April 21, 2010
Communication and uncertainty go hand-in-hand. Many of our theories in communication focus on uncertainty as a reason to communicate. In these cases, we usually focus on communicating to reduce uncertainy. We talk about how we use cues from others–such as how they dress, the hair style they wear, the way that they gesture, and even how fast or slow they talk and their accent–to decide how much we are like another person. In these ways, we are using nonverbal information to reduce our uncertainty about talking with someone.
In already established relationships, we also experience uncertainty. Relational uncertainty may happen because we don’t know if our friend or family member is being ‘honest’ about whether they think we should take the job, go back to school, or in a million little day-to-day situations–like what to wear, what to eat, or what to do with our free time. We often try to reduce our uncertainty in these sitautions as well by communicating. ‘What do you want to do?’ ‘What are you doing to wear?’ ‘Do you think I should take this job?’ ‘What about the fact that we can’t sell the house right now?’ ‘They didn’t offer me any moving costs–can we afford it?’ So relational uncertainty emerges in a thousand different ways as part of having relationships. And it is a challenge to imagine how to balance the relationship needs and well, live our lives. So what happens when into the mix we introduce illness?
A diagnosis, whether it is terminal or not–as suggested by one of the participants in my last post–may spark the motivation to communicate. The diagnosis might be for a chronic condition such as heart disease, high blood pressure, high cholesterol, diabetes, or even HIV. It might be a broken leg or a sprained neck. Into each and every one of these and possibly thousands of other diagnoses enters uncertainty. “Illness uncertainty” is a big part of the uncertainy. But “relational uncertainty” is introduced into a diagnosis as well. To improve our communication about health, keeping both kinds of uncertainty in mind may help.
A diagnosis often leads us to want to reduce illness uncertainty about such things as ‘what is it,’ ‘what does it mean for my life,’ ‘how long will it last,’ ‘how will we treat it,’ and a host of other questions that may lead us to seek information to reduce our illness uncertainty. Sometimes, there will be no answers as we seek information, and so we have to “manage” our illness uncertainty by knowing that we have done what we could to answer our questions and perhaps by joining support groups online or in other ways putting ourselves in a position to keep up-to-date with any new information. What we don’t often think about is that in some situations, “increasing” our illness uncertainty may offer the most hope. As an emotion, hope let’s us look forward to a future that is a positive one and where we see ourselves able to achieve important goals. When we do not have certain information about our illness, that may provide a path toward hope if we frame it based on such comments as, “the doctor told me, ‘I don’t see any expiration date on you'”,–meaning that there is no answer to a question framed as, ‘how long do I have to live’.
In some of my past research, I have talked about the acute phase following a spinal cord injuury. During this phase, patients and families often are most reassured by communication that increases their uncertainty about the course of the diagnosis. Doctors not knowing whether a patient will walk again is a hopeful thing. At the same time that the patient and family experience hope related to increasing their illness uncertainty, they may experience sadness and fear and anger about a sense of increasing relational uncertainty. This is a case where friends and family may be very supportive in the beginning but seem to be less so over time. Communication may need to be more direct to reveal what is happening. If a friend asks, ‘what can I do for you?’ and the ansswer is always the same–‘nothing’–the friend may quit asking and quit coming around. There are many reasons that we don’t ask for help–and we can discuss those in the coming days–but if we remember that it may increase a friend’s uncertinaty about the relationship if we say ‘nothing’ and we obviously need help. And their lack of helping when we obviously need help may in turn increase our uncertainty about them. And both may contribute to illness uncertainty in negative ways–relating to a lack of tangible and emotional support–perhaps we can stop the spiral and communicate about our health and our relationship in more fruitful ways… not always to reduce uncertainty… but at least in ways to manage it.
My cousin was the star running back for Buchtel High School in my hometown, Akron, Ohio. When we were entering our senior year, he was shot in the back at a graduation party. When my family went to the hospital, we were in extreme fear. He had the potential to play college football and our family was worried that he would no longer be given that opportunity. After going into emergency surgery, the doctor told us that it was a possibility that he would be paralyzed from the waist down; however, he referred us to a physical therapist that could possibly help us. The hope that the physical therapist gave our family demonstrates why uncertainty can be good at times. Although my cousin is still paralyzed, at that time we were able to cope with his injury because we still had hope. As time has progressed, we’ve realized that the chances of him walking again are slim, yet, the shock of him being paralyzed had passed, and we are able to cope with reality better. We have become his support system, which is important when dealing with permanent injuries. My cousin still gets very upset at times when watching football and when he is not able to do some of the things his friends are able to do, however, he still attends physical therapy sessions with hope of living a normal life again. Uncertainty is not always bad; in fact, it gives some people, like my family, the drive to keep moving forward each day.
