Talking About Health; Why Health Communication Matters

How does the bandwagon effect relate to selecting a physician for care?

August 14, 2013

Selecting a doctor is sometimes a difficult process. There may be several choices for our care. Doctors don’t generally advertise in the U.S., making it difficult to know what any doctor considers to be her or his best points for care. Education? Experience?

For most of us, one factor will be whether a doctor will be reimbursed by our health care insurance. But even after considering that constraint, we often have choices.

Online searches for information may help us sort out some of the characteristics of each person on our list. Input the physician’s name and you will be likely to find information about their education and experience. You often will also find comments from current or former patients. And you may even find rating systems, such as the use of one to five stars to rate the doctor–much like consumers rate products from cars to shoes.

Using the rating system as one piece of information to make a decision follows a long-established pattern of influence. The bandwagon effect acknowledges that what others think and do may help us make a decision about what to think or do. Those five stars give us a shortcut to having others tell us what they think and why. Sometimes, there are only two reviewers providing an assessment. Other times, there are hundreds and even more. If we see ourselves in some of their experiences, it just might save us some time and trouble.

What to drink on a hot day to get your antioxidants?

August 12, 2013

I love cold water to quench my thirst on a hot summer’s day. But I also like to get some antioxidants in my beverage. In the summer, when I am in the park or on the water, brewing my own tea is seldom an option. I wondered whether the bottled teas had much of the good antioxidant factor left in them and found a research article that revealed — probably not. It looks like if I want a beverage from the store to stick in my cooler or pick up along the way, it might be a good choice to have pomegranate or Concord grape juice over ice.

Here is the ranking of beverages in one research study that looked at their antioxidant content: http://pubs.acs.org/doi/abs/10.1021/jf073035s

Uncertainty, mammograms, and iodine–what do these things have in common?

August 10, 2013

As I looked at my grandson splashing about in the lake, I thought about the upcoming annual mammogram appointment. Last year, I had to go back for follow-up. That turned out to be an ultrasound and the ‘all clear’. More than ten years ago, I had a follow-up that required a needle biopsy but also worked its way to the ‘all clear’ signal. Because it had been so long ago, I wouldn’t say that I took my screening outcome for granted, but I didn’t feel uncertain about it the way that I did this year because of last year’s ‘call-back’.

I did a little research to settle my uncertainty while the days passed and I waited for my appointment. I searched for published science about what causes breast cysts. In one word, I came upon research linking iodine deficiency to breast cysts and a whole lot of other issues summarized by a physician in this Psychology Today article: http://www.psychologytoday.com/blog/complementary-medicine/201108/iodine-deficiency-old-epidemic-is-back

Here is an example of one of the published research studies related to iodine deficiency and breast cysts: http://link.springer.com/article/10.1023/A:1008925301459#page-1

I will be asking my primary care physician this week if I have iodine deficiency. In the meantime, while the technician took an additional x-ray picture at the screening, I did not get a call-back, and I did get a letter from the mammography site giving me the ‘all clear’ based on the screening.

It is interesting to ponder if this is a case of unintended consequences associated with communicating about the danger of consuming salt, which has been iodized to compensate for iodine deficiences noted in the 20th century.

Low vision and the Affordable Care Act [ACA]

July 11, 2013

I had my six month low vision doctor’s appointment this week. What is low vision? Well, it is impaired vision that cannot be corrected by eye glasses or surgery or medication, and interferes with daily living. I am not completely blind. But I cannot drive due to my impaired vision. I require some accommodations to assist me in my work. I hate stairs painted or carpeted all in one color. Movie theaters may as well be black holes.

I have been living with low vision since 2007. And it has been, excuse the pun, eye-opening. The tales I could now tell about disability and living with a disability, but that will be for another day. Today, I want to comment on ACA and low vision.

I asked my low vision doctor what ACA does for those with low vision. My doctor is fabulously upbeat. She said, “Well, it is a good news, bad news story. There are provisions for children’s eye care that we’ve never had before. On the other hand, there are NO provisions for assistance to people with low vision. According to the National Eye Institute at the National Institutes of Health, there are millions of people in the US living with low vision and about 135 million world wide [http://www.nei.nih.gov/lowvision/content/faq.asp]. That is a lot of people to ignore or put on the shelf, so to speak, because they cannot get assistance with work and daily living due to impaired vision. It seems that one of the biggest gaps in the ACA is outlining concrete strategies to address care for people living with disabilities. That is a very big oversight and one that has not perhaps gained the public’s attention as much as it should.

