Talking About Health; Why Health Communication Matters

Why should we keep track of our use of vitamins and other supplements and who should we tell?

February 11, 2010

119_1917a Taking vitamins is the number one way that U.S. citizens ‘complement’ the formal health care they receive. This is a finding that has been consistent for some years and the 2005 Institute of Medicine Report about use of complementary and alternative medicine [ http://www.iom.edu/Reports/2005/Complementary-and-Alternative-Medicine-in-the-United-States.aspx] considers this reality as well.

Many debates about using vitamins, minerals, and other supplements — including garlic or herbs or cinnamon or ginger — focus on getting us to eat ‘healthy’ rather than depending on vitamins to make up for a diet that may be lacking. Other debates focus on the cost of ‘unproven’ therapies.

Whatever the debate, keeping track of use increases our ability to report use to our doctors. Talking to our doctors about use may make the difference between a therapy working or not. Many prescribed medications have been found to interact with different vitamins and other supplements, spices, and/or herbs. Sometimes, we need more or less of a medication based on use. So keep track and talk about use to avoid harmful effects.

What is a “competent” health communicator?

119_1944a February 9, 2010

I received a ‘smileworthy’ email from my friend and colleague, Ed Maibach, on Monday. He had received word that one of the articles we co-authored had been named to the 50 most read articles in the Sage journal, the American Behavioral Scientist. In fact, the article is #5 on the list, as you can see if you visit http://abs.sagepub.com/reports/mfr1.dtl

The article’s title, “Competencies for the health communication specialist of the 21st century,” gives some idea why it has been one of the most read publications. The importance of this area both theoretically and in application has been widely recognized. This has contributed to a surge in adding health communication classes to undergraduate and graduate programs around the world. And in adding these programss, the debate continues about the focus of education and training.

As I looked back at the lessons learned to develop the article, I realize that many of these competencies are ones that we all need in order to successfully navigate the health information that might only be described as overwhelming in quantity and sometimes questionable in quality. One of the competencies that health communication specialists may choose as a focus focuses on gaining access to and using various electronic databases. As we’ve discussed on this site before, we all need to harness the skills to do this. One of the most important issues remains the ability to identify the sources of these messages in order to consider the validity of their claims.

The emphasis in the article reflects the importance of understanding the role of both media and interpersonal communication on our health habits. To continue the conversation from yesterday, we too often do not seek formal health care because our family or friends don’t support doing so. And we frequently substitute care from our support networks for formal health care. In fact, one of the roles that many faith-based organizations assume relates to providing support to members sruggling with illness or recovering from events that limit their well-being. This may include injuries on the job or the death of a loved one.

Perhaps one of the most surprising and least considered areas of health communication competence relates to impression management. This, too, flows from the knowledge generated from research and practice in interpersonal communication. I reflect on my own hesitation to reveal my failure to behave in ways that I know I should. I want others to form a positive impression of me and to like me. And it carries over into health realms. Besides wanting to present our own best image, we often–with little thought–help others project their own best image. So we may fail to ask our doctor about something we thought we would be talking about in our appointment because we are thinking that to do so might seem to imply that we are ‘criticizing’ our doctor.

Other competencies related to the 21st health communication specialist that we identified more than 15 years ago that all of us will benefit from include media literacy skills associated with understanding gatekeeping relating to content. As discussed in the former post, media stories about medical research likely appear far ahead of therapies to benefit our well-being related to the research findings. Understanding that media seek to give us novel content supports our ability to reflect on the gap between a story and its translation to our care.

So a competent health communicator likely begins with our intention…to understand, to reflect, and to participate in making decisions about our health in informed ways guided by our efforts and experiences. 119_1914

Why don’t our doctors recommend ‘it’?

117_1749 February 8, 2010

The fourth chapter of my book, ‘Talking about health…why communication matters,’ provides some answers to the question, ‘Why don’t we get care?’ The discussion goes beyond the vital limitation–we don’t have access–to consider what happens when we do have access and we still don’t get health care.

The first topic discussed in response to the question, ‘why don’t we get care’ is: our doctors don’t recommend it. There exist several answers to the question, ‘Why don’t our doctors recommend it?’

One reason our doctors don’t recommend a treatment that we might expect reflects the reality that no treatment yet exists. The media story bringing to our attention a scientific discovery published in a leading journal such as the Journal of the American Medical Association or Lancet or the New England Journal of Medicine may set our expectation that the discovery translates to new treatment. It is a long journey between scientific discovery and health care.

The National Institutes of Health–which includes the National Cancer Institute, the National Eye Institute, the National Heart, Lung, & Blood Institute, and others [see http://www.nih.gov/icd/index.html ] emphasizes the importance of translating discoveries to benefits for the people. But the process follows a series of steps. So, in short, our doctor cannot recommend what is not yet available. Still, it never hurts to ask in case there might be some clinical trials going on in efforts to develop treatment based on the new science. And, it can’t hurt to do a bit of sleuthing of our own on the internet to see whether the media story relates to the possibility for new treatment.

Other reasons that doctors may not recommend a treatment have to do with such realities as: time slips away during an appointment and it just didn’t get brought up. Or, the doctor planned to talk with you about a treatment but–forgot. Perhaps your doctor even said in your last appointment that she would talk with you about some other options for care at the next appointment, but then doesn’t. In all of these cases, if it is important to you, bring it up. These are ways that communication can indeed matter when talking about health.

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.