I’m glad you brought up uncertainty in already established relationships. For my communication class I recently had to interview three individuals regarding how they cope with depression. There was a great deal of uncertainty between me as an interviewer and them as my interviewees. Although I know all my interviewees, we still had to “feel each other out” before they would effectively disclose some of their personal information with me. There was uncertainty on my part because I was unsure which of my questions could be taken as insensitive or may have been too personal. For them, they had to reach a point where they felt comfortable sharing a part of themselves with me which they had not previously done before. I feel that all three interviews ultimately strengthened our relationships, now that they are comfortable enough to share these personal feelings and ideas with me.
I am a big believer in communication for anything, and when it comes to health, if I have questions I know where to go to find the answers. Uncertainty is inevitable in any case, but there are ways to become certain. My mom found a dark mark on her back about 2 years before she went to see a doctor. This mark didn’t look like a mole or freckle and she kept an eye on it and it would change shape and sometimes color. She approached me about it saying she didn’t know what it was, and when I asked her how long it had been – she told me two years and I said, “MAMA! GO TO THE DOCTOR!” She hadn’t done any research and in her generation, they all laid out as kids and the darker you were the better, skin cancer wasn’t something that was on her mind. Where, for our generation, skin cancer is a huge issue so maybe I take that education for-granted, especially after seeing my mom be so confused for two years. She finally went to the doctor and they found out she had Melanoma and it was still in the early stages so she was able to get rid of it completely. It just goes to show just how dangerous uncertainty can be, but if you know ways to figure it out, you’ll be ok!
This topic or uncertainty and illness reminds me of an event that happened not so long ago. Until last summer, my dad was not the healthiest man, he ate what he wanted, smoked, drank a lot of caffeine, ect. I say up until last summer because that is when events took place that changed the man who I thought was ‘invincible’. My dad began to lose weight, fast. He would eat more than any ‘normal’ person should but his clothes kept getting looser. After my mom, sister, his co-workers, other family members, friends and I kept begging him to go to the doctor, he went. While waiting for the results to come in, my mind went to the worst. Luckily, he had a hyperactive thyroid which is a lot better than the things that were rolling through my head however there were still so many questions about what exactly would happen. After many questions to the doctor and lots of articles from the internet, my family and I began to breathe easier.
The meaning of uncertainty and illness is a scary thing. Although some people like uncertainty, it drives me crazy because I always go to the worst case scenario, just in case. This question relates to the section in class about uncertainty and the chapter, in Dr. Parrott’s book, Uncertainty and Information Management Application. We learned that stories help to make things, in a sense, easier – especially when the stories end with ‘happily ever after’. For my family, after reading about his condition, and talking about it with one another, we began to feel better about what would happen to him. I agree that uncertainty, communication, illness and relationships go hand in hand. To get over uncertainty, you need to talk (communicate) with people you trust and care for about your illness so everyone can feel more at ease with the situation.
This article reminds me of a health issue I am currently facing. We learn about uncertainty reduction theory in my communications classes at Ohio State, but I never thought I would be prime example in health related terms. I discovered a spot on my stomach that did not look normal so I waited a few months to see if it would go away like many other skin irritations. However, it did not go away and was even growing slightly. My uncertainty about this health matter led me to seek a medical opinion. I went in for some tests but have not heard back as of this time. I considered not going in for testing but the uncertainty of the seriousness of the spot made me worried. Thanks for the article.
