HLOL Podcast Transcripts

Health Literacy

Choosing Wisely: A Campaign Helping Patients Be Engaged Consumers (HLOL #104)

Helen: Welcome to Health Literacy Out Loud. I’m Helen Osborne, president of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud.

In these podcasts, you get to listen in on some conversations with remarkable people. You will hear what health literacy is, why it matters and ways every one of us can help improve health understanding.

Today I’m talking with Beccah Rothschild, who is the Senior Outreach Leader for the Choosing Wisely campaign at Consumer Reports. Becca has over 15 years of experience in the field of adult literacy, health literacy, health communication and outreach, including direct service, interventions, research and policy.

Beccah’s role at Consumer Reports focuses on patient engagement around the issues of overuse and misuse of medical tests, and treatments and procedures that provide little benefit and in some cases cause harm.

I’ve known Beccah for many years, starting back in the 1990s when we were early adopters of health literacy. I am delighted and proud to see how far Becca has come. Welcome, Becca.

Beccah: Thank you, Helen. It’s nice to be here.

Helen: I’m delighted that you’re a guest on Health Literacy Out Loud. Tell us all about your latest hat at Consumer Reports and this Choosing Wisely campaign. Just start from the beginning. What is Choosing Wisely?

Beccah: Choosing Wisely is a campaign that we’re working on at Consumer Reports in partnership with the American Board of Internal Medicine, or ABIM, Foundation.

The campaign is about helping patients, consumers and healthcare providers such as doctors, nurses, etc., engage in a conversation about healthcare and the best healthcare at that particular time in a patient’s life.

Helen: It sounds like you’ve got all the pieces covered. There were patients, consumers, clinicians and everybody to talk about healthcare.

Beccah: Yes, and specifically to talk about medical tests, treatments and procedures that are not necessarily in the best interests of patients. Sometimes they’re just not necessary.

Helen: Like what kind of a test?

Beccah: Allergy tests, or imaging tests for lower back pain. That’s a pretty popular one. Lower back pain is very common and a lot of people go to their doctor to talk about their lower back pain.

What we’re trying to help people understand is that imaging tests, which are X-rays, CT scans or MRIs, are usually not necessary. Usually lower back pain works itself out within six weeks or within some amount of time.

What we’re trying to help people understand in this particular example is that these imaging tests don’t help you feel better faster, and they have risks, expose you to radiation and cost money.

Helen: I want to stop you because I’m really curious about this. I worked in healthcare for a long time as an occupational therapist. Not that I was in a situation of prescribing tests, but I know that those kinds of conversations take longer.

It’s probably easier if a patient goes in and says, “Hey, doc. My back hurts,” and the doctor says, “Okay, have an X-ray.” That’s a quicker conversation than, “Wait, maybe you don’t need it.” Is that right? Does this take longer?

Beccah: This can take longer, but what we’re hoping is that the patient goes in prepared to ask specific questions. We at Consumer Reports are working on the patient or consumer side to help patients engage in that way. The campaign is also working with healthcare providers.

The reason this campaign has really exploded and become so successful is that there are over 50 national medical societies and associations who have signed on to be part of this campaign, and even more are joining right now.

Helen: What does it mean that they’re part of the campaign? Does it mean that they’re part of Consumer Reports?

Beccah: They’re part of the Choosing Wisely campaign. Let me give you an example. I think that helps it come alive a little bit more.

For example, the American Academy of Family Physicians, the American Academy of Pediatrics and the American College of Cardiology have come forward and given a list of their top five topics that they have said, based on medical research and science, may be unnecessary in certain instances.

Based on these, we at Consumer Reports are creating materials that are patient or consumer friendly to help patients understand why they may not need these procedures, treatments or tests, and what types of questions to ask.

Helen: I see. The underpinnings of this are really changing that expectation of what we need when we have an ache or pain. You’re working with the associations on that, so it sounds like it’s all medically approved, but you’re also working to help patients understand this?

Beccah: That’s correct. We’re coming at it from two angles. The ABIM Foundation, who is really behind this, has done a fantastic job of getting all of these medical societies and associations to join. They’re saying from the doctor’s standpoint that these are tests that are overly prescribed and are not needed.

We at Consumer Reports are coming at it from the consumer angle and saying, “Look, this is what the doctors have said you don’t need to do. Here is what to talk about when you’re talking to a doctor. Here are the questions to ask.”

Helen: That sounds great. I was just thinking that you’re not leaving a doctor out there all alone answering this hard question. There’s a lot going on.

You used a term, and this has intrigued me for a long time. People were called patients, and now you’re referring to them as consumers. What’s the scoop here, Beccah?

Beccah: It’s interesting. A lot of people still think of themselves as patients, and they still are. I don’t want to take that term away, but we are also consumers.

As consumers, when we think about making purchases or making decisions and we think about questions to ask, it’s more of an engagement. That’s what we’re trying to promote in this campaign. It’s patient or consumer engagement.

When you go to buy a television or make a big purchase, you think about the cost, the pros and cons, and the ramifications. We’re trying to help patients make those same types of decisions and think about the same types of questions.

Helen: Beccah, it’s really interesting that right before this conversation on Health Literacy Out Loud, I was just talking with my dental office because I need a whole bunch of expensive stuff done in my mouth. She was going through in great detail and saying, “It will cost this much, this will happen and this is what you need.”

I’ve already had the conversation with the dentist about what I need and why and what I don’t need. Is that the same type of conversation that you’re talking about?

Beccah: That’s right. It’s the same type of conversation. We’re recommending certain questions that patients can ask. For example, “What are the options? What are the risks? What will happen if I don’t have this medical test or treatment?”

