Talking About Health; Why Health Communication Matters

Wind turbines and tornadoes in Oklahoma–the precautionary principle

June 3, 2013

In risk communication, an overarching guiding framework is called the precautionary principle. If an activity appears likely to cause harm to humans and/or the environment, even in the absence of evidence to prove it, the decision should be to err on the side of precaution and avoid even the possibility of likely harm I guess no one was thinking about that when theydecided to put wind turbines close enough to a school that one of the blades could fall off and land on the school. See the story here–listen for a bit to get to the wind turbine event: http://abcnews.go.com/WNT/video/deadly-tornadoes-strike-oklahoma-19306599

If there is a place where wind blows enough to generate energy from wind turbines, perhaps it is tornado alley. I don’t know. I haven’t reviewed those stats. But several things are certain. Wind turbines are huge. They come in different sizes but on average, 3 blades weigh about 40 tons, so one blade weighs 13 plus tons–26,000 and some pounds. Yikes.

Wind turbines are manmade. They have a lifespan. Even in the best situation, a blade will come off eventually. So why on earth would someone place a turbine near enough to a school that a falling blade could land on it. Were they counting on children being out of school at the time? It is this type of risk decision-making that requires some precaution.

The Affordable Care Act and part time employment

June 1, 2013

…thanks to Darci Slaten for this picture…

One of the most gifted undergraduate students I’ve had in a Penn State health communication classroom is crossing her fingers that she will get a job she has interviewed for. I am hopeful for her as well. An odd thing about the job is that it is for less than 30 hours a week. I also have a nephew who recently started a new job at a sandwich shop. He loves the work. And he too is being employed for less than 30 hours a week. Neither was looking for part time work. And it does make me wonder. Could it be the Affordable Care Act’s rule that companies with 50 or more employees be required to provide health insurance to employees–except if they work less than 30 hours a week.

I don’t know the answer to this question. I haven’t talked to my nephew’s employer and the question doesn’t fit into a conversation as a reference for a former student. I do wonder about risk data relating to part time employees and projecting the cost for health care.

State laws covering workmen compensation do cover part time employees. If my nephew is hurt on the job–let’s say, for example, cuts off the tip of his finger with a meat slicer or gets a hand caught under a heavy bread tray and breaks a finger–workmen’s compensation will require his employer to pay the medical costs related to the accident and cover wages for the time he cannot work. So, that is a relief. But what it won’t cover is time off or care for the flu or a bad cold.

Looking at the issue from a public health and public good perspective: Do we unintentionally incentivize ill workers to come to work when we adopt policies that won’t cover their care or give sick leave benefits? Do we pose other risks to the public besides exposure to ill workers when we move toward part time employment, risks associated with the experience one gains from being on a job full time, for example?

Face-saving and health communication

March 28, 2013

One of the topics discussed in my book, ‘Talking about health,’ is face-saving. One of the best explanations for why patients do not give or seek information during medical appointments is that they are managing their own and their doctors’ impressions. ‘I don’t understand’ is a hard statement to make. ‘I don’t even know that I don’t understand’ — even harder to express. In the face of questions from our doctors, such as, ‘have you been following your diet?’ or ‘when did this rash first appear?’–we may tell the truth but not exactly the whole truth.

For example, I am very susceptible to poison ivy. I blame myself when I get an outbreak because how many times can I study what poison ivy looks like in order to avoid it in the woods on my walks. Still, I manage far too often to brush up against the stuff and then the effects are just plain awful for me. I try to avoid going to the doctor with it until it is in such full blown raging bloom and typically covering more rather than less of my body. Why do I do this when I know the doctor will be likely to give me a prescription to ease the itching blistering experience? Because I feel stupid and embarrassed to have–as I think of it–done it to myself again.

Besides impression management, we also have the desire to ‘do what we want to do’ without others interfering with it. We intuitively know the kinds of information not to give in order to avoid being told not to do something.

In the face of a direct question, such as ‘how much alcohol do you consume each week?’, both managing our impression and wanting to do what we want to do may lead us to be less than completely truthful. A doctor may hedge a bit on such a question by saying, “One alcoholic beverage a day for women has been found to have some health benefits, while binge drinking of four or more alcoholic beverages a day does more harm than good.” In such a statement, I could get a sense of a range of behaviors related to drinking and some of their possible outcomes. If I want to ask for more information about ‘harm’ or ‘benefits’–the door has been opened. If a doctor wants to know how much alcohol a patient is drinking, it is likely in order to decide whether to caution a patient to limit their intake. So the message can be embedded without the more direct and likely face-threatening interaction unfolding. This may help to build positive rapport between a doctor and patient, closing some of the social distance between the two, and opening a space for a patient’s more sensitive disclosures.

