Various instruments have been used to measure reading skills or functional literacy in patients.11- 13 One of the most widely used instruments is the Wide Range Achievement Test-Revised, originally developed in 1936. It has 3 subscales—arithmetic, reading, and spelling—and the reading subscale measures the patient's ability to recognize words by reading aloud from a list of 74 words. Another widely used, nationally standardized test is the Slosson Oral Reading Test-Revised, which is also based on a person's ability to pronounce words in ascending order of difficulty. Both of these are thus general literacy tests. The Peabody Individual Achievement Test, a third, standardized, wide-range screening measure, in contrast, asks the patient to read whole sentences and then to select 1 of 4 possible pictures of the sentences' meaning. The Peabody Individual Achievement Test thus explicitly tests for understanding and reading ability. All 3 of these tests, however, share the drawback that they are obvious tests of literacy skills. For this reason, many patients with lower literacy skills may refuse to participate in such assessments.