Talking About Health; Why Health Communication Matters

What is race-based medicine?

Winter afternoon January 31, 2010

Medical research has shown that there are some patterns linked to racial group categorization in how some medicines work. Some medicine may metabolize faster or slower for some racial groups–in general. Lower does of some medicne may be required for treatment of members of some racial groups–in general. Similar patterns have been observed when comparing how men and women respond to some medications or therapies–in general.

What’s wrong with talking about race-based medicine?

First, stereotypes emerge from communicating about any group as if every member of the group behaves and responds in the same way to anything. Not everyone in the group will respond as suggested.

Second, it may seem to suggest that others who are not members of the racial group are less at risk for a condition. If we are a member of a different group, we may distance ourself from feeling at risk for the condition and socially distance ourselves from those who are at risk. This may happen because communicating the medical research that finds members of a particular group seem likely to respond in a particular way may seem to suggest that anyone not mentioned is not at risk. If, for example, efforts are made to commmunicate about a particular group’s response to treatment for heart disease becomes the focus of advertisements aimed at selling the treatment to members of the group, the unintended message may be, ‘They aren’t talking about me so I have less risk for heart disease.’ When communicating about therapies for men, for example, women may have long assumed that they were not a risk for heart disease, and that, of course is not true.

Third, communicating about race-based medicine may unintentionally contribute to the formation of stereotypes. As shorthand, classifying someone as a member of a group reduces our uncertainty about how we expect he or she will ‘be.’ As a result of such communication, we may, for example, form views that all members of a particular racial group are at risk for a particular health condition.

Finally, stereotypes of others and our own feelings of social distance from them often forms the foundation for stigma…our feelings of stigma about people and conditions, and our behavior toward those we consider to be members of a stigmatized group.

In sum, communicating about race-based medicine must be done with care to achieve valuable health outcomes and to limit harmful social outcomes.

Why don’t we ask doctors to clarify information when we don’t understand it?

January 15, 2010

I’ve done it. Have you? Walked out of the doctor’s office scratching your head, telling your waiting family member or friend, or running to the nearest computer to get online…and figure out what the doctor was talking about. Why don’t we just ask?

First, it is a bit embarrassing if the doctor says something and doesn’t ask us if we have any questions. It seems like we should know what is going on. So, we don’t ask because we feel embarrassed that we don’t understand. These days, I try to ask myself, “Do I literally want to ‘die’ from embarrassment?” If I don’t understand and I don’t ask a question, what are the chances I could…fail to follow advice, fail to understand my diagnosis, and well—harm my health…

Second, we have to admit to ourselves that we don’t quite understand what’s going on. Cholesterol called good cholesterol and bad cholesterol…what does that mean? Isn’t it all bad? If I at least ask the doctor to spell it or write it out, I find that most of the time, I get more information and I get it reinforced in writing.

…two ways to help myself out when I don’t understand……

What should I do if my doctor interrupts me when I am trying to explain why I am there?

January 14, 2010

Ahhh. A friend asked me this question recently. I’ve heard it from family members, too. And it has happened to me.

So, first, don’t take it personally. It feels hard not to because we use communication to regulate conversation, and we have learned cues that signal it is our turn, like the other person stops talking. When we haven’t stopped talking and someone interrupts us, it feels rude. We feel devalued. What? You don’t want to hear what I have to say??

Second, realize that time constrains a doctor. It is frustrating for us to wait in the waiting room. Then we wait in the exam room. Finally, the doctor appears. Then we seem to get about 10 minutes if we are lucky. Truth is that a doctor works for an organization. Even if it is the doctor’s organization or practice with a couple of others, it is an organization that has employees and must manage its resources–the doctor’s time in this case. A certain number of patients need to be seen to satisfy the organization. So the doctor really does not have the luxury to spend more time with you…unless an emergency necessitates it.

Third, ask yourself, are you telling a story as a way to tell the doctor why you are there? A story about how we were gardening all weekend and then we noticed a thorn seemed to be lodged in our finger and then we tried to get it out but it now seems to be infected even after we washed it really well and kept it covered in antibiotic ointment for the past several days… Or a story about how we have been doing a lot of traveling for our job and it all began with the downturn in the economy and so in the past month we have spent more days on the road than at home and suddenly, we’ve noticed a sharp pain at the back of our knee. Or the one about how between our job and our family–with a lot of details built in–there is just no time to exercise.

Fourth, if you are telling a story, stop. The reason you are there is: an infected finger, pain in the back of your leg, an annual check-up and help to lose weight. See how much more concise that is? Then if the doctor has questions, elaborate. But again, come to the point.

