Ask Me 3

As a nurse practitioner providing health care and education in the home, I’ve
never had a person tell me outright that they have a low literacy level or are poor
readers. Today, I had a woman whose highest education level was 3 rd grade. She
had been born with a congenital defect, was ridiculed by her fellow students, and
ultimately stayed home to raise her younger siblings. Consequently, she was
nearly illiterate.

It is the responsibility of the provider to assess for low literacy when first meeting
a patient. In my experience, patients are reluctant to reveal they are poor readers
because they are embarrassed to do so. However, if asked about this during the
visit they will readily admit their deficiency within the confines of a trusted
professional relationship. A provider should never assume that a patient will
understand the pages of discharge instructions that are handed to them at the
conclusion of a visit. I inform all my patients that it is a shared responsibility
between them and their health care team to make certain complex discharge
instructions are understood. Reiterate to your patients that the most important
questions to ask at the conclusion of a visit are the “Ask Me 3” questions:

1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?

Additionally, be sure the pharmacy of their choice understands this as well.
Encourage your patients to disclose to the pharmacy of their choice that they
have a low literacy level. Be clear when sending the prescription that the purpose
of the medication is added to the label. Encourage the patient to ask for extra
help from the pharmacy team if they are not clear about medication instructions.
Low literacy level is a silent epidemic in some communities. Go the extra mile for
your patients to be sure their low literacy level is not causing them further harm.
Click here for more information on “Ask Me 3” developed by the Institute for
Healthcare Improvement.