or hospital,” Coleman continues. “We need creative incentives like graduation and accreditation requirements, as well as the strong support of senior leaders, to make clear, effective communications a reality in health care.”

Coleman also leads the professionalism, ethics and communications portion of the OHSU M.D. program’s curriculum. Since 2018, OHSU’s M.D. graduation requirements have included medical students demonstrate effective, compassionate communication through a skills test involving a simulated encounter with an actor hired to portray a patient.

The importance of health literacy rose to national attention in 2004, when the National Academy of Medicine, then known as the Institute of Medicine, issued a report that found about half of American adults at that time had difficulty understanding and using health information. The report also found patients with inadequate health literacy were hospitalized and used emergency services more.

Coleman has spent much of his career encouraging health systems to improve their organizational health literacy, and improving how medical students and residents learn about health literacy and clear communication.

“It really doesn’t have to be this way,” Coleman said. “We have the skills to transform the way our health care professionals communicate. It’s just a matter of finding the will and the investment needed to make it happen.”

REFERENCE: Cliff Coleman, Samantha Birk, Jennifer DeVoe, Health literacy and systemic racism — using clear communication to reduce health care inequities, JAMA Internal Medicine, June 26, 2023, doi:10.1001/jamainternmed.2023.2558.