Reading “Talking About Health” and keeping up with the blog has already changed the way I communicate about health. One example in particular happened just a week ago between my dad and I reguarding illness uncertainty. While visiting my parents, my dad pulled up his shirt and pointed to a lump on his chest and said “you have this don’t you?” I could tell by the way he asked that he knew I didn’t have it and he felt uncertain about the lump. It was his round-about way of asking my opinion. After I told him that he should see a doctor, he pushed my opinion to the side. After learning about illness uncertainty however, I quickly realized why he didn’t want to see a physician. His mother died of cancer when she was his age, and I think that being uncertain about the lump was better than knowing for sure it was cancer. Knowing that communicating with my dad about how much I wanted him to see a physician was the only way to get through to him. He saw a doctor and is cancer free. Before reading this book, I might have just shrugged off the whole situation. I’ve learned that uncertainty plays a huge role in our health. We must learn to communicate about our uncertainties in order to overcome them.
..thank you… I am so gald your dad asked the question and you supported him in finding an answer…
This article reminded me of the time when my mom shattered her kneecap from falling on black ice and had to have surgery to fix it immediately. The surgeon was excellent, except for one thing, he didn’t communicate very well. My mom would ask him questions about the recovery process, such as how should she shower with her entire leg in a cast, and he would continuously say “you’ll figure it out”. This caused so much uncertainty for my mom, because she was always afraid of doing something wrong since she was never told how to do certain things. The uncertainty almost caused her to be afraid to get out of bed because she did not want to do anything that would hinder her recovery process.
I feel that communication between the doctor and patient is so important. Good communication will reduce anxiety as well as make sure that the doctor and patient are on the same page for everything. Any sort of surgery or procedure will cause uncertainty because it is something that many people who are not doctors or health care providers know much about. If the communication between the doctor and patient is thorough, then the whole surgery and recovery process will be much smoother.
Last year, my very close friend (she was only 21 at the time) found a lump in her breast. Having been healthy her whole life, this caused a new level of illness uncertainty for her as she questioned the probability that the lump was cancerous. How could a healthy, athletic, 21-year-old be facing the possibility of having breast cancer? Because she was worried, she expressed her uncertainty to me, reaching out for some sort of hopeful social support. I tried my best to comfort her by explaining to her that my mother and several others I know were affected by a disease which causes benign tumors in breasts. Although she was extremely upset by the danger appraisal, she began to cope through mobilization, seeking information about the illness I had mentioned. Thankfully, the tumor she had also turned out to be non-cancerous. In her case, communicating about her uncertainty led to social support and opened the doors for sharing information. Communicating about her illness uncertainty played a positive role in helping her regain a sense of hope. Not only did talking about her illness relieve some of her illness uncertainty, but knowing she had a friend she could confide in and turn to for help increased her relational certainty, as well.
Uncertainty can definitely reach both ends of the spectrum when it comes to illness. A loved one extremely close to me recently suffered a very high spinal cord injury, so I have personally experienced a lot of the uncertainty mentioned in this blog. Like Dr. Parrott mentioned, we have found hope and reassurance through the uncertainty of his injury. If the doctors had told us that there is no chance he would ever move or walk again, we probably would have given up. Instead, we were told that, although it is very unlikely, there is a slight chance that he could regain some movement. Despite not having any idea what the future holds, we have found comfort in this uncertainty because each spinal cord injury case differs and a possibility of some amount exists.
On the other hand, I have experienced uncertainty negatively in some relationships. Whether we (those closely and directly affected by the illness) reject offers of help from, refuse to disclose our feelings to, or don’t spend as much time with friends and family, this uncertainty may cause them to eventually withdraw. In turn, we may begin to host negative, uncertain feelings towards their ability to support us.
Obviously every illness, diagnosis, injury, etc. differs, but the majority of negative uncertainty stems from communication. It is important that those experiencing an illness and those who serve as their emotional support both realize the importance of communication so that negative feelings of uncertainty can be avoided or at least managed.
great post as usual!
Communication is key in all situations because you can’t assume anything. Uncertainty is one of the hardest challenges to face because you aren’t sure which direction will help you, but like Roxanne says being honest is not always easy, especially when it’s a loved one. Emotions play a huge role in our decisions as well as the impact of our families. As uncertainty lingers conditions could worsen. I was always told “sometimes the hardest things in life are the ones worth doing.”
Uncertainty is similar to gambling, you have a 50-50 chance something will go your way. Going off of Roxanne’s illustration of spinal cord injuries, my 16 year old brother’s friend was recently told he would never walk again, the uncertainty of this injury left his family to make a decision to find a doctor that would give him and his family hope that he will someday walk again. This is how they choose to manage their situation.
