Talking About Health; Why Health Communication Matters

What is a conscience clause and how does it affect health communication?

January 14, 2012

Do you remember the first time that you heard the word ‘conscience’? I grew up in a household where my parents used the word and shaped my ‘conscience’ — my sense of right and wrong. And as an adult, I feel the twangs of my conscience guiding my decisions. I would hate to have a job where someone told me that I could not follow my conscience. It is hard enough to work in a job where and live in a world where not everyone shares my ‘conscience’. But at least I am able to behave based on my moral code, even if it doesn’t always reward me to do so.

Health care providers face challenges to their ability to act based on their conscience in some situations. Efforts have been made to adopt policies to allow health care providers to act based on their conscience. These ‘conscience clauses’ aim to allow doctors and pharmacists and other health care providers to choose not to provide some services because to provide the service would go against their conscience. Watch this video and we’ll talk more about this issue in the coming week.

I guess it’s time to get a new dentist…

October 27, 2011

I don’t have good luck with dentists. I do my best to get recommendations. Things go along OK for awhile. Then I start getting advised to do things that don’t make sense to me. I ask questions. But I don’t get satisfactory answers.

My current dentist knows that I came to him several years ago. Not because I was just moving to the area. But I wasn’t feeling good about how talk with my former dentist was going. So, this dentist seemed great for awhile. But last year, he recommended that I get a crown in a tooth where it seemed to me that we should start with a filling. I should have gotten a second opinion because instead, I put off doing anything, built up resentment that the dentist couldn’t explain why a crown was needed. “It will just be better in the long run” doesn’t tell me anything. I guess we could just put crowns on all my teeth and it would be better in the long run if what that means is that my natural teeth wouldn’t be wearing anymore.

OK, I should’ve gotten a second opinion last year. I didn’t. I have all the same excuses everyone has. I didn’t have time. I didn’t want to offend my current dentist. I didn’t know how to go about finding another dentist and asking for a second opinion. Yikes.

Well, this week I had my first scheduled cleaning since the crown. The technician asked me how it was going and I told her that it hurt to chew a steak on that side where the crown is… “I don’t eat much red maet,” I said, “But when I do, it hurts.”

She said, “That’s nornal. It’s new.” I should’ve known right then that things were not gonna go my way. She took exactly 12 minutes to clean my teeth and then went for the dentist. He took 15 minutes to appear. When he appeared, the technician said, “He’s Mr. Funny man today.”

He took a look and a poke and announced, or mumbled I should say, something to the technician. She said, “So you want to do the four now?” Four what, I wondered.

“Let’s do all six.” Six what, I panicked.

“Six what?” I asked.

“Fillings.”

“What?!” Mind you, I had been to the dentist six months ago. I didn’t have any new x-rays done at the current appointment. What was different today from six months ago?

“Well, you have some wear in the enamel on the top of some of your teeth. The dentin is about to be exposed in some places. I just want to prevent that.” I guess I looked skeptical as he said, “I can show you.” He handed me a mirror. I opened my mouth. He pointed to one of my incisors. “See?” I looked and, yes, I could see a dip in the enamel. Nearly six decades of living might do that, don’t you think? That’s a lot of chewing and, well, grinding my teeth–a bad habit of mine. I must have looked skeptical still as he said, “I could show you the others, but you might have to stand on your head to see them.”

“I see what you mean,” I said to the technician. “He really he is a ‘funny man’ today. What are you going to do? Why?”

“I will just put a bit of filling in there to protect the tooth. It won’t take much drilling at all. But I’ll still numb you up real good.”

I checked out. Literally and figuratively. I didn’t ask any more questions. But I didn’t make the appointment for the fillings. I have been looking and can find no research or recommendations relating to taking this action. I do find some discussions that lead me to believe that the dentist will have to etch my tooth to make the filling stick–my lay term. And that it is the first step toward the filling not sticking and then needing–a crown.

I would love to be wrong about this. I want to trust the health care professionals I pay for my care. But I need them to explain why their recommendations make sense and to respect my decisions about actions labeled ‘preventive’ care. I don’t feel either of these exists in this situation. And so, I guess it’s time to get a new dentist.

Inquiring minds want to know–floss before or after brushing?

October 10,2011

Well, conversation at conferences can turn from the serious to the mundane but arguably serious. “Do you floss before or after you brush?” was the question at a recent conference. My answer: brush, floss, and brush again. Why? Who wants to brush before — yuck! But alas the American Dental Association provides a reason for flossing before brushing http://www.ada.org/1318.aspx.

