Whether from lack of understanding due to language barriers or because drug and medical instructions are so poorly written, millions of Americans regularly are at risk of getting improper care.
Some 50 million Americans speak a primary language other than English at home, and about half of them have limited English proficiency -- speaking and understanding ability that is less than "very well."
Surveys have found that fewer than half the people who don't speak English well get a medical interpreter when they seek care at a clinic or hospital, and only about a quarter of U.S. hospitals do any significant staff training on working with interpreters.
Too many medical encounters are either reduced to a few bits of shared language, some sign language or the use of a friend or family member as translator who may not realize the medical significance of pale and dry skin versus pale and clammy skin, or mistranslate "tablespoon" for "teaspoon."
For patients who don't speak or read English well, the risk from misunderstanding drug labels is particularly high.
A report last summer in the journal Medical Care found that less than half of 764 pharmacies surveyed in four states with substantial or growing Latino populations (Texas, Colorado, Georgia and North Carolina) had full ability to translate drug instructions.
Thirty-five percent of the pharmacies could provide no translation service and the rest offered only limited translation services. The results showed that 44 percent of pharmacies located in counties where Hispanics made up more than a fourth of the population were unable to translate instructions.
Stacy Bailey, director of the Health Literacy and Learning Program at Northwestern University, said the study suggests that the language problem behind the pharmacy counter is much worse than indicated by previous studies done in New York City and Milwaukee.
The problem is no doubt even worse for languages other than Spanish. She said some pharmacists are afraid to use translations on labels because they don't know what computer-generated translations mean and fear liability.
"But knowing how to take your medications correctly is essential," Bailey said, adding that nearly three-quarters of the pharmacies in the survey were part of national, regional or state chains.
Even when English isn't a second language, medical directions may seem to be a combination of hieroglyphics, Latin and medical code.
The Institute of Medicine's landmark reviews of medical errors found that up to 90 million adults have difficulty understanding directions like drug dosage and drug-interaction information, resulting in more than 1 million medical mishaps in this country each year.
Aside from language and literacy, many drug labels and instructions are confusing even to the highly educated. ("Take as directed" -- by whom?; "Take one tablet twice daily" -- do you cough it up or split it in half?; or Latin terms that should be left to medical tomes.)
Earlier this month, an advisory committee set up by the U.S. Pharmacopeial Convention, a scientific organization that sets standards for the quality and purity of drugs in the country, recommended first-ever standards to improve drug-container labeling. The committee worked on the standards for nearly three years.
Among the guidelines:
-- Labels should be concise and only include the most critical information a patient needs for safe and effective use of the drug;
-- Language needs to be simple, free of medical jargon and Latin and use common terms. The most critical information should appear in large type, using familiar words and terms to explain how the drug should be used;
-- The label should tell the patient why they're taking the drug -- for high blood pressure, or infection or stomach cramps -- while not being so specific that the label might cause embarrassment;
-- Dose and timing of the medicine should be very clear -- "Take 4 tablets each day. Take 2 tablets in the morning and 2 tablets in the evening" is preferred over"2 tablets by mouth twice daily,'' for example;
-- Whenever possible, labels should be written in the patient's preferred language.
The complete guidelines can be seen at www.usp.org/USPNF/compendialNotices/recommendContainerLabeling.html