Addressing Cultural Competence as an Element of Health Literacy and Patient-Centered Care

Inadequate health literacy is a well-known communication issue facing patients and their healthcare providers. Patients' inability to properly receive, process, understand, and act on health information can result in a host of problems, including uninformed decision-making, nonadherence, poor outcomes, and lack of trust in the healthcare community. Inadequate health literacy also can lead to misunderstandings and mismanagement of patient expectations, which can increase liability risk for healthcare providers.

Strategies for addressing health literacy often target patient comprehension and involve speaking clearly, avoiding jargon, using words that patients understand, reducing redundancy and ambiguity, and so forth. Although these strategies are crucial, another critical element of effective communication — cultural competence — is overlooked at times.

Protecting Patient Confidentiality: A Legal and Ethical Obligation

Trust is a fundamental element of the provider–patient relationship, and building trust helps ensure that patients disclose accurate and thorough health information to doctors, nurses, and other healthcare personnel. In turn, healthcare providers and staff members have an ethical and legal responsibility to protect patient confidentiality and prevent unauthorized disclosure of patients' protected health information (PHI).

Both state and federal laws address patient confidentiality and release of health information. Some state laws are more specific than federal laws about certain aspects of confidentiality, such as the definition of an emancipated minor or information pertaining to the treatment of mental illness. Providers and staff members should understand these legal requirements and their role in upholding them.

Keep It Simple: Using Plain Language to Support Patient-Centered Care

A significant hurdle in patient-centered care is effective communication throughout the care process. If patients do not understand their diagnoses, test results, recommended treatment plans, and follow-up instructions, they cannot fully participate in their care.

A common barrier to effective communication is poor health literacy. Research shows that only a small percentage of adults have proficient health literacy skills, and most adults have difficulty using the everyday health information that is routinely available in healthcare facilities.¹ These statistics are significant because people who have low health literacy are at increased risk for poor outcomes, higher rates of emergency department visits and hospitalization, and death.² Patients who have limited health literacy also might feel ashamed about their lack of knowledge, and they may "mask these difficulties in order to maintain dignity."³

Inadequate Informed Consent Process for Orthopaedic Surgery Complicates Malpractice Defense

Residents performing surgeries and procedures under the supervision of experienced physicians is an integral component of the medical educational process. At the same time, disclosing to patients which providers will be involved in their care is an essential component of the informed consent process, which recognizes patients' rights to make informed decisions about their care.

In this case, the patient was a 66-year-old male with a long history of arthritic and orthopaedic problems in his right knee. His medical history included one arthroscopy and one high tibial osteotomy. Continued evaluation of the knee resulted in the recommendation that he have a total knee replacement, to which he consented. The patient was aware that a resident would be assisting in his surgery. In actuality, though, an orthopaedic resident (Dr. A) performed the procedure with an attending surgeon (Dr. B) assisting.

Accountability for Informed Consent in Healthcare: Considering Shinal v. Toms

Issues related to informed consent are a persistent area of concern in healthcare and a source of liability exposure. MedPro Group malpractice claims data show that more than one-fourth (27 percent) of all communication-related malpractice claims involve allegations associated with informed consent.¹ Of these allegations, the majority are related to inadequate consent processes and failure to manage patient expectations.

The Fundamental Elements of Informed Consent

Informed consent is a legal and ethical principle that supports disclosing important information to patients so they can understand proposed treatments and fully participate in their care. The basis of informed consent rests on the principle of autonomy, which recognizes an individual's right to make decisions regarding his/her healthcare.

Opioid Prescribing: Navigating Through a Crisis

Opioid addiction is arguably one of the most significant public health crises in the United States over the past few decades. Increases in opioid prescribing and consumption in the late 1990s and first decade of the 2000s fueled an epidemic of overdoses, a national heroin crisis, and a rise in deaths from synthetic opioids.¹