In some cases if a person needs help they may not want to turn to someone close to them for information or emotional support because they feel in doing so they are exposing themselves. As mentioned in Parrott’s response, nonverbal cues can play a huge role in reducing uncertainty and in the context of online support groups these cues may not be as easily expressed via internet blogs. Nevertheless, current research is finding that people using online social networks are experiencing social presence and nonverbal cues by other users by signaling the actions through text or by using punctuation to represent facial expressions. (*hug* or 🙂 =smile ) This idea of online support networks as a means to reduce uncertainty in the context of anonymity can largely benefit patients dealing with stigmatized health problems.
It seems like people focus more on maintaining positive emotion such as hope when they think reducing uncertainty is impossible or when they are afraid to know the exact result. I’m encouraged to learn that (though it might be painful at the moment) direct communication will better prepare a patient and his/her caregivers over time. But I was wondering…is there any intercultural communication training for the doctors? People from highly collectivistic cultures are likely to ask doctors questions indirectly in order to show respect and modesty and not to appear as aggresive. What are some tips for intercultural patient-physician interactions? I think if a patient is from a high-context culture and he/she wants to know his/her exact health condition but hesitates to ask direct questions, I’m afraid that a doctor from a low-context culture would interpret it as “less motivation to reduce uncertainty” thus not sharing all the information at once.
UNCERTAINTY IS A MAJOR PART OF EVERYDAY LIFE AND COMMUNICATION. BASED ON MY EXPERIENCES I FEEL THAT UNCERTAINTY CAN BE BOTH BENEFICIAL AND HARMFUL IN RELATION TO HEALTH ISSUES. I BELIEVE THAT A PERSON’S UNCERTAINTY CAN LIMIT THEIR DISCLOSURE, WHICH ULTIMATELY MAY LEAD TO A PROBLEM NOT BEING SOLVED. FOR INSTANCE, A FRIEND OF MINE NOTICED SOME SCARRING AROUND HER VAGINAL AREA THAT WAS ABNORMAL. SHE DID NOT KNOW WHAT IT WAS, BUT BECAUSE SHE WAS EMBARRASED SHE NEVER WENT TO THE DOCTOR. ALMOST FOUR MONTHS LATER THINGS GOT WORST AND SHE WAS DIAGNOSED WITH A RARE SKIN DISEASE THAT SHOWED UP ON HER SENSITIVE VAGINAL AREA. HER DOCTORS INFORMED HER THAT SHE SHOULD HAVE COME IN AS SOON AS SHE NOTICED THE SCARS, IT WOULD HAVE HELPED HER IN THE LONG RUN. ON THE OTHER HAND, I GO TO THE DOCTOR ANYTIME I FEEL THAT I AM UNCERTAIN ABOUT A SYMPTOM THAT I MAY HAVE. I WOULD RATHER BE SAFE THAN SORRY IN ANY SITUATION. I KNOW THAT WITH SOME MEDICAL CASES WAITING OR NOT GETTING HELP LEADS TO DIASTER.
I totally agree that communication and uncertainty go hand-in-hand when it comes to relationships or illness of any sort. I also believe that a person’s friends and family play a significant role in reference to how they respond to the illness. How someone makes you feel or what they do for you while you’re ill is very important. Sometimes we disclose information to certain people so that we can gain that social support but how they respond to our disclosure can make us uncertain about the whole relationship. For example, results for my yearly exam came back abnormal for the second time within three years. I disclosed this information to someone I thought I could depend on and get the social support I needed. But how they responded or how they showed a lack of support made me question our relationship. I believe that how we communicate is the most important key.
This blog post makes me think of a situation I had when I was about 15 years old. One day these bumps appeared on my legs. I decided not to tell my mom because the uncertainty of what the bumps were let me talk myself into thinking they were nothing and would go away. I was intentionally avoiding reducing my uncertainty. More bumps started to appear and I asked my friends if they though it looked bad. I experienced relational uncertainty because I didn’t think they were being completely honest with their answer that it didn‘t look bad at all. After that I decided to communicate with my mom about the uncertainty I was having with these bumps on my leg. She took me to my doctor that week. The doctor gave me a prescription for a medicine that got rid of them within a week. Without that relation uncertainty I felt after asking my friends I probably would have waited to talk to my mom about it and would have had to endure having those bumps for longer then was necessary.