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

P. Adam Kelly, Paul Haidet

Research output: Contribution to journalArticlepeer-review

249 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)119-122
Number of pages4
JournalPatient Education and Counseling
Issue number1
StatePublished - Apr 2007

All Science Journal Classification (ASJC) codes

  • General Medicine


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