Jordan Franco is a medical student in the UVM Larner College of Medicine Class of 2025.
In the following blog post, Franco writes about the importance of laboratory literacy as a key component of health literacy.
During the summer of 2022, Franco worked alongside Professor of Pathology and Laboratory Medicine Mark Fung, M.D., Ph.D., with whom he conducted research on health literacy.
Health literacy, or the ability of a patient to obtain, understand, and apply health-related information, is an important determinant of health because low health literacy can act as an obstacle to making informed and knowledgeable health decisions. Health literacy has been spoken and written about extensively. However, laboratory literacy is a novel concept regarding how well a patient can understand their lab results and if a patient understands why a particular test was ordered for them. Through research this past summer, my mentor, Mark Fung, M.D., Ph.D., professor of pathology and laboratory medicine, and I hypothesized that laboratory literacy exists as a key component of health literacy.
When considering the regularity with which lab tests are ordered at doctor visits, and the increasing frequency with which patients have access to their labs even before their doctor has a chance to review the results, it seems reasonable to consider laboratory literacy as a natural subcomponent of health literacy. If so, are there tools that researchers and providers are using to assess for laboratory literacy? This is one key health literacy-related question I am seeking to answer.
I am enthusiastic about the topic of health literacy because it is a connection between the fields of medicine and communications. When I was an undergraduate student, most of my time was spent studying chemistry as my major, but I had the opportunity to take two communications classes—a public speaking class and “Intro to Personal Communication”—that were two of the most valuable learning experiences I’ve ever had in my life. The public speaking course fundamentally changed how I view external communication in group settings. The personal communication course taught me about the value and impact of relationship-building and how crucial this is to meaningful discourse.
I consider communication in healthcare as fundamental to optimizing patient outcomes. I think that the type of exam room-based interactions most likely to foster and support a patient’s good health and well-being will be characterized by trust, encouragement, and rapport. All of which require constructive communication to build meaningful connections with the patient.
Communication is the area where medicine takes on characteristics of an artform, and I believe it’s also the area best suited for helping patients with low health literacy. It has been established that one of the best ways to help a patient with low health literacy is to encourage and give space in the visit for the patient to ask questions. Encouraging multiple questions and asking the patient to repeat back what they understand allows the provider to both gauge the level of the patient’s understanding, and tailor the answers so that information is included (or excluded) to best educate the patient on their condition without overwhelming them. This style of communicating disrupts a maladaptive behavior that can take place inside an exam room.
It has been anecdotally reported that patients who don’t understand the situation may respond by disguising or masking the fact that they have a lack of understanding because they don’t want to be judged. I have personally seen this when I’ve accompanied my parents into doctor visits. I’ve observed them saying “yes,” “right,” and nodding along to what the doctor is saying. Having the insight that comes with being closely related and knowing that my parent is only grasping surface details, I make a point to ask clarifying questions. In situations like this, if the provider solicits and encourages question-asking and asks the patient to repeat back their understanding of the discussion, it can serve as a start towards reversing this phenomenon, so in the future the patient feels empowered and more comfortable seeking clarification and asking questions without hesitation.
The elephant in the room with lab literacy and seeing results before the physician does, is that it can result in unnecessary anxiety for the patient. This was voiced to us as a concern from multiple people we worked with for my summer research project.
The research project I worked on this summer explored both health and laboratory literacy using multiple methodologies such as a systematic review of the scientific literature, a survey of local patients, and an internet traffic analysis. We also collaborated with faculty who had prior health literacy research experience to give us guidance in this area of research. They include Drs. Nancy Morris (University of Massachusetts-Amherst), Joy Deupree (Univ of South Carolina), and Dan Chu (University of Alabama-Birmingham). My goal this past summer was to generate knowledge in these fields and to publish our findings. My more formative goal will be to take what I have learned about health literacy with me on my journey into becoming a physician, so that I can put this knowledge to use, to best serve the future patients that I care for.