Category Archives: Communication

There Are No Dumb Questions

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“There are no dumb questions.” We’ve all heard this before, and as a result, we ask questions for all sorts of reasons. We ask questions because we want to know the answer or because we want to prompt someone else to get to the answer. We ask questions to impress our professors or classmates, to stand alone rhetorically, and to fill awkward silences. We ask questions constantly to other people, to anyone who’s listening, and even to ourselves (don’t pretend you don’t talk to yourself too).

So, why is it that we suddenly clam up in front of our doctors?

Many patients suffer from “white-coat silence,” or “a reluctance to vocalize questions to physicians.” At first this might sound ridiculous. Isn’t that your doctor’s job? To be the medical expert who answers your questions? Why wouldn’t you talk to him/her? While for many people this might seem obvious, for others, the doctor’s office is a strange, scary place where it’s a lot safer to just listen and let the doctor tell you what to do.

However, communication is key to successful patient-doctor interactions. In fact, a study found that the most powerful predictor of positive physician communication is good patient communication, which—surprise, surprise—includes the tendency of patients to ask questions. By asking a question, patients catalyze a cycle of patient-doctor communication in which they provide an opportunity for physicians to share information and give support. Not only does this increase a patient’s knowledge about their own health, but it also makes them feel more comfortable in the clinical setting, making for a better patient-doctor relationship.

So, why don’t patients talk to their doctors?

Intimidation, anxiety, and even impatience are just a few reasons. However, a study published in 2007 found that low health literacy is one of the most influential factors negatively affecting patient communication. Patients with low health literacy ask fewer questions, are less likely to use medical terminology, and ask less meaningful questions (e.g. “What is the name of that medicine?” rather than “Will I be in danger if I increase my dosage?”). Conversations with your doctor are much less beneficial if you don’t know what to say. With such a short amount of time per visit, low-literacy results in missed opportunities for patients to become more engaged and informed about their own health during their doctor’s appointment. Sometimes, patients who are aware of their low health literacy are too embarrassed to ask questions at all.

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So, how is this being addressed?

The Agency for Healthcare Research and Quality (AHRQ) released a toolkit for improving health literacy. One of the guidelines was to “Encourage Questions.” Patients with low health literacy can benefit more from their visits if they know what questions to ask. By empowering these patients to see the benefits of speaking up, they can slowly learn that there are no dumb questions and learn to effectively communicate with their doctors. Over time, this increased communication can lead to the gathering of more health information, improved health literacy, better communication, and ultimately better health outcomes.

So, what can we do about this?

AHRQ also published a question guide that can be utilized by all patients, as everyone can stand to benefit from communicating with their doctor. Any MMAL group involved in patient-doctor interactions should keep patient-initiated solutions as an important consideration. Patient involvement indicates to the doctor that the patient is interested and engaged in their own health. It also helps battle the ‘intimidation’ factor in white-coat silence by empowering patients and giving them some authority. In developing our media solutions, the ‘not-dumb’ question we should ask is “How will this help catalyze patient-doctor communication?” because active patients make for happy doctors, which leads to better patient care.

Judson, T. J., Detsky, A. S., & Press, M. J. (2013). Encouraging patients to ask questions: How to overcome “white-coat silence”. Journal of the American Medical Association, 309(22), 2325–2326

Street RL Jr, Gordon H, Haidet P. Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor? Soc Sci Med. 2007;65 (3):586–598.

Katz MG , Jacobson TA , Veledar E , Kripalani S . Patient literacy and question-asking behavior during the medical encounter: a mixed-methods analysis . J Gen Intern Med . 2007 Jun;22(6):782–786 Epub 2007 Apr 12.

Walking a Mile in a Patient’s Shoes

This past week, I had an appointment with a specialist in the Medical Center. I arrived to my appointment a few minutes ahead of time only to walk into a waiting room crammed full of people. I have never in my life seen a waiting room that full! I hoped that all the people in the waiting room were families of the patients not actual patients as I waited for the nurse to call my name. My hope was not realized, and an hour later I finally was called back to an exam room.

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source: www.greatcanadianjokebook.com

At this point, I was already extremely frustrated and I honestly wished I had canceled the appointment.

When the nurse checked my vital signs, I didn’t even bother to ask what my blood pressure was. When the doctor asked me if I had any other questions, I quickly replied “no.” I didn’t event make an effort to think of any of my concerns. All I wanted to do was to leave. I had quickly transformed into an unengaged patient, just like the patient my team is trying to help.

It made me wonder if new innovations in technology could streamline this process. The main source of my lack of engagement was due to my frustration that built up while I was in the waiting room.  My appointment had been a check-up, and there was no reason why I physically had to be in the doctor’s office. Everything could have been done from my home through a platform like Skype (although more secure.) My vital signs could have been recorded by the various mobile applications available and then sent to my doctor. A new smartphone app allows you to record your heart rate using the flash on your camera, and you can buy blood pressure cuffs and readers that connect directly to your smartphone.

telemedicine

This new trend in healthcare is called telemedicine, which means providing healthcare at a distance. Using telemedicine, a patient can have a virtual appointment with their doctor through a webcam. Telemedicine could prove extremely useful for situations such as check-up appointments, where there is no need for a patient to physically be in the doctor’s office. It also might be valuable for psychiatric care or primary care in rural locations. Telemedicine could provide a way for patients to feel less frustrated at their doctor’s appointments. Patients would no longer have to waste time driving to and waiting at their doctor’s appointment. Their appointment would be in the comfort of their homes, which could lead patients to ask more questions and become further involved in their treatment plans. While telemedicine won’t work for every appointment, it is becoming a increasingly feasible and attractive option for several different facets of healthcare.

