Talking About Health; Why Health Communication Matters
A BLOG to support my book, Talking About Health; Why Health Communication Matters
February 10, 2012
Why do we talk in “either” “or” terms when we know better?
It is not “either” we drill for Marcellus shale “or” we will remain energy dependent.
It is not “either” we quit drilling for Marcellus shale “or” we will destroy the environment.
As long as we keep talking and thinking that way, here is the story…
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.
June 2, 2011
We have been hearing about the World Health organization’s conclusion that cell phones pose a health risk that is similar to lead exposure [http://www.latimes.com/health/la-he-who-cell-phones-20110601-1,0,3926296.story]. A summary of the report will appear in a medical journal in July. But advance news stories indicate that as with lead exposure, more exposure increases risk. Cell phone use rarely–less risk. Cell phone use for hours at a time and/or every day–greater risk.
Why has this report come out now? Last year, the U.S. National Cancer Institute reviewed research relating to cell phone use and cancer and posted a summary of their conclusions at http://www.cancer.gov/cancertopics/factsheet/Risk/cellphones. It is tricky to read through the findings. They sometimes suggest that the issue has been directly studied. The ‘gold standard’ for clinical trials is based on randomly assigning individuals to a condition in which the thing to be studied is ‘given’ to those participants and another condition for which the randomly assigned individuals do not have exposure to the thing being studied. Thus, when the NCI reports about studies that have compared individuals who subscribe to cell phone service with those who do not, it begins to sound like a randomized trial. I subscribe to a cell phone service and seldom use my cell phone. My daughter has a cell phone service, it is the only phone she has [no land line], and she uses the phone–talks on it–a lot. So if we were both included in the study mentioned by NCI based on being subscribers, the results might not be an accurate reflection of a relationship between cancer and cell phone use. Subscribers who seldom use their cell phones, if included in the denominator of an equation designed to inform about risk, may artificially reduce the overall risk.
For example, if there are 2 cases of cancer in people in the population that is not subscribed to cell phone service–let’s say that is 100 people–and there are 2 cases of cancer in people in the population that is subscribed to cell phone service–let’s say that is 200 people–it suddenly appears that there are fewer cases in the latter…. But what if only 50 subscribers use the cell phone everyday….not even counting how long everyday–just everyday. 2 cases among 50 people is twice the risk of the poulation of nonsubscribers… Is that accurate?
So that has been the challenge for some years now. No one is going to conduct a randomized trial of cell phone use in which they randomly assign some people to be users and some to be nonusers, and then have some users use briefly everyday, and some users use for two hours, and some more…and track cancer incidence across yearssssss of the lives of the participants. So we have to rely on the research that makes comparisons such as the one described above. The WHO’s group of scientists apparently reached the conclusion that the nearly four dozen published studies reviewed with the thousands of particpants is sufficient evidence to classify cell phones as a possible risk for cancer. In view of how cell phones work, it seems a safe bet. And the ways to reduce risk by using the cell phone with a device that keeps the phone away from my brain is an easy and effective way to reduce that risk…
March 26, 2010 GUEST POST by Jason Bankert
It is the common belief that nurses are the care givers and thus are more compassionate than physicians who are often perceived as hard and emotionless. The Intensive Care Unit (ICU) can be emotionally draining as many patients are in critical condition or are terminal. The care of terminally ill patients is called end of life care or EOLC. How do health care professionals, such as physicians and nurses cope with the emotional burden of terminal illness in the ICU and how do there perception, treatment and communication involving terminal ill patients differ? These different perspectives impact physician-nurse collaboration as well as their satisfaction with the quality of EOLC (Hamric and Blackhall 2007).
In a recent study conducted in the ICUs of a rural hospital in Southwestern Virginia and an urban hospital in Eastern Virginia, investigators examined these questions to provide an insight on how these different perspectives on EOLC ultimately impacts patient care and what interventions can be taken to reduce moral distress and improve physician-nurse collaboration (Hamric and Blackhall 2007). The study, based on survey responses, showed that RNs experience more moral distress during EOLC than do physicians, even though both groups identify the situation as morally distressful (such as aggressive treatment as requested from a family member when both groups feel the treatment is unnecessary (Hamric and Blackhall 2007). As a result, these nurses are less content with their environment or the perception of the quality of care given to the terminal patient. This higher emotional burden on nurses may be the result of their job. It is the nurses who provide the majority of the bedside care during EOLC and are in contact with the patient more often than physicians. Also, nurses lack finally authority over the treatment options implemented by physicians. Even though nurses may disagree with the way physicians communicate prognosis and diagnosis, they feel that they have no say in the final decisions regarding patient treatment during EOLC.
