February 12, 2011
“What are you doing in your free time?” “What do you guys eat?” “Do you have a problem eating healthy?” “Why is tanning so important to you?” “Do you have an eating disorder?” “Do you think you have a problem with eating healthy?” “Do you choose white or whole wheat bread?” “How were you raised?”
Each of these questions has the potential to seem critical. Asking someone what they do with their free time…could be a friendly rapport-building question in the mind of the person asking the question. But it also has a risk related to seeming to imply that there might be a right or a wrong answer. And if that is true, if you ask me the question, I am going to want to appear to be the kind of person who spends my free time doing things that fit my sense of self. I don’t think of myself as “lazy” and so if I tell you that I like to watch “Survivor” or “American Idol”–will it seem like I am lazy?
And asking me what I eat–when, yesterday, today, over the holidays, when I eat alone, when I am at work? Again, there are so many ways to think about that question and how my answer may say something about me that I don’t want it to say. So, how about if I just say, “It depends,” is that helpful in suggesting how to guide my eating habits?
And what about tanning? I heard that you need some sunlight to get enough vitamin D to help avoid osteoporosis. So why shouldn’t tanning be important to me?
The questions and our answers are likely to be linked to telling us to change our behavior, and we have some instinct about that as well. Most of us like to make smart choices. So a little bit of coaching can go a long way toward helping… But, just telling us “to stop tanning,” or “don’t eat junk food,” or” find more time to exercise…” –well, we’ve heard it all before.
When we talk about health, it helps to think about the fact that most of want to be liked by others or at least to have a chance to show how what we do matches who we think we are…most of the time.
A negative face-threatening question that we as a group thought of was “there is a program I have enrolled you in to help you child make better eating decisions” This statement does not give the parents a choice of whether or not they would like to participate in this program at all. A better way to go about this and soften the request would be “there is a program that has helped many people in your situation before that is designed for healthier eating decisions” This statement makes the parents feel less threatened. This will help the parents ease into the program and not feel as if they were forced into it.
The topic that I originally considered was based on communicating to parents about childhood diabetes. These issues arise because at a young age the child depends on their parents for diabetic education. Often times, how effective parents are able communicate with their child about diabetes and the upkeep the disease entails, the better off they will be. A question that would threaten positive face to parents is: “Do you keep a lot of high sugar content foods around the house?” A better way to go about this question would be to say “what kinds of food do you keep around the house”? This question does automatically assume that all food in the house has high sugar content and doesn’t put blame directly on the parents.
The second question our team developed really hit on both positive and negative face. It’s a bit lengthier, so it seems unlikely that a doctor would say this – perhaps a rambling doctor? Maybe a nutritionist or dietician? Or a family friend who happens to be a doctor? Anyway the statement is: “You need a diet plan, so we created one for you, so you can be a better role model.” Instructing a parent to follow a diet plan limits their individual freedom, posing a massive threat to their negative face. Rubbing salt in the wound, “so you can be a better role model” really implies that they currently are a terrible role model – very damaging to positive face.
Hopefully, diet plans have been discussed previously, so a doctor can lessen the face threat by hedging a little, or by admitting to their own humanity; something like, “I know we’ve discussed diet plans before; I gave it some more thought and I was wondering if maybe you’d like to give this one a try.” When the doctor/dietician/nutritionist hints like this at their own uncertainty of the patient/parent’s acceptance of their offer helps to give back some of the free will/sense of independence (an inherent negative face threat) that a patient loses simply by the power dynamic that is the doctor-patient interaction, I think.
On the topic of communicating to parents the long term effect of the food habits they influence in their children, doctors may find that face threatening acts are easy to miss in the doctor-patient interaction. A threat to positive face, a person’s self-esteem, might be a phrase like “How often do you eat fast food?” or “How often do the kids eat fast food?”
