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Let’s face it: Doctors speak a different language than the rest of us. Not surprisingly, it’s possible for even well-educated people to leave their physician’s office a little fuzzy about the treatment recommended or how long they’re supposed to take that medicine.

Mix that fact with the expanding elderly population and a growing number of immigrants with marginal English skills, and you have a prescription for a mounting health literacy crisis in the United States, say health experts.

Last week, about 100 representatives from hospitals and health-care and education agencies from across Iowa met for a daylong conference in Des Moines to discuss the problem. Their goal: establish an Iowa Center for Health Literacy within two years to serve as a resource for patients and health providers.

“Patients have the right to understand health-care information that is necessary for them to safely care for themselves, and to choose among available alternatives,” said Dr. Mary Ann Abrams, a health management consultant with Iowa Health System, which coordinated the event. “Health-care providers have a duty to provide information in simple, clear and plain language and to check that patients have understood the information before ending the conversation.”

The conference included “rapid-fire brainstorming sessions” among the participants to develop ideas and plans for how such a center would be structured and funded. Among the groups represented was New Readers of Iowa, an adult literacy group working in partnership with Iowa Health System to promote a “shame-free environment for all patients,” particularly those with low literacy skills, new readers or those for whom English is a second language.

An estimated 90 million U.S. adults have low health literacy, with health literacy defined as the ability to obtain, process and understand basic information needed to make appropriate decisions regarding their health. That’s according to a report from the Institute of Medicine of The National Academies, a nonprofit research arm of the National Academy of Sciences.

This problem has profound implications for all Americans, as it adds significant costs to the health-care system, driving up health insurance costs, experts say. It’s estimated that low health literacy accounts for between 7 and 17 percent of all U.S. health-care costs, or an estimated $106 billion to $238 billion annually.

“I think that health-care organizations have for years struggled with the issue of helping patients better understand the implications (of health literacy),” said Bob Dickerson, a process improvement specialist with Iowa Health. “It’s recognized as a problem, but it’s not always the primary thing on the agenda, because there are a lot of regulatory things that health organizations are responsible to.”

The initiative to focus attention on the issue and create a statewide center appears to be building momentum, he said. “The neat thing about this is you’ve got people from all over the state, not just from hospitals, but also from the education sector and public health agencies,” he said. “And Gov. (Chet) Culver came and spoke at a reception for this event, so it’s really getting some top-level attention.”

Inadequate health literacy increases with age, said Dr. Nicole Lurie, an expert in health literacy who spoke at the event. “By the time you’re 85, you have a 75 percent chance of being below average in health literacy,” she said. “Because of an increasing aging population, this problem is growing.”

Lurie, co-director of the RAND Corp.’s Center for Domestic and International Health Security and director of RAND’s Center for Population Health and Health Disparities, is also a staff physician at a community clinic in Washington, D.C.

“Not surprisingly, about 55 percent of our patients (at the clinic) have low health literacy skills,” Lurie told the participants. Recently, she saw a patient, “Mr. S.,” whom she had referred to the emergency room nine months earlier with symptoms of a heart attack. He was again having chest pain.

“He said he wasn’t sure what the hospital told him,” noting that Mr. S. works as a hot-dog vendor and has minimal reading abilities. His discharge instructions were a list of the four medicines he was supposed to take, along with untranslated Latin abbreviations that doctors scribble on prescription pads. Also on the sheet was written: “f/u cards 1 wk RTC if chest pain,” which translated, meant: “Follow up with cardiology tests in one week; return to clinic if you have chest pain.”

“It’s no wonder he had no idea what to do,” Lurie said. “The health-care system failed him in failing to communicate effectively with him.”

One effective technique that many hospitals and clinics use to try to ensure better communication with patients is the “Ask Me 3” campaign. Before leaving their doctors’ office, patients are encouraged to ask three simple questions: What is my main problem? What do I need to do? Why is it important for me to do this?

Lisa Baumhover, a geriatric clinical nurse specialist for Iowa Health – Des Moines who was among the participants, said health literacy is particularly critical in dealing with elderly patients.

“The older people get, the more chronic illnesses they’re dealing with, they’re going to several different physicians, they’re taking usually multiple medications,” Baumhover said. “If they don’t get clear instructions about how to take their medications, how to watch for symptoms and what to do about them, they’re just going to continually keep coming back to the hospital, and be a little sicker each time. Each time, there’s a chance they’re not going to get back to their baseline, so it’s huge in geriatrics that people understand what their illnesses are and how to take care of themselves.”

Baumhover said she believes Iowa Health is making a good attempt to reach out to educate patients. “I know that any nurse you ask can tell you what teach-back is, and what Ask Me 3 is about,” she said. “They’re very simple, basic processes in how to communicate with a patient or a family, but they’re the kinds of things that probably don’t come naturally. You have to practice and be aware of them and make a real effort to do it. So we all probably need to continue practicing this and verifying with patients and families that they’re understanding what we’re telling them.”

Abrams said the next step will be to produce a white paper within the next six to eight weeks to summarize the results from the conference and outline the vision, mission statement and objectives for the center.