So back to that question, ‘when did the rash first appear?’ — does it really matter because it’s here now and raging. Well, yes, it might make a difference when it appeared and help with an accurate diagnosis. So rather than feeling stupid in the face of such a direct question, it is important for us to remember that doctors ask questions to help make diagnoses rather than to embarrass us. But doctors could remind us of that and say something like, ‘In order to have a better idea what this might be, it would help to know when the rash first appeared.’

The federal sequester and health communication

February 28, 2013

Little else dominates the news right now besides the sequester. I have to wonder if anyone has calculated the costs associated with calcuating the costs of cuts linked to the sequester. Here is just one example: http://astho.org/Advocacy/Sequestration-Fact-Page/ The Association of State and Territorial Health Officials has taken the time from their already overloaded and underfunded docket to explain the effects of the impending cuts as envisioned. The picture is not pretty.

Besides the lost dollars and lost work hours, the lost productivity across all kinds of spheres associated with this ‘event’ relates to emotional tolls and the anxiety within families created by such uncertainty. These events turn into physical and mental health problems, including diseases associated with stress and depression. Interpersonal violence increases in personal and social relationships.

I hardly know what to say. From an ethical perspective, the dilemma linked to distorting and manipulating information for so long leaves so many with feelings of distrust. I like a good debate probably even more so than the average citizen, but the time is long past for beating the drums of authority and power, and instead to lead by example.

Clean Your Hands Campaign

February 19, 2013

The World Health Organization — WHO — has long promoted hand-washing as an important way to reduce the risk of spreading infections. While we all can reduce the risk by washing our hands, we may also assume that healthcare workers would be among the people most likely to practice hand-washing. Apparently not. A study designed to increase hand-washing among healthcare works cites evidence that compliance with the practice is just 25-40%. The article appears online in PLOS ONE [ a publication of PLOS [ http://www.plos.org/] an organization designed to make peer-reviewed medical research accessible in less time and with less cost than more traditional approaches to publishing scientific results. The research led by Chrsitopher Fuller, “The Feedback Intervention Trial (FIT) — Improving Hand-Hygiene Compliance in UK Healthcare Workers A stepped Wedge Cluster Randomised Trial”, conducted the study in 60 locations that included 16 acute hospitals and 44 general medical wards or acute elderly care sites. All sites were already participating in the “Clean Your Hands” campaign. This campaign includes placing alcohol hand-rub at patient bedsides, using posters and other educational materials to encourage workers to clean their hands. an audit and feedback on compliance was cinluded at least once every six months, so workers knew that the behavior is expected and would be evaluated. The FIT focused on goal-setting for and rewarding of handwashing behavior as an additional compoment to the national campaign.

A significant increase in hand-washing occurred with the FIT, with more change in the 16 intensive therapy units than in the other sites — achieving 13-18% change versus 10-13% change, ranging about 60% to nearly 80% compliance. The improvement declined over time. There were difficulties associated with implementing the protocol, including that the trial place extra responsibilities on some ward staff, who did not receive additional training beyond the initial introduction to the intervention and were not monitored after the initial observation of their placement of materials bedside. To increase the likelihood that such a campaign would be successful over time, the authors recommend that the tasks be integrated into the role of some employees and audited regularly as part of job performance. As for me, I will be watching to be sure healthcare workers wash their hands. And I will do the same.

Taking Healthcare Into Your Own Hands Guest Post by Bill Paquin

January 24, 2013

Debates about the federal health care overhaul aside, one truth has emerged from the recent national discussion about the health care and insurance industries. In the end, we are all responsible for our own individual health.

Now, that sounds obvious, but it’s not necessarily how we’ve lived for half-a-century, in a world where many peoples’ employers covered whatever malady might strike them. Without the financial stress of paying ‘a la carte’ for anything from stitches to a coronary stent, there was less pressure on the individual to take preventative action to protect their health. When an issue arose, you went to the doctor, and that was that.

With far fewer employers offering comprehensive health care, and those that are moving to high deductible plans that put the burden of paying for small accidents and illnesses back on the individual, personal health care has become much like other commodities, where shoppers find the best price and only purchase what they need.

Whether you’re self-employed or a full time employee living with a high deductible plan as your sole coverage, remember these guidelines to help you navigate the ever-changing system:

Get in Shape

If wanting to look and feel your best never motivated you to eat the right foods and exercise, perhaps saving big money at the doctor will. Obesity accounts for more health maladies than any other condition, from type II diabetes to heart problems. By keeping your weight in check, you’ll need fewer trips to the doctor. When you’re feeling great, your wallet will thank you.

