Case 1: Arnold, a 62-year-old plumber, had been experiencing a series of symptoms, including increased thirst, frequent urination, and unusual weight loss. After some prodding from his wife, he went to see his family physician, Dr. Lopez. The doctor gave him a physical exam, ordered some blood work, and scheduled a follow-up appointment. On the return visit, Arnold sat down with the doctor to discuss his diagnosis. Dr. Lopez explained, "You have noninsulin-dependent diabetes or type 2 diabetes, which is a chronic condition that affects the way your body metabolizes glucose. Insulin is a pancreatic hormone that transforms dietary glucose into energy for your cells. If you had type 1 diabetes, it would mean that your pancreas produces little or no insulin. However, with type 2 diabetes, your pancreas produces sufficient amounts of insulin, but your cells are no longer utilizing it efficiently, which causes fluctuation in your blood glucose levels. To treat your condition, you'll need to start eating a healthy diet, start exercising regularly, and monitor your blood sugar. I'm writing you a prescription for Metformin and a glucose monitor." After finishing his explanation, Dr. Lopez asked Arnold if he had any questions. Slightly stunned, Arnold just shook his head and replied, "No." Dr. Lopez also told him that his practice has a diabetes fact sheet posted on their website and suggested that he look it up and read it. Arnold thanked him and left. He went to the pharmacy to have his prescription filled and also bought a bottle of glucosamine, a dietary supplement used by some people to treat joint pain. When his wife asked what the glucosamine was for, Arnold said, "I think I'm supposed to be taking it. The doctor mentioned it a few times.

1. What are some reasons why Arnold likely did not understand what Dr. Lopez told him?

2. What could Dr. Lopez have done to better present the information in a way that Arnold would understand?

3. Was it a good idea for Dr. Lopez to refer Arnold to his practice's website for more information? Why or why not?

Case 2: Dr. Falk and Dr. Keller operate a family medical practice. One afternoon, as they ate lunch in the break room, they discussed an article about health literacy that Dr. Falk was reading in a national news magazine. "There's been a growing trend toward healthcare organizations becoming healthliterate," Dr.Keller said. "The statistics are pretty surprising," Dr. Falk replied. "More than half of the people surveyed had only basic or below basic health literacy skills." "Do you think it's something we should look into at our practice?" Dr. Keller asked. "I think we should," Dr. Falk replied. While they were talking, Amanda, the office manager, and Jean, one of the nurses, came into the break room to get some coffee. They overheard what the doctors were discussing, and Amanda asked Jean, "What does health literacy mean?" Jean answered, "I think it refers to understanding your own health and knowing what you need to do to stay healthy."

1. Is Jean's explanation of health literacy accurate? Why or why not?

2. Do you agree that Dr. Falk and Dr. Keller should address the issue of health literacy in their practice? Why or why not?

3. What are some resources that Dr. Falk and Dr. Keller can use to improve the level of health literacy at their practice?