Illiteracy is not just a historical phenomenon

Editor—West suggests that doctors' reluctance to copy letters to patients is an anachronism stemming from the fact that patients were often illiterate in the 18th and 19th centuries.¹

Glasgow Royal Infirmary is a large teaching hospital, whose local catchment population is one of the most deprived in the United Kingdom. One of us with colleagues surveyed 127 consecutive, unselected patients with rheumatoid arthritis attending a rheumatology clinic and found that 3% could not read and 15% (1 in 6) were functionally illiterate.² We have no reason to believe that these patients were in any way unrepresentative. Copying letters to these patients is not an effective way of empowering them.

Email and internet sites, although popular with a minority,³ will not serve the needs of patients with low levels of literacy. In our cohort illiteracy was associated with significantly more hospital visits, but overall function was similar, with implications for resources and funding.

We wholeheartedly believe in fully sharing information with our patients, but whereas audiotapes and videotapes may be useful, they assume access to appropriate equipment and again have implications for funding.

For some, the best option is likely to be adequate time with an appropriate healthcare professional—a resource unfortunately in short supply.

Perhaps Glasgow is different from York, but we suspect illiteracy is more widespread than many doctors appreciate, even in the 21st century.