In short, flossing gets the ‘yuck’ out so the fluoride in your toothpaste can reach your gums and promote health by reducing gingivitis. OK. Now you know.

Why didn’t my dentist ever tell me that? I suspect that dentists are happy if we floss at all…any time.

Would you like to have a copy of the book, ‘Moral problems in medicine’, edited by Samuel Gorovitz and colleagues?

October 7, 2011

It happens. My library at home and in the office spills over onto the floor in my office. The floors at home. In the library. And the bedroom. There is the chair beside the TV. Oh and the table in the library. There is the tactic of placing a few books here and a few books there. All in the name of ‘decorating’ with books. But it reaches a critical mass and is just…too much. So I have selected some to part with. Before just dumping them into the local book drive box, I thought I would give you a chance to say that you would like to have this book. I will tell you a bit about it and how to have it [book jacket in tact and all] for your own.

First, let me just say that Penn State has approved a dual title degree program in bioethics, with Communication Arts & Sciences being one of the departments within which a student might elect to pursue this degree http://live.psu.edu/story/54735. I have always been fascinated and engrossed in debates about health, health care, and ethics. Not the least of these is the continuous discussion about whether access to health care paid for by insurance ’causes’ individuals to use more care–the moral hazard linked to insurance. It is because of my interest in this area that I’ve read hundreds [yes, ’tis true] of books dealing with the topic on all kinds of levels in all kinds of nations. And I own a lot of books on this subject–broadly speaking. Which brings me to this book.

Regarding the book itself, it is listed in this bibliography: http://www.qcc.cuny.edu/SocialSciences/ppecorino/SS640/bibliography.html regarding “General works in medical and bioethics.”

The book was reviewed positively in the Journal of the American Medical Association shortly after publication. http://jama.ama-assn.org/content/236/25/2906.1.short Notably, the reviewer comments on the fact that the book does not limit the topic to any one field but provides varied views from contributors in a number of fields. At any rate, if the topic interests you and you want this book, tell me so in the comment section. I will select someone to receive the book and go out of the blog to get your mailing information via email. Then the book will soon be traveling your way…

What interesting bit of information did I learn on the Rachael Ray show?

September 8, 2011

Imagine my surprise when I was listening to Rachael Ray’s cooking show and one of the guests was a female doctor who talked about a number of important health issues and took some questions from audience members. I was surprised that this guest was on a cooking show. But then I was surprised by some of the information she discussed.

Along the way, she told the audience that they should refrain from sexual intercourse for 24 hours before having a pap smear to screen for cervical cancer. The reason for doing so is to increase the accuracy of the test results. I always receive written guidelines about preparing for my annual mammogram, including such things as not to wear deodorant or powder or lotion. But I have never received any guidelines about preparing for a pap smear. Not on an appointment reminder card. Not face-to-face with the person checking me in. Not from my doctor. Not in passing in conversation with other women.

I wonder how many dollars we would save if women knew to avoid sexual intercourse for 24 [the recommendation in the attached summary says 48] hours before an appointment for a pap smear and followed this advice. Apparently, sometimes the test result will show something that seems to be a problem but isn’t because a woman has had sexual intercourse.

I looked online and found some guidelines at http://womenshealth.about.com/cs/papsmears/ht/preparepapsmear.htm. I guess I will make it a goal to check whether there are things I should do to prepare for screening tests I have from now on. I suspect if you are like me, getting these things done on the prescribed timetable is hard enough. Too easy to procrastinate. I sure don’t want to have to them again just because I wasn’t prepared properly the first time.

I’m No Martha Stewart… So Why Do I Like to Garden So Much…?

5 minutes of gardening improves mood… that’s something worth talking about.

August 6, 2011

I grew up in the Korean War era as the daughter of an enlisted Air Force father, with both my parents’ families living in Michigan. And both had gardens. [here’s a site with some great garden blogs… http://www.invesp.com/blog-rank/Gardening ]

My father’s parents lived in town and when you stepped outside the back door and turned left, you came to Grandpa’s garden… Row upon row of carefully tended fresh produce…including tomatoes that Grandpa picked and offered with a sprinkle of salt and a smile… We would both bite into our red ball and let the juice run off our chins…grinning at one another. Then he would pick tiny little cucumbers and we would repeat the same ritual… salt, bite, less juice…big grin.

My mother’s parents lived on a farm. The barn. The hay wagon. The cows that got milked…

Flowers and flower bushes growing along the house, along the field, and in clumps dotting the mowed lawn. All things that fed into my ideas about gardens.