 

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Conveying information (Feat. The best infographic ever)

First things first—doesn’t anyone else find it funny that there are  10  13 new posts here in the past couple days? No, just me? Ok…

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How is everyone today? I’m a bit miffed writing this, because I’m not scoring as well as I would like in this class, according to my critique and dossier grade (pre-med problems, am I right?). No biggie, I can do better next time, but I’ve got to solve a very important problem first. In our presentation, we gave a lot of information—probably too much as we went a good 2 or 3 minutes over time. Having this information is great, but the problem seems to be that we couldn’t convey it effectively. My introductory linguistics professor described it well: language is used to take an idea in one’s head and vibrate some air with some flaps in our body in such a way that another person in the vicinity can have the same idea. We could not accomplish this pseudo-telekinesis, so we didn’t do as well as we wanted.

I can guess what you’re thinking though: “Wah-wah. That’s not a real problem. How does this apply to me?” Well, I figure that if we cannot get an idea across accurately to doctors, professors, and others sufficiently, what chance do we have of getting the same (or other) ideas across to the patients that we aim to empower?

There are a couple of things we could do, actually. For one, we can work on basic presentation style, so that the information we give is more engaging for an audience. We can also make analogies. When you simplify an idea by comparing it to other things (e.g. the heart to a pump) people can get a better sense of what something truly means and can figure out implied effects or solutions of that thing.

However, one new trend that is becoming more and more used is called an inforgraphic. For those of you who don’t know what that is, it’s basically some type of image that conveys information, usually in a fun and easily digestible manner. If you want a few examples, here’s like 80 of them.  Info graphics are useful because people only really read a portion of the information they encounter, according to Dr. Paul Lester in his paper “Syntactic Theory of Visual Communication” . People following instructions with infographics are much better at following them than without and adding pictograms to medicine labels increased patient compliance significantly (around 25%). And honestly, infographics are just fun. People like them—a lot. If you want to know more about why we like infographics, check out this one.  I know I put up a lot of links, but you seriously should check it out.

No, seriously. Look at it. It’s pretty great. I’ll wait.

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Anyway, I feel that both in our next presentation and in our solution, it would be a great idea to create some visual representation of our information. I’ve been looking up infographics and how they work so we can harness their powers for good, but honestly, this information is pretty useful for us all.

A Technocultural Medical Revolution

ePatients are often lauded for their effective use of technology.  They use technology as a means to take measurements, research information, and create communities.  While their use of technology is often the focus of attention, their culture is often neglected.  Ferguson and Frydman (2004) address both of these points in their seminal article about ePatients and argue, “We are witnessing the most important technocultural medical revolution of the past century.”

The culture of the ePatient movement definitely needs attention.  By changing the dynamics of the physician-patient relationship, ePatients are effectively changing the culture of how laypersons interact with physicians.  Carman (2013) proposes that there is a continuum of engagement for patients in direct care.  Currently, most patients fall under the category of consultation; that is, they receive information about a diagnosis.  ePatients argue that they should have greater engagement.

Patients may get more involved by sharing their preferences in a treatment plan, thereby taking into account their individual culture, background, and spirituality.  On the most engaged end of the spectrum, patients have partnership and shared leadership with the physician.  Carman (2013) imagines that with this level of engagement, “treatment decisions are made based on patients’ preferences, medical evidence, and clinical judgment.”

Clearly, this is a step away from current physician-patient interactions.  With higher levels of engagement, patients are expected to be health literate.  They are considered equals with the physicians and can elect their own treatment plans.

But is this change in culture possible?  People around the globe unanimously regard physicians to be the most respected professions, and there are multiple reasons for this.  Medical professionals have a direct impact on the lives of everyday people.  They are present when people feel the most vulnerable, and they serve as their confidants.  Physicians tend to have higher levels of education and higher income, and they have great responsibilities and expectations.

Photo Credit: illustrationsource.com

In cultures that have a predominant social hierarchy, the idea of being an ePatient seems almost frightening.  For many East Asian countries, some patients would not dare correct their physicians.  It would be disrespectful, impolite, and indicative of lesser social status.  It would disregard power dynamics, and the patients would be overstepping long entrenched boundaries.  It is, therefore, unsurprising that the ePatient movement has its roots in the Western world.

Additionally, in the ePatient-physician relationship, it is critical to distinguish the difference between health literacy and medical education.  While patients may understand the biological processes behind their illness, physicians have had at least seven more years of education in medicine whether in medical school or in residency.

Photo Credit: healthydebate.ca

In this technocultural medical revolution, there must be balance.  Mutual respect is key.  There must be an acknowledgement that the physician has greater expertise, but physicians cannot regard themselves as superior.  It is true that the physician cannot fully understand what the patient is experiencing, but the physician can at least practice empathy.

In any case, we must be aware of these cultural phenomena if the ePatient movement is to be globally ubiquitous.

Photo Credit: growingolder.org

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