Physician overestimation of patient literacy: a potential source of health care disparities

Patient Educ Couns. 2007 Apr;66(1):119-22. doi: 10.1016/j.pec.2006.10.007. Epub 2006 Nov 30.


Objective: To investigate physician overestimation of patient literacy level in a primary care setting.

Methods: The study sample consisted of 12 non-academic primary care physicians and 100 patients from a U.S. Department of Veterans Affairs Hospital in Houston, Texas. Patient literacy level was measured on a 1-4 scale using the Rapid Estimate of Adult Literacy in Medicine (REALM). Physicians rated each patient's literacy level on a corresponding scale. Chi-square was used to test for association of patient race/ethnicity and gender with: (1) patient REALM level and (2) discrepancy between patient REALM level and physician rating of patient literacy level.

Results: Patient REALM level was not statistically significantly associated with patient race/ethnicity or gender. Physicians overestimated the REALM level for 54% of African American, 11% of white non-Hispanic, and 36% of other race/ethnicity patients (p<.01).

Conclusion: Physicians commonly overestimate patients' literacy levels, and this apparently occurs more often with minority patients, and particularly with African Americans, than with white non-Hispanic patients. This discordance in estimation of patient's literacy level may be a source of disparities in health care.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Attitude of Health Personnel*
  • Black or African American / education
  • Chi-Square Distribution
  • Communication Barriers
  • Educational Status*
  • Female
  • Hispanic or Latino
  • Humans
  • Judgment
  • Male
  • Minority Groups / education
  • Outcome Assessment, Health Care
  • Physician-Patient Relations
  • Physicians, Family / psychology*
  • Prejudice*
  • Primary Health Care
  • Quality of Health Care
  • Sex Factors
  • Surveys and Questionnaires
  • Texas
  • White People / education