Thanks to coal miners for keeping the lights on … for all of us

July 9, 2013

Women’s health messages and more

June 16, 2013

Sometimes, we have a bit of a summer camp at my house. Here are my daughter and niece making candles. When I get to share time with my three sisters and my sisters-in-law, all their daughters, my mother, my daughter and daughter-in-law, and my granddaughters–I feel grateful and blessed. They all know that I will eventually somehow end up talking about health messages. But they don’t mind. Most of them have read my co-edited book, ‘Evaluating women’s health messages’ [http://www.amazon.com/Evaluating-Womens-Health-Messages-Resource/dp/0761900578/ref=sr_1_1?ie=UTF8&qid=1371768886&sr=8-1&keywords=evaluating+women%27s+health+messages]. And even though it was published it 1996, it’s still relevant because it tells the history of bringing women’s health and medical research onto the political agenda. It was, after all, only 1990 when the Office of Women’s Health was formed. And until that time, it was just taken for granted that funded medical research should systematically exclude women for all the biological reasons that make us women. What research included women focused mostly on their reproductive health, leaving men out of the reproductive equation just as women were being left out of all the rest of the human health equation research–things such as heart disease research, for example.

The gap in health and medical research is still reflected in society’s norms and language. ‘Reproductive health’ as an expression automatically brings up an image of a woman. Just as ‘outdoorsman’ of course brings up an image of a man. So imagine my surprise when I went to do some shopping online at Bass Pro. A store I dearly love, I usually wait for visits to cities where they are located. but yesterday, I googled them and went to their site and was greeted by, ‘Welcome Outdoorsman’–huh?

Yes, I found the contact information and emailed them promptly. And, yes, they answered promptly. Let’s see what happens next!

What is a patent and what did the US Supreme Court decide about human genes and patents?

June 13, 2014

The US Supreme Court ruled that human genes cannot be patented. A patent is the authority to make, use, or sell something. Myriad Genetics Inc. sought patents regarding genes for which some versions have been linked to breast and ovarian cancer–the BRCA gene mutations. The Court decided that identifying and isolating these genes is not worthy of a patent. On the other hand, Myriad also has created a synthetic form of DNA known as cDNA and that was determined to be worthy of a patent.

For patients, testing for BRCA gene mutations may become more accessible. Until now, Myriad has had the only genetic test for BRCA gene mutations. Perhaps others will now develop testing and contribute to cost reductions, since Myriad does not hold exclusive rights to make, use, or sell products associated with these genes.

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.’

Jennifer Ohs talks about how older adults make medical decisions

March 14, 2013

I am using a new text in my undergraduate health communication course. The text is edited by Maria Brann, a professor at West Virginia University. It is called, “Contemporary case studies in health communication” and is published by KendallHunt, 2011. The text has a unique approach that is working well to spark discussion in my diverse undergraduate classroom. Each case in the book leaves out the conclusion to the case, so that the class can speculate on the possible endings. Then, as the instructor, I have access to the conclusions written by the case study authors and can share these with the class. We have lively debates about how a case is resolved versus other ways it might have gone. For example, the case that I will discuss with the class tomorrow was written by Dr. Jennifer Ohs, a professor at Saint Louis University. The case discusses medical decision-making and uses the example of an older woman who is deciding whether to have sinus surgery. It is a case used to illustrate problematic integration theory, which is the theory we are discussing in class this week, a framework for understanding proposed by Professor Austin Babrow who is a faculty member at Ohio University. The theory explains why communication may cause us to form judgments that a good outcome is highly unlikely, while a bad outcome is very likely. Other situations that are problematic to integrate with our experiences include situations in which communication makes two options seem to be equal, both in terms of how likely or unlikely they may be and/or how good or bad we judge outcome linked to the option. The case discusses how an older woman considers what her husband, son, and daughter have to say about the surgery, the role of prayer, a friend’s view, and the conversations that her usual doctor and the specialist who would conduct the surgery have with her. In the end, she decides not to have the surgery. It is a good decision for her as it turns out, because she later learns that she needs dental surgery, and having that surgery resolves the issues she was having with her sinuses as well. Of course, she did not know that when she made the decision. Rather she made her decision because her daughter did not offer to come and be with her, because she really wanted a second opinion and her husband would not like to have to drive to the city to see another specialist, and because her son had a similar surgery that did not improve his health much. These were weighed with the doctor’s advice to have the surgery and led to her choice. It will be interesting to see how the class views this case and the ideas they come up with for possible conclusions.