Read the Fine Print of Your Insurance Plan

Every insurance plan is different, and finding out that a test or doctor’s visit isn’t covered after you’ve already gone can be an unexpected roadblock in our budget. Read your plan, understand the terminology, and ask questions about cumulative costs of any tests and procedures before agreeing to them. Of course, don’t forgo necessary care, but do seek out the best options and decide ahead of time, if possible, if you plan to reach your deductible or not.

Ask Questions About Cost

It’s somewhat engrained in our culture to follow ‘doctor’s orders.’ But if the doctor suggests a further test or procedure, don’t hesitate to ask about the costs. Oftentimes there may be an alternative that better fits your budget. [or the constraints of your insurance]

Use In-Network Doctors

Insurance providers typically have a network of ‘preferred’ providers, and finding a doctor within this list can mean significant savings. Also remember that you never have to stick with the first doctor you find — search around until you find a provider you relate to and trust. And if you’re starting from scratch, your provider’s network list is a good place to begin your search.

Keep Track of Your Health Expenditures

Although tax write-off eligibility for health care expenses may be slightly altered in 2013 at the national level, you’re still likely entitled to a tax break if you have significant health-related costs in your budget. Save every receipt and keep track of any expense that’s health related to report on your tax forms.

Start a Health Savings Account

People with a high-deductible health insurance plan are eligible to begin an HSA, which lets account holders deposit pre-tax dollars into a fund specifically for their own health care. This money can be used for doctor’s visits and procedures and count against your deductible, but can be written off of income taxes. Best of all, an HSA means you’ll already have money set aside when an emergency arises.

Research What Ails You

In the past, doctors have advised patients not to trust what they read online. Fortunately, reputable providers like the Mayo Clinic now offer comprehensive, accurate information about health issues and diseases on the internet. Understanding your symptoms and diagnoses is integral to making smart financial decisions about your own health care.

Choose Generic Medications

Doctors may prescribe a name brand medication . Most doctors, however, will be responsive to your inquiries about less expensive, generic alternatives. Of course, ensure that the drug you are prescribed is safe and effective, but oftentimes a generic medication may be exactly the same as the well-known name brand manufacturer.

When it comes to paying for care, individuals are more responsible than ever for their own health. Remember, the buck ultimately stops with you.

About the Author

As the CEO of Vertical Health, patient care advocate http://www.billpaquin.com Bill Paquin works to convey accurate health information to consumers. He operates web sites including http://www.diabeticlifestyle.com, http://www.endocrineweb.com and other sites focused on improving patient care associated with endocrine disorders. Bill is a husband and father, and writes about improving patient care in our healthcare system.

Health Communication, Health Literacy, and the Affordable Care Act

November 8, 2012

If you are like me, you imagine a time when you will be less ‘scheduled’. This has been a time of being over-scheduled in the past half dozen weeks. I have a pile of topics I want to discuss relating to communicating about health. And too little time to do so.

One of the topics that keeps coming through my piles relates to an article written by Stephen A. Sommers and Roopa Mahadevan that was commissioned by The Institute of Medicine–IOM–and published in October 2010. I came across it when preparing to talk about health literacy and health communication with my undergraduates last year. It has been shuffling about on my desk since then. Today is finally the day I will share my thoughts about it.

First, the relationship between health literacy and health communication that I discuss with my undergraduates in a ‘designing health messages’ course is two-fold. On the one hand, low levels of health literacy, meaning the audience is unlikely to understand many health and science terms or be able to use math and statistics to make decisions–suggests that health communicators, whether they are public health program planners or medical doctors, should adapt their communication so that it will be understood, and informed decisions can be made based on an accurate understanding. A great deal of health communication message design research and practices focuses on this effort, working to assure that knowledge gaps do not become wider between more and less educated audiences, for example.

The second issue related to health communication and health literacy relates to efforts to improve health literacy. In other words, how could we communicate to motivate someone with low levels of health literacy to become excited about learning more vocabulary and applying more statistics in making choices about health?

Addressing both health literacy issues in health communication is the ethical thing to do. Knowing that someone does not understand health vocabularies or may be embarrased to ask questions when they do not understand places a responsibility on the health communicator to adapt. Knowing that high levels of health illiteracy uniformly exist in the U.S. suggests that health communicators ought to be involved with improving the situation across the many contexts for talking about health.

Stephen A. Sommers and Roopa Mahadevan open their paper with the statement that the Affordable Health Care Act does not address low health literacy directly. BUT–they assert–the law cannot be successful unless national efforts strive to address low health literacy. Health literacy is mentioned in the ACA in relation to research dissemination, shared decision-making, medication labelings, and workforce development. “All four suggest the need to communicate effectively with consumers, patients, and communities in order to improve the access to and quality of health care” (p. 6).