So it is the time of year when I am picking cucumbers from my own garden. I have harvested some tomatoes with more to come. And I have been enjoying flowers all summer long…

And I am catching up on some reading.

Prevention magazine in June 2011 had a headline: ‘JUST 5 MINUTES of gardening improves both self-esteem and mood [p. 19]. I read further and learned that an article published in “Environmental Science & Technology” reported these results. I wanted to know more… this turned out to be harder than I expected.

I went to the journal site…punched in gardening effects on mood, since Prevention magazine did not name researchers or an exact issue in which the research appeared. This kind of source-layering has been discussed here before… I was surprised and a little annoyed that I couldn’t find the study being reported so I could consider the evidence leading to the magazine’s conclusion. I read it in Prevention magazine which might be good promotion for them… or not — depending on whether a reader is willing to just take the magazine’s word about what the research concludes and how such conclusions were reached. It did get my attention but led to me asking: based on what?

After some time and leaving the journal site to just search Google more broadly, I found another article reporting about the research: http://pubs.acs.org/doi/pdf/10.1021/es101129n. It appeared May 15, 2010 in the journal on p. 3649 and was written by Robin Meha. She summarizes the research that Jules Pretty and Jo Barton did leading to the conclusion that just five minutes… FIVE MINUTES of gardening improves mood… http://www.ncbi.nlm.nih.gov/pubmed/20337470 .

And that is why I like to garden so much….

How do we communicate about responsibility and health?

July 18, 2011

I have been basking in the summer heat… catching up on some research and and reflection, and most importantly–my family. July is the month that my granddaughter, Grace, visits… and we have been reading the American Girl book that introduces Kaya…an American Indian. And that is what made me think of today’s topic.

Chapter 2 of the book introducing Kaya, the title is ‘Switchings’, Kaya and all of the youngsters old enough to share in the responsibility for Kaya’s mistake [leaving her twin brothers when she was responsible for watching them] gets a ‘switching’ — that is, she must lay face down on the ground along with all of her peers and pull her clothing up on her legs to her knees. Then the ‘Whipwoman’–elected by the tribe to administer switchings to the youth–takes twigs from a tree and gives the children lashes. The message is that what one of them does affects all of them… So, the bad behavior of one gets all of them into trouble….

Grace is 7 years old… I asked her what she thought about everyone getting a switching because Kaya had done something wrong. She said that it was fair because Kaya went off with two boys to ride horses when she should’ve been watching her brothers. So, she said, those boys should be punished, too. What about the others, I asked What about some of the kids who were punished who were nowhere near the other three kids? It seems fair…what we do does affect everyone, and everyone should support us in doing the right thing…

Interesting. I considered that I might use this book in my health communication classes this year to capture the many meanings of responsibility and health. Personal responsibility, as illustrated here, has more meaning than just what and how our behaviors affect our own health… It affects others, including the nation’s health care costs. But it is impossible to be responsible when all around us are people and ways temptinig us to forget about what we know we should do. And when there seems to be no support on the other end–no one and no ways to achieve the right things… ‘Switchings’…it is a good metaphor for what we are doing to ourselves as a nation when it comes to health and health care…

…only 54,000 new jobs in the U.S. for May 2011… what’s wrong with this picture?

June 4, 2011

As a college professor, I get to bask in the reflected glory of graduating seniors each semester…especially every May. Until the past couple of years. Especially this year. This year, I hear the same story from students whether they were graduating with experience or not, an engineering degree or communication, and high grade point averages or just average. No jobs.

I feel their pain. I see it in their daily classroom attitudes. ‘Once upon a time’ is how they hear the refrain ‘go to college, study hard, and you’ll get a good job’… Maybe in the old days they say…

This in the same period of time as Oprah retiring and telling us all to live our best life… ‘Our best life?’ asks students whose parents sacrificed for them to go to college and may themselves be faced with unemployment or forced early retirements. How shall we define that life?

Of course, when there are no jobs, there is no health care insurance. When there are no jobs, there tends to be less healthy eating, as fresh foods cost more and fattening high calorie foods are…cheaper and often comforting in the face of disappointment. Higher rates of depression… So physical and mental health suffer.

And then last night I watched the ABC show, ‘Shark Tank’…wow! Inspirational, motivating… The person seeking money for his idea had invented a filter paper in the form of a “nose contact”–not his words exactly, but mine to help you visualize what it looked like if you don’t have time to go to the show’s online site and watch an excerpt. He did say that to insert the filter paper into your nose, you place it on your finger like putting in a contact…which seemed to be understood by all of the ‘sharks’–the panel with money to invest if they see profit potential in an idea.

