Literacy and language

A 47-year-old man was found to have advanced lung cancer. After discussing options with his primary care physician, the patient decided in favor of palliative care. His physician referred him for home hospice. Two months later, the patient’s brother called because the patient had been having intractable pain. Because the patient had lost his insurance, home hospice had rejected the referral and sent him to a social worker, who gave the patient a Medicaid application. Neither the patient nor his brother had been able to read or complete the form. The brother eventually submitted the form with the assistance of the physician. Two weeks after the patient died, his brother received a letter informing him that the patient had qualified for Medicaid.A Spanish-speaking woman with claudication was found by her primary care physician to have a 5.5 cm abdominal aortic aneurysm (AAA) and was referred for consideration of surgery. A consultation was faxed to the Surgery Department and a copy given to the patient. At the follow-up visit, when the physician asked her whether she had decided to proceed with surgery, the patient informed her physician that no surgery was necessary. The surgeon’s note in the chart described the claudication symptoms and recommended the patient increase her walking; there was no mention of the AAA. The patient acknowledged that she had not handed the consultation form to the surgeon because she couldn’t read it and did not know what it was for. The patient was re-evaluated, but the AAA had expanded to the renal arteries. The patient ultimately went to surgery but did not survive the operation.An elderly Cantonese-speaking woman was hospitalized because she had taken too much warfarin. Late that night, she got up to go to the bathroom. A nurse on duty stopped her and tried to get her back into bed. When the patient persisted in wanting to go to the bathroom, the nurse thought she was agitated. Instead of getting an interpreter, the nurse had the patient put in restraints, and gave her a sedative. When she didn’t respond immediately to the sedative, the staff gave her more. By morning, she was barely responsive.