So there we have it. If we are to achieve the aims associated with the ACA, including improving the population’s health and bringing health care costs under control, we will only achieve these aims through communication that adapts to and accommodates low levels of health literacy while motivating citizens to improve their health literacy.

Health communication and IOM paper findings about how to discuss medical evidence

September 26, 2012

I have talked often about the importance of evidence to guide our informed decisions about health. A new paper from the Institute of Medicine discusses how to talk about medical evidence [see http://www.iom.edu/Global/Perspectives/2012/~/media/Files/Perspectives-Files/2012/Discussion-Papers/VSRT-Evidence.pdf].

One of the interesting issues considered addresses ways that language relates to patient confidence about evidence and health care. 1,068 US adults were surveyed to answer this question: 71% were White, 48% male, 46% 55 years of age and older, 55% rated themselves as in ‘very good’ or ‘excellent’ health, 62% were not living with any chronic condition, 88% had health insurance, and 36% usually or always bring a list of questions with them to ask their doctors.

The summary of findings is in Table 1. ‘What is proven to work best’ was found to be the phrase leading to the greatest level of confidence, 79%–in the evidence used for their health care.

I wonder, given that so many come prepared to ask questions, if the participants would ask any questions about the evidence. Things like ‘is the evidence based on someone my age, my biological sex, or my race/ethcnity?’

I wonder, too, about the levels of education for this group. IOM has convened panels to write reports about health illiteracy in this nation. What does ‘evidence’ mean to the large percentage of adults in the US who are health illiterate? What does ‘evidence’ mean to this group of mostly white, mostly insured, and very healthy personal advocates [they ask a lot of questions on their own behalf] participants?

Hopefully, the responses do not become scripts for medical interview education.

The paper also makes ‘evident’ that US health consumers want their personal goals to take a priority in conversations about their health with health professionals. So, we need to understand what goals the patient has about the ‘evidence’ being used to guide decisions. Is it their goal to understand more about what makes up medical evidence? If so, I am not ‘confident’ that this advances that aim.

Health communication online for supporting fitness–SparkPeople.com

September 21, 2012

Today is my daughter-in-law’s birthday. September is filled with birthdays in my family. And we celebrate them. Not so much with cake. More with talk and support. Reminding each other of all the good things from the past year and all that we have to look forward to in the year ahead. That support makes all the difference in the world for living a fulfilled life. That must be part of the idea behind SparkPeople.com. I read about the online site when I was going through a pile of old magazines this summer. I do that now and then, tearing out pages for items I want to follow-up on and throwing the rest of the magazine away or–if it is not too destroyed–donating it for others to read. At any rate, I read about SparkPeople being a site where members find support for reaching fitness goals. So today I visited the site.

My first impression in joining is that the site has a lot of capacity for customization. I could [tho I didn’t] create my own personal page. Even without creating the personal page, I entered some information in a very quick fashion and the screen rolled over to content relating to my interests. The site is filled with color and images and all kinds of links. There are communities to join, friendships to make [the site says], stories of success before and after joining.

I wonder how long members, on average, spend on the site and how many weeks, months, or years they remain active members. I noticed that the site has a lot of advertising support. As far as I have gone, that apparently supports the site so that it is free to subscribers. So far anyway. I do wonder if the site is doing so much for so many topics that it might prove to be less depth than some would want. I also wonder about the name and how people would find their way to the site if they didn’t read about it in a magazine. Perhaps others have experiences with the site and will let us know more.

Health communication about eating sugar and wrinkles

August 29, 2012

Another one of those incomplete messages came my way. I was reading again while waiting for a meeting. And the headline was ‘Face facts about sugar.’ There it was. A statement, with no link to the published medical research and no mention of a journal it was published in. The magazine is a 2012 one. But when I went to search for research related to the idea that “Consuming sweets can damage skin’s collagen”–the article’s claim–I found research that was published in 1998 and conducted on male rats [see http://jn.nutrition.org/content/128/9/1442.short]. OK, interesting. But it seems worthy of at least a descriptive study in humans. And worthy of including female humans. While we might not want to volunteer for a randomized clinical trial in which we get assigned to a group that eats, let’s say, the amount of sugar that is ‘average’ or eats no sugar at all, it seems like there may be some ‘natural’ study groups out there to observe and survey. Folks who simply don’t eat sugar or eat very little sugar. Let them provide photos of their faces, or some lab work relating to collagen levels. Compare the results to a group that eats more ‘normal’ levels of sugar. Factor in whether they are male or female, how old they are, and a few of the other correlates related to collagen–such as lifetime sun exposure [see, for example, http://www.ncbi.nlm.nih.gov/pubmed/8642084]. It would be interesting to ‘see’ if there are differences in the appearance and would give us some actual ‘human’ face facts.