Talking About Health; Why Health Communication Matters

How do you talk to your kids about sex?

roxgrace-beach_1370a January 21, 2010

How odd that we have such difficulty talking with our kids about things that are so important. Why is that?

For one thing, it might lead to questions we can’t answer. Once we open the door with a toe halfway wedged, we know we shouldn’t be surprised if we get asked questions. We might not be able to answer questions because we don’t know the answers. They just might be asking about technical stuff that relates to science and biology, and we might not know. So, agree to find the answers. If your child is of an age where it seems appropriate, find the answers together.

Another thing that happens, of course, is that we want to save face–for us and for them. We don’t want to appear to fail to practice what we preach, whether it is having engaged in premarital sex or failing to protect ourselves from sexually transmitted infections. And we just know that if it sounds like we are trying to control our kids’ behavior, they won’t like it anymore than we do when sometimes tries to control us.

So, how do you do it–talk with your kids about sex? Listen. What do they have to say and what are they asking you? That is the part of talking that we so often forget…listening.

Who is the source of that information about health on the internet?

119_1916 January 19, 2010

Surveys show that most of us go to the internet to search for health information and we do it fairly often. I was reminded of that as I had one of my infrequent flair-ups of pseudogout. It has been years since I’ve had the pain and swelling in my knees and this time it affected my fingers, my wrists, and even my back. And it didn’t go away after a few days. So I went online. And I found lots of information.

How we search for health information on the internet and what we do with the information once we have it is likely to predict whether the information is going to help or harm us. We can conclude that we are not at risk based on the information and be wrong. We can conclude that we are at risk based on the information and also be wrong. So a good place to start thinking about health information found on the internet is to consider the source of the information.

First, consider the motivation of the source. In the broadest sense, .com sites are commercial, while .org sites identify organizations, and .gov sites come from the government. We usually start with a search engine such as Google to seek answers to our questions. When I did, Google health came up as the first link to information. With so many people searching for health information, I guess it isn’t too surprising that the owners of a search engine like Google might want to get in on the act…

Second, consider the expertise associated with a site. Just ‘who’ is the author of the content you are reading and applying to your health? Is it a doctor or a nurse or a physical therapist? Is the doctor speaking on behalf of research or based on experience as a doctor? Is the information just presented, so the source is just the internet with no way of knowing if there is medical research to support the claims, particular researchers presenting the claims, or doctors supporting the research conclusions. I followed the Google health link and I searched for information about the expertise. I found some information at the bottom of a loooooooong page of information. But I couldn’t trace it back to any research. So I couldn’t find out much about where all the conclusions were coming from. Health communication researchers find this to be the case time and again. Not just on the internet. In newspapers, magazines, and broadcast news reports, the expert source on which information is being based is too seldom mentioned.

Third, what part of the information is the author of the content emphasizing, and what part is not being discussed? Is the author providing information for an organization that wants them to present a particular point of view? So, they might be describing the benefits of getting care at the organization whose site they represent but not tell you that it cost more than your insurance is likely to pay. Or, they might be telling the benefits related to one type of treatment for the drug company who has paid for the site you are reading, and they likely believe in those benefits, but there may be no discussion of the risks for the treatment. So, consider not only what content is included in the information but what content might be missing as well.

Doing so should help to make the information we find useful and help us to frame additional searches for more information to fill in the missing content…

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….

What about public health care reform?

117_1784 January 10, 2010

I never hear anyone talk about public health when they talk about ‘health care reform.’ This bothers me because we have a univeral system of public health in the U.S. and we spend quite a lot of resources on it. The services linked to our public health care system range from checking the quality of restaurants and ‘grading’ them to providing newborn screenings. We spend quite a lot of time deciding what services to provide in each state. Besides registering births and deaths, and newborn screenings, many states have prenatal care programs, other women’s health programs, and a wide range of programs from smoking cessation to drug prevention to cancer screenings.

We don’t talk much about public health. But what might a connected system of health care built on the system of clinics and services for public health look like? How would doctors and health care staff feel about building on their infrastructure? Some states have regional health care directors? How would they regard an effort to connect the services they oversee to a broader range of services for the public to consider as a choice for care?

Anyone?

HPV, HIV, HBV…and more

January 8, 2010

I am working on a project designed to understand how college students think about HPV. I have learned that the human papillomavirus — HPV — is confused with HIV by some male college students in this project and that some females confuse it with HBV — the hepatitis B virus…

The media has covered the HPV vaccine and, of course, we have all those direct-to-consumer ads appealing to the ‘I want to be one less’ angle. What isn’t clear in many of these stories and ads is that HPV is transmitted by skin-to-skin contact. That is why genital HPV cannot be guaranteed to be protected by use of a condom during sexual intercourse.

The HPV vaccine is, of course, not designed to prevent HIV. A female who has completed the series of HPV shots likely has about five years of protection from HPV. She is not protected from the human immunodeficiency virus — HIV. Males who mistake the two conditions, HPV and HIV, may wrongly believe that the HPV vaccine protects her and him from HIV and thus feel less inclined to use a condom to prevent HIV. That is a serious mistake.

The incidence of head and neck cancers over the past decade has been found to be related to oral HPV. College males who report engaging in open-mouthed kissing have been found to be more likely to test positive for oral HPV. But this is not the only path for transmitting oral HPV. As with genital HPV, the skin-to-skin contact provides a transmission route.

There is a vaccine for HBV. HBV affects the liver and is transmitted in ways that are similar to HIV, including blood and bodily fluids. It really can be a matter of life and death if we fail to keep straight the differences between these three and our actions to prevent them.

Direct-to-consumer advertising..

January 7, 2010

Only the U.S. and New Zealand have policies that allow advertisers to sell prescription drugs, durable medical goods, and even medical tests by appealing to consumers to be informed and ask their doctors to ‘prescribe’ specific drugs and therapies. On the one hand, these ads provide an opportunity for consumers to learn about different treatments. They also may reduce the sense that particular symptoms or conditions are unusual or embarrassing. For example, depression has long been a stigmatized condition. DTCA have undoubtedly played a large part in making us feel like the prevalence of depression is much greater than we might otherwise think. That might make us more willing to tell our doctor about our symptoms and seek help with them. On the other hand, DTCA have been faulted for providing a lot of content about the benefits of particular prescription drugs or treatments and providing very little information about possible harms.

If we find ourselves learning something new about health from DTCA, we should look for the content to give us a balanced review. Companies want to make profits. They won’t make profit by harming us, but they may make profit by persuading us that our life will be better if only we take a pill…

Feeling susceptible…

January 5, 2010

When talking about health, one of the most important things to say if we really want someone to listen is, “You are at risk. This is about you. This isn’t about your neighbor, your child, your boss… You are susceptible.”

If I don’t think I am actually personally at risk because I don’t have a family history, then what makes me susceptible? If I don’t think I am because I do all the right things like eat healthy and exercise, then what makes me susceptible? If I don’t think I am because I just never get sick and never get injured and never forget to take my vitamins or never neglect to wash my hands, then what makes me susceptible?

Our age can make us more susceptible. Some health conditions happen more often to children and some happen more often to people in their 50s or their 70s or older. We saw this discussed with the H1N1 virus and the need for younger people to be vaccinated because they were more likely to be affected. But what are each of us more susceptible to because of our age?

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?”