We’re really trying to find out if there are other options and if we can look at the wait-and-see approach. Are there other choices right now, or do I really need to have this particular treatment or test right now?

Helen: It’s wonderful. I’m totally on board. What can we as listeners be doing about this? I don’t know exactly who listeners are, but I know we all care about health communication a lot. We may be clinicians, public health specialists, teachers, librarians, patients or and caregivers.

As somebody who is part of that health conversation, what would you like us to know and do?

Beccah: First of all, all of us at some point are going to be a patient or a caregiver. I don’t think there’s anyone who hasn’t at some point been a patient. It’s just thinking about this campaign and these types of questions and knowing that it is okay to ask questions of your healthcare provider.

I think a lot of patients are scared to do that. There are a lot of cultural issues as well. A lot of people think, “The doctor is all-knowing. They have had background and education in this area and I haven’t, so I should not question anything.”

A lot of that is true. The provider has gone to medical school and does have significant training. You can still have a conversation and ask questions to make sure you’re getting the right care for you right then.

In addition to that, I should mention that at Consumer Reports we’ve created an abundance of consumer materials. All of these materials are available for free for the public. This is a part of Consumer Reports that we are making available to the public at no cost.

To get these materials, people can go to our website at www.ConsumerHealthChoices.org.

Helen: We’ll have that URL on the Health Literacy Out Loud web page.

Beccah: Once they’re there, they can look at the Choosing Wisely campaign or any of our other health campaigns on that website. They’ll also find all kinds of materials. They’ll find easy-to-read materials about all different types of medical tests and procedures.

I mentioned back pain earlier, but there are all kinds of tests and treatments, like antibiotics for kids with sore throats, bone density tests for adults, cancer treatments, cardiac imaging and colonoscopy. They can go and look at all of these and become educated and more informed before they talk to their healthcare provider.

Helen: They can go look at these. Can they print them out?

Beccah: Yes, they can absolutely print them out. Not only can patients print them out, but healthcare providers can also print them out and have them available at their offices.

Helen: I’m assuming because you have all of these associations on board that these are all vetted medically and scientifically?

Beccah: Absolutely.

Helen: Beccah, I know you have been very involved in the literacy world for years. What do you think about the health literacy part of these materials?

Beccah: The reason I actually got involved in this campaign at the beginning was because in my previous role at UC Berkeley I was working in health literacy. Consumer Reports came to us and asked if we could create these materials in an easy-to-read language so that people with lower literacy skills would find them accessible.

All of these are available in plain English at a lower literacy level, and also in Spanish in plain language.

Helen: That’s terrific. I’m so glad you were part of it. You were a true believer beforehand as you were helping to write these. I can’t wait to see them. What else would you like all of our listeners to know or do?

Beccah: There are also a lot of other campaign materials that people can use. We have videos, posters, and wallet cards that patients can put in their wallets so that they remember the questions to ask when they get to their doctor’s office. They can become partners on the campaign if they are in a nonprofit organization that is interested. I can talk to them about that.

Helen: What does it mean to be a partner?

Beccah: A partner agrees to distribute our material and work with us on the campaign. They’re our dissemination partners. One of the most important things is to get this information out to the public and to patients and consumers.

Helen: How would someone reach you if they want to be a partner?

Beccah: They can reach me by email. I imagine you can find my email on the website.

Helen: We’ll have that on the Health Literacy Out Loud website too.

Beccah: That’s great. They can also contact us through the www.ConsumerHealthChoices.org website. There’s a “contact us” button there.

Helen: It sounds like that journey that you and I started many years ago has become amplified. I think I met you at a meeting where maybe there were 100 of us that were starting to do this health literacy work a long time ago.

Look at us now. You’re across the country and we’re having this podcast. It’s just magnified so many times. Do you ever reflect on that little germ of an idea and where this has gone?

Beccah: Yes, I do think about that. You’re right. You and I met many years ago at a health literacy conference in Montreal with only about 100 people. It’s really amazing to me how far the field of health literacy has come in all of those years and how many different types of organizations have become involved.

It’s really on the radar screen of hospitals, policy organizations and public health departments. I think it’s great that Consumer Reports is working in this area as well.

Helen: I think it is too. Look into your crystal ball. What do you see happening or hope will happen in about five years?

Beccah: What I would love to see is that this campaign takes off into a much larger movement, and I think it already is doing that. Providers and consumers are starting to engage in conversation. I think with the Affordable Care Act, there will be a lot more patients in the healthcare system than ever before.

What I would love to see is for this Choosing Wisely campaign to take on a much bigger life than it already has, although it already has quite bit, and make it so the patients and providers are engaging in open conversations about healthcare and the best possible treatment for them at that particular time.

Helen: Thank you for your vision and for doing all you are doing in bringing together all of those pieces about literacy, health literacy, patient engagement and the consumer’s perspective. Thank you for sharing that with us on Health Literacy Out Loud.

Beccah: Thank you.

Helen: I learned so much from talking with Beccah Rothschild, and I hope that you learned a lot from our conversation too. But health literacy isn’t always easy.

For help clearly communicating your health message, please feel free to visit my health literacy consulting website at www.HealthLiteracy.com. While you are there, please sign up for the free monthly enewsletter, What’s New in Health Literacy Consulting.

NewHealth Literacy Out Loud podcasts come out every few weeks. Subscribe for free to hear them all. You can find us on iTunes, Stitcher Radio and the Health Literacy Out Loud website at www.HealthLiteracyOutLoud.com.

Did you like this podcast? Even more, did you learn something new? If so, tell your colleagues and friends. Together, let’s let the whole world know why health literacy matters. Until next time, I’m Helen Osborne.

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