“He came in for a “tune-up.” He was 64 years old, with a “history of noncompliance,” according to the resident, and he hadn’t taken his diabetes or cardiac medications for weeks. We weren’t quite sure why. He was alert, he appeared to be intelligent and interested in getting well, and he was able to get his prescriptions filled at a reduced cost. Before he went home, we explained why he needed to take his medicines and reviewed the frequency and doses with him several times. He told us he would follow up with his doctor (though he couldn’t remember the doctor’s name or telephone number) and left the hospital with a handwritten discharge summary.

Five months later, he appeared at the community clinic. He said he was taking his medications, but he wasn’t sure of their names or how often he took them. A medical student and I reviewed the regimen again. The student typed up simple instructions in big letters for him to follow, as well as a list of dates and times at which he should record his blood sugar levels. We asked him to come back in two weeks.

When he returned, the student saw him first — and made a diagnosis that no one else had considered: illiteracy. The clue lay in the jumbled mess of his glucose log. Many of the sugar values were written next to future dates. We quietly asked him to read his list of medications aloud. Haltingly, he told us he couldn’t do it. Born in the rural South, he had left school in the second grade. He lived alone. He had been able to support himself as a gas-station attendant and handyman, but he had never learned to read.

We were stunned. We had tried to avoid jargon and to use simple language in explaining our instructions, and he had seemed to understand everything we had told him. He had seen scores of doctors, nurses, and social workers over the years without anyone’s guessing he had a reading problem.

Although we had been blind to his illiteracy, our patient’s problem is not uncommon.”

For full article: http://content.nejm.org/cgi/content/full/355/4/339?query=TOC