While it may seem that these questions are an improvement to “Do you allow your kids to eat junk food or fast food?” which forces a parent to confess that they allow such terrible foods… (Gosh, what a terrible parent! – This is especially damaging if the doctor’s non-verbals are also perceived as disapproving or negative), “how often” implies that fast food is already a part of the children’s diet. Perhaps a small substitution can make the uncomfortable question a little less threatening. “Do the kids get to enjoy fast food once in a while?” since “once in a while” is a very open-to-interpretation term, when the parent answers “yes” they’re already expecting a follow up into how often, making the “how often” question not so threatening to their view of themselves as an adequate parent.
– The negative face question we had come together with stated, “I have assigned a program for all of you to join to work on you communication skills.” This kind of comment would be very offensive towards doctors of future med. Students. To help develop a more supportive alteration you could say, “There are some great programs as a team we should join to help our communication skills with our patients, I have found a few and would really like everyone to think about participating.” By allowing the doctors to know you have their best interest in-mind this really helps form a connection, allowing you to connect with them. Also stating “team” helps makes everyone feel on board and a part of something, and no one wants to be a part of team activities, because everyone wants to feel connected. This will help the doctors and others see working together is what’s best for their job and their patients.
– The positive-face question developed between my group and I decided was, “You and the other doctors really need to work on your communication skills with your patients.” This comment would definitely be way too aggressive; in trying to make these individuals change their speaking skills and improve interactions with their patients. To help work on changing this comment to a more positive one and be a less aggressive message, I’d alter it by saying, “I think working to improve our speaking skills with our patients here at (blank) hospital, and would be a great idea to help better our connection with our patients.” Stating a comment such as this allows the point to get out there and communication should be worked on by everyone to help our patience to the best of their ability.
-The positive-face question developed between my group and I decided was, “You and the other doctors really need to work on your communication skills with your patients.” This comment would definitely be way too aggressive; in trying to make these individuals change their speaking skills and improve interactions with their patients. To help work on changing this comment to a more positive one and be a less aggressive message, I’d alter it by saying, “I think working to improve our speaking skills with our patients here at (blank) hospital, and would be a great idea to help better our connection with our patients.” Stating a comment such as this allows the point to get out there and communication should be worked on by everyone to help our patience to the best of their ability.
A negative face-threatening comment to doctors would be a hosptial administrator saying: “I’m going to enroll all physicians in classes on how to be more respectful to nurses.” This is a threatening statement because it’s placing the blame of this commnication barrier on the physicians and targeting them specifically without considering the view of the physicians. Another statement that would soften the request would be: “I you guys (doctors and nurses) sometimes disagree with each other. We would like to invite you to a class to assist in the understanding of both sides of the education difference and bridging the communication gap so to improve the quality of patient care and also improve the working conditions between you guys.”
My topic involves the communication issues that occurs between physicians and nurses the intensive care unit. These issues arise mainly due to the differences in education that can lead to communication barriers and threaten the lives of the patients. A question that would threaten positive face for nurses would be: “Is your medical advice less important than doctors’? This threatens positive face because nurses see themselves as equal in thinking capacity as doctors, yet the common misconception is that they are less intellegent than doctors.
An action that posed a threat to negative face was a doctor saying “I asked someone to come talk to you about medical coverage programs” without the patient’s previous request or approval.
There are better ways to address this type of situation in order to uphold negative face. If a patient has disclosed that they are struggling to pay their bills or in the case that a doctor suspects that a patient is struggling, then the doctor should say “If you’re nervous about affording today’s visit, then there are some helpful options we can discuss. I think you would really benefit from this particular assistance program.”
My original topic considered communicating with disadvantaged populations about health. One inherent topic that arises in health care is insurance coverage, or in many cases, the lack thereof. Unfortunately, many people cannot afford their health care, and conversations turn to how one will pay for their services.
My original question that posed a threat to positive face was: “Can you afford today’s visit?”
A better way to ask that question would be: “So I was wondering if you have health insurance to help cover today’s visit?”