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Patient Educ Couns. 2007 Apr;66(1):119-22. Epub 2006 Nov 30.

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

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U.S. Department of Veterans Affairs, Baylor College of Medicine, Houston, TX 77030, USA.



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


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.


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).


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.

[Indexed for MEDLINE]

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