At any rate, the paper is designed to filter out viruses and air pollutants. The person seeking money for his idea had a signed contract with another country for 8 million dollars and needed 500 thousand to produce enough product to fill the order. Well, to make a great story short, most of the panel wanted in… One even offered to buy the company for 4 million dollars and give the inventor a royalty. As discussion unfolded, two of the sharks teamed up with an offer, another shark made a separate offer, and then–they asked for a time-out and the contestant left the room. The latter three teamed up with a combined offer.

In the end, the contestant accepted it and did not sell his company. He now has 750 thousand in cash and three partners in his company…three partners with proven success in bringing innovations to huge distributions. This is an idea that is smart, solves a problem that is much bigger in many parts of the world than it is currently in the U.S., requires manufacturing–i.e. jobs…

Perhaps this is a path of living our best life in the 21st century…solving persistent problems with simple solutions.

I am going to keep a diary of the ‘problems’ or ‘challenges’ I face each day this coming week for which I have no solution but have experienced before. I will add to it notes about my own observation of media reports that suggest others’ problems. I will listen for insights about these matters in conversations.

Perhaps you would join me in this venture. Let me know what you come up with and let’s get a conversation going about these matters…

How do you communicate to children about cancer?

April 5, 2011 GUEST BLOG POST by Joey Debernardis

Since cancer has such a huge impact on many people’s lives, I thought it would be a very important topic to talk about. More specifically, the study below considered how to talk to children about cancer. This specific study was done at ‘Three Principal Cancer Treatment’ in the United Kingdom.

The study was based of 38 participants at different levels of their cancer journey. The groups broke down as follows: young children (4-5 years), older children (6-12years), and young people (13-19 years).

Some of the results that were found were quite interesting. As a young child, the cancer patients were not able to voice their preferences. They just did not have the ability to do so. Children also worried about the permanence of symptoms. Older children were unhappy about their parents leading communications with the health professionals.

The children aged 4-12 years reside in the background of information sharing with health professionals until they gain autonomy as the young people (roughly 13 years). They then moved in a foreground, and their parents transition into a supportive background role. In this way, younger children begin to realize their abilities to voice their preferences. Parents and the professionals, in turn, can learn to develop their supportive background roles…

Gibson. F. (2010). Children and young people’s experiences of cancer care: a qualitative research study using participatory methods. Pubmed. http://www.ncbi.nlm.nih.gov/pubmed/20430388

How can we really understand informed consent?

April 3, 2011 GUEST BLOG POST by Aimee Hilton

You are told you have a left clavicle contusion and your face just screams “What?” You go home to research and find you simply have a bruised collarbone, i.e your shoulder is going to hurt for a little while. Doctors may forget that they spent eight plus years in education learning the medical jargon that most of their patients do not understand. So when the patient has an important decision on the line, like whether or not to participate in a clinical trial based on their illness, how do we organize the information to make an informed decision? When we can’t understand words like randomization and placebo, how can we really understand the informed consent?

A study performed by Jefford et al. (2009), looked at how well patients understood the clinical trial they recently enrolled in. 102 patients who signed up for a clinical trial concerning cancer within the last two weeks participated in the research. The most important results showed that doctors needed to ask specific questions pertaining to the patient’s understanding of the trial, instead of simply “Do you understand”. Using a method known as “the teach back method” allows the patient to understand and develop questions. As a patient, if making a decision about a clinical trial, be sure to restate the clinical trial process and informed consent to your doctor. It will make sure you understand and they know you understand.

Patients should also receive written information and a recording of the conversation discussing the clinical trial. This allows the patient to go back and look over any information they found confusing or did not comprehend. Doctors also should be sure to discuss the standard treatment and other possible treatments in the trial. Patients should be aware of all options and possibilities throughout the trial.

It may seem that clinical trial information is overwhelming. However, if the doctor presents the information in an organized process, the patient will be more likely to understand and receive enough information to understand the informed consent they need to sign. Clinical trials are very important for the advancement of science and treatments. If doctors can help patients have a better understanding of the trial, hopefully more patients will be willing to participate.

Jefford, M. Mileshkin, L. Matthews J. et al. Satisfaction with the decision to participate in cancer clinical trials is high, but understanding is a problem. (2009) Support Care Cancer, 19, 371-379.