Consistent with the LEARN Model and the prior recommendations for ensuring health literacy, the following is an outline of universal rules to follow in a clinical encounter^{[3, 5, 7, 14]}:

• Address the patient with respect.

• Use “Mr.”, “Mrs.” or “Ms.” as appropriate unless first name is requested
   
• Always ask patients for permission before touching
   
• In some cases, such as a gynecologic exam, consider warning the patient that a particular action is about to occur and what she we likely feel. Asking for permission in sensitive interactions, such as a gynecologic exam, may cause embarrassment to the patient

• Speak slowly and at a normal volume.
   
• Give verbal instructions slowly and periodically assess comprehension.

• Ask patients to restate in their own words;

• Avoid medical jargon and multi-syllable words, for instance:

• Use common words like “bruise” instead of “contusion” or “cut” instead of “laceration” or
        “walk” instead of “ambulate”
• Use phrases such as “heart attack” instead of “acute myocardial infarction” or “stroke” instead
  “transient ischemic attack” (TIA)

• Ask patients whether they prefer to see pictures, brochures, demonstrations, etc . . .
   
• Present information in segments.
   
• Ask patients to tell you who is involved in their care and include those individuals when giving instructions
   
• Use specific times and emphasize when timeliness is critical

• (clock times (such as “12 p.m.” or “noon”) rather than “after lunch”, for example)

• Ask about any other therapies or treatments that patients include in their care. (Patients may not feel that the “other” care is an alternative, but rather complementary or even the main treatment.)
• Ask patients about whether they include religion/spirituality in care. For instance, ask if they wish to have a clergy member, spiritual guide, or faith healer present for all or aspects of their care.
• Nonverbally, you should:

• Control facial expressions – make sure to convey acceptance and tolerance
   
• Avoid expressions of annoyance or impatience - especially when a patient may have low literacy
   
• Do not rely on written materials alone to convey instructions or explanations

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