It had been a particularly rainy, cloudy, messy spell of weather that makes up a typical British winter.

I took one look at my car in the health centre car park and realised that it was a disgrace. Mud was splattered everywhere, chiefly the result of a home visit to a farm on the periphery of my practice patch, where the potholed track was better suited to a tractor or a Land Rover than to my small Renault.

I drove to the nearest garage and joined the queue for the car wash. Directly in front of me was a very smart, albeit very dirty, large car. As it pulled up to the car wash entrance, the driver got out and stood there looking distinctly puzzled.

As the minutes ticked by, and my impatience grew, I eventually got out of my car, walked over, and asked what the problem was.

The driver turned to me, and I realised that he was one of my patients. He was an immensely successful and very affluent businessman who did something I didn’t really understand in the City, not that I really understand what anyone does in the City.

He had a long-term health problem that we always really struggled to get under control.

I had assumed that his priorities were elsewhere, and that he just didn’t give his health the attention that it required.

He looked very embarrassed, and I realised that he didn’t know how to get the car wash started – where to put the token, which button to push.

I joked about these machines always being rather confusing and showed him what to do.

He thanked me, got back in his car and drove into the car wash.

As I got back into my car, the penny dropped. I suddenly realised what my patient’s problem had been for all these years. He couldn’t read.

It seemed extraordinarily unlikely – after all, he was such a successful businessman – but I also realised that an inability to read is far more common that many of us realise.

So, a few weeks later, when my car wash patient came to the surgery for a check up, I very gently asked him if this was the problem.

The inevitable tears of shame and embarrassment followed almost immediately. I reassured him that he had absolutely nothing to feel ashamed about. Indeed, he should be proud of everything he had achieved despite being unable to read.

I realised how completely futile all those printouts, booklets and advice sheets on the management of his condition had been. It was little wonder that they hadn’t had any impact. He hadn’t been able to read them, let alone act on the well intentioned advice.

In England, it is estimated that 16% of the population have very poor literacy skills, equivalent to around seven million people, according to the National Literacy Trust. (https://literacytrust.org.uk)

That’s a huge number of people, equivalent to more than 300 patients on the average GP’s list.

If a patient is struggling, and you don’t understand why, it might be worth bearing this in mind, even if they are hugely successful in their chosen line of work.

It had been a particularly rainy, cloudy, messy spell of weather thatmakes up a typical British winter.

I took one look at my car in the health centre car park and realised that it was a disgrace. Mud was splattered everywhere, chiefly the result of a home visit to a farm on the periphery of my practice patch, where the potholed track was better suited to a tractor or a Land Rover than to my small Renault.

I drove to the nearest garage and joined the queue for the car wash. Directly in front of me was a very smart, albeit very dirty, large car. As it pulled up to the car wash entrance, the driver got out and stood there looking distinctly puzzled.

As the minutes ticked by, and my impatience grew, I eventually got out of my car, walked over, and asked what the problem was.

The driver turned to me, and I realised that he was one of my patients. He was an immensely successful and very affluent businessman who did something I didn’t really understand in the City, not that I really understand what anyone does in the City.

He had a long-term health problem that we always really struggled to get under control.

I had assumed that his priorities were elsewhere, and that he just didn’t give his health the attention that it required.

He looked very embarrassed, and I realised that he didn’t know how to get the car wash started – where to put the token, which button to push.

I joked about these machines always being rather confusing and showed him what to do.

He thanked me, got back in his car and drove into the car wash.

As I got back into my car,

the penny dropped. I suddenly realised what my patient’s problem had been for all these years. He couldn’t read.

It seemed extraordinarily unlikely – after all, he was such a successful businessman – but I also realised that an inability to read is far more common that many of us realise.

So, a few weeks later, when my car wash patient came to the surgery for a check up, I very gently asked him if this was the problem.

The inevitable tears of shame and embarrassment followed almost immediately. I reassured him that he had absolutely nothing to feel ashamed about. Indeed, he should be proud of everything he had achieved despite being unable to read.

I realised how completely futile all those printouts, booklets and advice sheets on the management of his condition had been. It was little wonder that they hadn’t had any impact. He hadn’t been able to read them, let alone act on the well intentioned advice.

In England, it is estimated that 16% of the population have very poor literacy skills, equivalent to around seven million people, according to the National Literacy Trust. (https://literacytrust.org.uk)

That’s a huge number of people, equivalent to more than 300 patients on the average GP’s list.

If a patient is struggling, and you don’t understand why, it might be worth bearing this in mind, even if they are hugely successful in their chosen line of work.