Physician overestimation of patient literacy: a potential source of health care disparities.
OBJECTIVE
To investigate physician overestimation of patient literacy level in a primary care setting.


METHODS
The study sample consisted of 12 non-academic primary care physicians and 100 patients from a U.S. Department of Veterans Affairs Hospital in Houston, Texas. Patient literacy level was measured on a 1-4 scale using the Rapid Estimate of Adult Literacy in Medicine (REALM). Physicians rated each patient's literacy level on a corresponding scale. Chi-square was used to test for association of patient race/ethnicity and gender with: (1) patient REALM level and (2) discrepancy between patient REALM level and physician rating of patient literacy level.


RESULTS
Patient REALM level was not statistically significantly associated with patient race/ethnicity or gender. Physicians overestimated the REALM level for 54% of African American, 11% of white non-Hispanic, and 36% of other race/ethnicity patients (p<.01).


CONCLUSIONS
Physicians commonly overestimate patients' literacy levels, and this apparently occurs more often with minority patients, and particularly with African Americans, than with white non-Hispanic patients. This discordance in estimation of patient's literacy level may be a source of disparities in health care.
Kelly
P Adam
PA
U.S. Department of Veterans Affairs, Baylor College of Medicine, Houston, TX 77030, USA. pakelly@bcm.edu
Haidet
Paul
P
D001741:Black or African American / Q000193:education; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D003144:Communication Barriers; D004522:Educational Status; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D007600:Judgment; D008297:Male; D008913:Minority Groups / Q000193:education; D017063:Outcome Assessment, Health Care; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology*; D011287:Prejudice; D011320:Primary Health Care; D011787:Quality of Health Care; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013781:Texas; D044465:White People / Q000193:education