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Literacy and Misunderstanding Prescription Drug Labels
Submit responseI commend Davis and colleagues on their recent article, which showed that patients frequently misunderstand directions on how to take their prescription medications. (1) The conclusions imply that poor literacy among patients is often responsible for patients misunderstanding the directions. However, I believe that further emphasis should be put on the responsibility of the physicians and pharmacists to simplify their directions.
The study showed that many patients had difficulty understanding directions when there were told to take a medication “twice daily”. Since the word "daily" often means “once a day," it is understandable that a patient would be confused by being told to do something “twice, once a day”. Why not simplify such directions to say "twice a day" (which would be more consistent with common layperson language) instead of "twice daily"? Better yet, research should be done to find the phrases best understood by patients with poor literacy skills. Then physicians and pharmacists should be taught to adopt those understandable phrases instead of our traditional jargon.
It is a noble goal to bring patient literacy levels up. But a more rapidly fruitful focus should be on having physicians and pharmacists bring our traditional terminology down to the literacy level where our patients can understand us.
1. Davis TC, Wolf MS, Bass PF 3rd, Thompson JA, Tilson HH, Neuberger M, Parker RM. Literacy and misunderstanding prescription drug labels. Ann Intern Med. 2006;145(12):887-94.
Conflict of Interest:
None declared
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Literacy and Understanding prescription drug labels
Submit responseIn 2004, in the Department of Medicine grand round of Louisiana State University in Shreveport, Dr. Davis (the first author of the article) discussed patients’ illiteracy in understanding instructions of medications. I contended then, as well as here, that this problem is partially iatrogenic.
As a physician who practiced for 18 years in developing countries such as Egypt, I can witness that despite that the level of patients’ illiteracy there was much deeper than USA patients, the confusion here is much greater; thanks to our traditional “brown containers” with labels loaded with printed information, which our pharmacies use. In Egypt (as well as in some other developing countries), medications are dispensed in their original pharmaceutical bottles that have fixed specific colors and designs for different medications. Free samples also carried the same design and size as purchased one. Pharmacists would hand write the instructions for patients through drawing a black line on the box for each tablet to be taken; the location of the line on the box may indicate which time of the day it would be taken. A pretty primitive, far from ideal, but is definitely less confusing than our current system in USA, and persuasively better than 34.7% reported by Davis et al.[1] Back then, illiterate patients did not remember the name of their medicines, but remembered the “green boxed water pills” for Furosemide, the white tablet with “horse drawing” for Lanoxin, or the blue box with red writing, and so forth. Compare this with our current system where various medications dispensed in similar bottles labeled with plenty of information that unite in containing strange names, and varies on their pertinence to patients with low level of literacy.
Dr. Davis’ report is probably the first step to warrant a change in our drug labeling and dispensing system, to another one that may already be in application in third world countries.
Conflict of Interest:
None declared
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Prescription Instructions should be made 'ridiculously' simple!
Submit responseDear Editor,
Davis et al (1) have very rightly highlighted the impact of patient literacy on understanding of the prescription instructions/ labels and the subsequent correct use of the medication. Originating from a developing country, where general population illiteracy still remains a harsh reality, I can well relate to the viewpoint. However, I also see the vagueness of instructions on prescription labels as an important contributing factor which must not be ignored while considering the issue. This has been pointed out earlier from Brazil (2), Germany (3) as well as United States (4) itself. There is a dire need to make the prescription instructions more simplistic, elaborative and explicit. In my humble opinion, a simple diagrammatic elaboration of the medication use method can serve to greatly improve the medication use practices of general population. Davis et al have themselves mentioned that a major fraction of the participants of their study mistook ‘teaspoon’ for ‘tablespoon’. Similarly, it has been reported from New Zealand (5) that a substantial subset of medication errors in anesthetic practice is made up by erroneous route of administration of drugs. A simple diagrammatic depiction of the drug dosage as well as the administrative route can potentially cause a significant reduction of such errors. I perfectly agree with the author on the verity that an increase in literacy has unmatched alternative in improving the medication use practices. However, considering the importance of patient safety, alternative approaches to convey medication instructions should be explored into. Such techniques can potentially prove valuable for the illiterate populations of many Asian and African countries as well. Let us learn from a lay man analogy. The traffic warning signs are so explicit, one feels ashamed to use one’s intellect to understand them; are so yellow and distinct, they almost look funny; are so repetitive, one gets tired of them. They however, save hundreds of lives every day.
1. Davis TC, Wolf MS, Bass PF 3rd, Thompson JA, Tilson HH, Neuberger M, Parker RM. Literacy and misunderstanding prescription drug labels. Ann Intern Med. 2006;145(12):887-94.
2. da Silva T, Dal-Pizzol F, Bello CM, Mengue SS, Schenkel EP. Drug package inserts and the adequacy of patient's drug information. Rev Saude Publica. 2000;34(2):184-9.
3. Fuchs J, Hippius M, Schaefer M. Analysis of German package inserts. Int J Clin Pharmacol Ther. 2006;44(1):8-13.
4. Williams-Deane M, Potter LS. Current oral contraceptive use instructions: an analysis of patient package inserts. Fam Plann Perspect. 1992;24(3):111-5.
5. Abeysekera A, Bergman IJ, Kluger MT, Short TG. Drug error in anaesthetic practice: a review of 896 reports from the Australian Incident Monitoring Study database. Anaesthesia. 2005;60(3):220-7.
Conflict of Interest:
None declared
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Health Literacy
Submit responseWe applaud the Annals of Internal Medicine for publishing the editorial, "Misunderstanding Prescription Labels: The Genie is Out of the Bottle" and the article, "Literacy and Misunderstanding Prescription Drug Labels" (December 19, 2006). These articles help direct greater physician attention to the ability of patients to understand and follow basic health information. In addition, it spotlights our critical need to provide patients with health information in a form they can read and follow.
Recognizing these needs, the American College of Physicians Foundation embarked on a nationwide campaign in 2001, the Health Communication Initiative. This ten-year initiative focuses on the individual patient's capacity to obtain, process, and understand basic health information and services. The ACP Foundation's goal is to strengthen the nation's ability to address the needs of our aging population and the growing numbers of persons living with chronic disease. Many of the health literacy experts mentioned in these articles are working with us to develop materials which we hope will improve the care of our patients.
Our projects include development of a diabetes self-management guide, a prescription bottle labeling study, and an initiative called HEALTH TiPS. The latter gives physicians - for distribution to patients - handy, two-sided, 4X6-inch cards that contain essential, easily readable information about managing chronic conditions.
An important moment in the Health Communication Initiative occurred in November when, in conjunction with the Institute of Medicine, the ACP Foundation hosted its fifth annual National Health Communication Conference, a meeting devoted to improving health literacy and developing better ways of communicating health information to patients.
Conflict of Interest:
None declared