We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Letters |

Health Literacy and Numeracy

Carlos Estrada, MD, MS; Vetta Barnes, MD; Cathy Collins; James C. Byrd, MD, MPH
JAMA. 1999;282(6):527. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-6-jbk0811.
Text Size: A A A
Published online


To the Editor: Dr Gazmararian and colleagues1 identified problems in numeracy, the ability to understand basic mathematical concepts, and health literacy among managed care enrollees. Such problems may not be limited to patients. We assessed numeracy in a convenience sample of 24 physicians, 4 nurses, 12 doctorate faculty, and 5 medical students attending a grand rounds. Numeracy was assessed with the following written questions: (1) Imagine that we flip a fair coin 1000 times. What is your best guess about how many times the coin would come up heads in 1000 flips? (answer: 500 times); (2) In a lottery, the chance of winning a $10 prize is 1%. What is your best guess about how many people would win a $10 prize if 1000 people each buy a single ticket for the lottery? (answer: 10 persons); (3) In ACME sweepstakes, the chance of winning a car is 1 in 1000. What percentage of tickets to ACME sweepstakes win a car? (answer: 0.1%); (4) If you have 5-mg pills of warfarin sodium and you take 7.5 mg/d, how many of those pills should you take every day? (answer: 1.5 pills); (5) You have 5-mg pills of warfarin and you take 7.5 mg/d. If you have 9 pills left, would you have enough for 1 week? (answer: no); and, (6) Your international normalized ratio should be 2 to 3. If your international normalized ratio today is 3.5, would your international normalized ratio be low, normal, or high? (answer: high). The first 3 questions had been used in a study that examined the role of numeracy in understanding breast cancer screening.2 The last 3 questions are now being used in a study to assess the role of patients' numeracy skills in the use of warfarin.3


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.