Residentsʼ Ability to Identify Patients with Poor Literacy Skills

PURPOSE: To determine whether residents could identify patients with poor literacy skills based on clinical interactions during a continuity clinic visit. The authors hypothesized residents would overestimate patients' literacy abilities and fail to recognize many patients at risk for poor literacy. METHOD: The Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R) was administered to screen patients for potential literacy problems. Residents were asked "Do you feel this patient has a literacy problem?" and answered yes or no. Continuity adjusted chi-square was used to test for overestimation of literacy abilities by residents. RESULTS: REALM-R scores and residents' evaluations of literacy were available for 182 patients. The residents believed 10% of patients (18) had literacy problems based on their clinical interactions. Only three patients passing the literacy screen were incorrectly identified as at risk for literacy. Of the 90% of patients (164) the residents perceived to have no literacy problem, 36% (59) failed the literacy screen. CONCLUSION: Resident physicians overestimated the literacy abilities of their patients. A significant portion of these residents' patients may not have the skills to effectively interact with the health care system and are at increased risk for adverse outcomes.