What else is required in order for the patient to actively and effectively engage in medical decision making on his own behalf?
He must add one more competency—statistical competency—to the linguistic and conceptual competencies he has already acquired.
Statistical competency does not mean any real ability in mathematics or statistics, but rather a basic understanding of how
medical probabilities work in principle and how to apply these principles to his individual medical condition.
In the case of high cholesterol, this patient needs to understand that taking a statin significantly reduces the probability
that he will have a heart attack or stroke in the future. His physician can attempt to describe the differences between "Absolute
Risk Reduction," "Relative Risk Reduction," and "Number Needed to Treat"—and perhaps for some sophisticated patients that
may be appropriate. However, for most patients, statistical competency only requires the understanding that if 1,000 patients
with a condition similar to his own take a statin every day, compared to another 1,000 who do not, then fewer patients in
the group taking the medication (10 or 20 or 30 fewer, depending on the data) will have a heart attack or stroke compared
to those not on medication. What is most important is a basic appreciation of the scale of the benefit.
When this patient is now contemplating the potentially serious adverse effects associated with a statin, he must also be able
to comprehend the very different scale of probability that the risk represents compared to the benefit. Again, the exact numbers
can be accessed or communicated, but what is most important is the relative scale of difference—1 in 10,000, 1 in 100,000,
etc. (again depending on the precise data).
This is statistical competency. By understanding the relative differences of benefit and risk as described, our patient can
now make an informed evaluation of the risks and benefits of taking his medication every day—and the risks and benefits of
not treating his condition.
Our hypothetical patient, thus equipped with linguistic competency (hypercholesteremia = high cholesterol); conceptual competency
(cholesterol is manufactured in the liver, the medication described by my physician is designed to work in the liver to reduce
the amount of cholesterol manufactured); and statistical competency (the benefit from taking a statin far outweighs the risk
of developing a serious side effect from the medication) is in possession of a sufficient body of knowledge to achieve decision
making literacy regarding informed consent and empowerment.
What Are the Implications for Decision Making Literacy?
There are several significant implications of this specific expansion of the idea of health literacy:
1. It raises the bar of responsibility for the pharmaceutical marketer, payer, and provider seeking to provide the information,
and increases the capacity of the consumer/patient to exercise informed consent and to actively participate in making medical
decisions. The added dimension of competency as defined by this new language can specifically guide the creation of content,
design, and choice of media channels associated with specific patient-directed programs.
2. It defines measurable communication endpoints with which to measure the efficacy of patient education, CRM, and adherence
programs designed to inform the patient and to support their decision-making competencies. These applications can include:
new approaches to research methodology and investment to gain initial insight into patient needs, ongoing metrics for patient
communication materials and programs, and an expanded approach to patient (and even provider) segmentation.
3. It provides an expanded vision and architecture for the creation of and investment in collaborative programs with healthcare
delivery systems and institutions designed to improve and validate increased quality, efficiency, and health outcomes.
Signal and Inspiration for Change
Language matters. It can be the signal of change—and the inspiration and active cause of change. Decision making literacy
can be—and should be—both.
Joe Gattuso is EVP and Chief Strategic Officer for Ogilvy CommonHealth's business development group. He can be reached at firstname.lastname@example.org