Fifth, be direct about what you want as well. If you haven’t read Deborah Tannen’s book, You Just Don’t Understand: Women and Men in Conversation, it’s worth reading. Some of the lessons to be learned apply to talking with our doctors. There is an example about saying, “the trash is full” in hopes that a spouse will know to empty it and feeling frustrated when the trash doesn’t get emptied. “Please empty the trash” is the more direct approach and more likely to lead to success. A story about how your friend has acne and her blemishes are not as bad as yours and her doctor prescribed such and such…still may not generate the doctor’s answer to your question, “Why aren’t you prescribing such and such?” In the age of internet searches for medical information, perhaps there is a list of things you think the doctor might do and none of them happens. So, ask about it in a straightforward way. No, you don’t need to tell about how you were googling the news and came upon a story about someone’s condition that sounded just like yours so you started paying more attention to your symptoms and it seemed like you should come and get checked out. Just say, “I have these symptoms and I wondered if such and such might help.” Doctors know we are using the internet to get medical information. It is no surprise to them. Sometimes, they are really happy about it. Other times, not so much.

It’s a start. See if it works.

Why should you talk about family history and health?

roxannebuggy January 12, 2010

The woman on the horse is a relative that I share a first name with…tho, of course, I never knew her. I wonder what else we might share. Hair color, height, health?

The U.S. Surgeon General advises us to ‘know our family health history.’ The problem is, what to know and how to know it. Since 2004, the Surgeon General has declared Thanksgiving to be National Family History Day [http://www.hhs.gov/familyhistory/] as part of an initiative to get us talking. While we do need to find a time to talk with our family about our health histories, few things seem more doomed to failure than pushing families to talk about poor health at a gathering aimed at celebrating.

First, older adults in our families have many interesting things to tell us about that go on in their lives besides poor health. Many have good health and no reason to focus on poor health. Many want to avoid the stereotype linked to old folks talking about their health and nothing else…even when they do have poor health.

Second, younger adults who need to know about their family health history need to know details that are unlikely to be discussed in such public settings, or if they are discussed, unlikely to be remembered.

Third, it is not particularly helpful to know that there is diabetes or heart disease or cancer in your family if you don’t also know who had the condition, at what age they had the condition, what treatment they used to address the condition, and with what success. Or, knowing what family members have died from should be accompanied by information about the age at time of death.

In this era when we have more awareness of how genes affect health and our reponses to medications and other therapies, we may want to know whether our family members have had any genetic tests. If they have, what ones led to positive results indicating the presence of a particular form of a gene?

Talking about family health history is important but can be difficult if we don’t make time and don’t know what to talk about….

New Year’s resolutions…

The beauty of winter January 4, 2010

Everyone is talking about them. Diet. Exercise. Smoking. Alcohol. Getting cleansed. Staying cleansed. If only we could figure out how to bottle all those good intentions and keep them next to too much work and too little time.

Where is ‘play’ on the list? That is what I love most about being with my grandchildren. They remind me that jumping rope and playing catch and swinging and wrestling shouldn’t be such work. They should be fun. And reading the comics in the daily paper…that’s fun, too. When was the last time your doctor asked you, “Are you having enough fun?”

Why does Dr. Oz talk about “gas”?

imgp0014 January 1, 2010

A couple of days ago, I was listening to the Dr. Oz show, and he talked with the audience about ‘gas.’ He described how much gas or flatulence is ‘normal’ and showed the audience a balloon filled with the amount of gas that any one of us on average has in a given day. Dr. Oz described some of the foods linked to forming flatulence. He did a great job of filling some of the void in our understanding about this topic.

But there is more to it than that as anyone who watched could tell from the giggles and embarrassed expressions on audience members’ faces. While we many now understand both that having gas is part of the human experience and that some foods cause more gas than others, we may be struggling with the fact that our doctor told us to start eating a diet that is higher in fiber and doing so has — you guessed it — caused us to have more gas than is normal for us and some discomfort or gas pains as well.

So now the problem is that we are not sure how to tell our doctor about the discomfort. It is after all embarrassing. So do we just give up trying to eat a diet that is higher in fiber? I hope not. A higher fiber diet has a lot of health benefits. So try increasing the fiber in your diet with a little less gusto… perhaps add 1-2 servings of fiber a day rather than 7, and keep track of how that makes you feel. Still a problem? Realize that your doctor may have advice to help with the gas, and no way of knowing you are having discomfort if you don’t disclose the experience. Tell your doctor what you have been eating and what you have experienced and that the gas is not normal for you and is causing discomfort. Normal is, after all, best judged by each one of us when it comes to our own health.