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April 2009 | Modern Hygienist
Is your medical assessment DOA? Easy ways to bring it back to life. Oral healthcare providers learn about the importance of conducting a thorough health history in the first week of professional education. Before providing dental care, one must determine which past or current medical issues exist, and whether there are any accompanying signs and symptoms. Physiology and pathology courses further clarify the relevance of medical conditions and the significance of signs exhibited and symptoms reported. Students hone interviewing skills by asking health history follow-up questions to patients treated during their student clinical experiences. When establishing a practice, the health history questionnaire is often modeled after that used in school. If joining an existing practice, the new graduate likely “bought in to” the existing health history form and format already established. During the ensuing years of practice, follow-up interviewing skills improved, but the questionnaire probably stayed the same. As society has become more complex, with changing social issues, and as the understanding of disease etiologies has progressed, it is necessary to update the medical history assessment to accommodate these changes. By doing so, medical emergencies can be better prevented, and patient care optimized.
Health Literacy Health literacy is defined in Healthy People 2010 as, “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”4 Individuals lacking basic health literacy may not be able to fully comprehend the health history form. They may not be aware of this lack of understanding, or may be too embarrassed to acknowledge it. Even if the questionnaire is completed to the best of their ability, the information provided may be inaccurate or incomplete. It is tempting to believe middle or upper-middle class individuals who comprise the patient load of a traditional private practice dental setting would not have such literacy issues. However, a large-scale national and representative study found only 12% of U.S. adults have proficient health literacy, with 53% having intermediate health literacy, indicating the majority of adults may not have adequate information to make appropriate health decisions. People older than 65 have the lowest health literacy skills.8 Only 60% of the current U.S. population speaks English as a first language, further complicating communication efforts. Reading abilities are typically three to five grade levels below the last year of school completed. Therefore, people with a high school diploma typically read at a 7th or 8th grade level. Approximately half of Medicare/Medicaid recipients read below the 5th grade level.9 The literature suggests information written at a 6th to 8th grade level will be accessible to most Americans.10 It is best if the material is written in short sentences in the active voice, using words with fewer than three syllables, and simple grammar. Making the material look easy to read is as important as the actual reading level. Larger fonts and liberal amounts of white space and graphics allow the reader to be more comfortable with the content. Illustration can provide essential information in non-verbal ways. Keeping this information in mind when the health history form is modified can increase the accuracy of the information provided. The combination of a written and interview format will be more likely to reveal discrepancies in understanding than an exclusively written format. CONTINUED ON NEXT PAGE
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