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Assessment of Patient Health Literacy: A National Survey of Plastic Surgeons

Vargas, Christina R. M.D.; Chuang, Danielle J.; Lee, Bernard T. M.D., M.B.A.

Plastic and Reconstructive Surgery: December 2014 - Volume 134 - Issue 6 - p 1405–1414
doi: 10.1097/PRS.0000000000000737
Special Topics

Background: Health literacy affects patient participation, compliance, and outcomes. Nearly half of American adults have inadequate functional health literacy. Identification and accommodation of patients with low literacy is an important goal of the American Medical Association, U.S. Department of Health and Human Services, and the Healthy People 2020 initiative. This study aims to assess plastic surgeons’ perception of patient literacy.

Methods: A survey was distributed to American Society of Plastic Surgeons members about time devoted to patient counseling, use of techniques for evaluating and enhancing patient understanding, perception of level of education, and estimated literacy. Participation was voluntary and data were collected anonymously using an online survey tool.

Results: There were 235 participants in the survey (9.9 percent response rate). Patient literacy was most frequently assessed using their general impression (62.2 percent) and by asking patients about their employment (37.3 percent); 26.2 percent did not assess literacy. The majority of surgeons (62 percent) reported spending at least 20 minutes counseling new patients, and 37 percent reported spending more than 30 minutes. Lay terminology (94 percent) and pictures/diagrams (84.6 percent) were common patient education aids, whereas only 8.1 percent use teach-back methods. Plastic surgeons overestimated the level of education and reading level of their patients compared with national data.

Conclusions: Formal assessment of health literacy is rarely performed, as most plastic surgeons use a general impression. Although plastic surgeons devote significant time to patient counseling, evidence-based communication methods, such as the teach-back method, are underused. Simple, directed questions can identify patients with low literacy skills, to accommodate their communication needs.

Boston, Mass.

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School.

Received for publication May 8, 2014; accepted May 27, 2014.

Disclosure: The authors have no financial information to declare in relation to the content of this article.

Bernard T. Lee, M.D., M.B.A., Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite 5A, Boston, Mass. 02215,

©2014American Society of Plastic Surgeons