The emotional environment is more important for nurses who are in contact with the patient more often than physicians, providing most of the daily beside care tasks (Hamric and Blackhall 2007). Therefore, it is necessary to improve this environment to ultimately improve the overall quality of patient care. The best care in the ICU occurs when nurses are active participants in diagnosis and treatment decisions and are active in communicating with patients and families alongside physicians (Hamric and Blackhall 2007). In order to provide a environment where nurses can be proactive in the patient care, special attention and policy needs to be implemented to increase physician awareness of the extra emotional burden experienced by nurses and respect their input in regards to EOLC. Equally important is the improvement of physician-nurse collaboration. This may be accomplished by promoting open communication about the different perspectives of EOLC through team meetings, individual meetings with chief staff members and conferences involving staff and specialists from other institutions.
Hamric, A. B., L.J. Blackhall. (2007). Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate. Critical Care Medicine, 35, 422-429. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/17205001
January 28, 2011
One of the blogs I follow is Belinda Brasley’s, ‘Losing vision, Gaining insight…’ http://losingvisiongaininginsight.wordpress.com/2011/01/27/to-blog-or-not-to-blog/ Her journey with low vision is so parallel with my own that it is at times uncanny…. She puts into words my own experiences, including how she feels about low mobility training, using a cane, and other aids to adapt to losing one’s eyesight. Today, her post addresses how she felt at the news of having lost even more vision after being stable for some period of time. It made me think about how any kind of bad news about our health can drain us emotionally and physically.
In part, we go through a number of stages when dealing with bad news about our health. It takes some time to understand and it can make us angry. We need to grieve about what we have lost. We need to understand what it means for all the other parts of our lives, including relationships and plans we had for the future–work and play. Gilotti, Thompson, and McNeilus wrote about how bad news delivery is perceived in a 2002 article in Social Science and Medicine http://www.ncbi.nlm.nih.gov/pubmed/11999499. In short, it is not a good time for small talk. And it is probably not the best time to go into a lot of information about the situation. As I said, it takes some time… Being ready for all of that information will be an important part of managing the bad news.
January 26, 2011
Perhaps a lifetime of health problems. Perhaps early dementia. If the headache is related to a sports concussion…
When I was a child, we didn’t wear helmets to ride our bikes. My kids didn’t wear helmets to ride bikes or to skateboard. We were lucky. They were lucky. Really.
I remember falling off my bike. Plenty of times. We raced and crashed and burned. Perhaps the scariest crash riding a bike without a helmet happened when my daughter way old enough to sit up in the child carrier on the back of my bike, I was riding with her on a bike trail, and some crazy person pushed us off the trail and we–crashed. I was able to keep her upright by sheer will as we went flying and I lunged around backwards to grab the bike that I was no longer sitting on. The deep bruise on that leg and knee that went down is still memorable…it lasted for months.
It’s important that we are talking about athletics and concussions. http://www.heraldextra.com/news/opinion/editorial/around-the-nation/article_a952962f-591c-53c2-9ad6-64bf42b5ebfc.html It is important that parents wear helmets when they ride bikes and get helmets for their kids. And if there is an accident, get a new helmet…it is designed for a one time use. And let’s keep talking about it, so that we are less to have concussions that go unreported and untreated…
January 24, 2011
Dr. Oz talked about heart attacks on his show today. He emphasized things we can do to manage our risk for ourselves. He talked about the risk for women as well as men. One of the issues that he emphasized was ‘stress.’ He noted that stress is a big contributor to heart disease. He has talked about this in terms of our diet before http://whyhealthcommunication.com/whc_blog/?p=328 I have talked about Dr. Oz referring to stress before on this blog .http://whyhealthcommunication.com/whc_blog/?p=236
This time, I want to applaud the very concrete suggestions that Dr. Oz gave us for handling stress. He said, “Have two social conversations each day.” And, “Have one social outing each week.” This is very useful for us. How often do we find ourselves stressed with feelings that there is ‘no wait out.’ Then we talk to a friend or a colleague about a new movie coming out, or our passion for a sport, or our love for our children. Even five minutes, and some of that stress melts away. And, yes, as impossible as it seems when we feel stressed, having a social outing–a walk at the city park or in the mall when it is too cold outdoors, lunch at Subway’s or each other’s home, or going to see that new movie–everything looks and feels different afterward. So thumbs up to Dr. Oz for concrete ideas that we all can do to manage our stress…
April 21, 2010
Communication and uncertainty go hand-in-hand. Many of our theories in communication focus on uncertainty as a reason to communicate. In these cases, we usually focus on communicating to reduce uncertainy. We talk about how we use cues from others–such as how they dress, the hair style they wear, the way that they gesture, and even how fast or slow they talk and their accent–to decide how much we are like another person. In these ways, we are using nonverbal information to reduce our uncertainty about talking with someone.
In already established relationships, we also experience uncertainty. Relational uncertainty may happen because we don’t know if our friend or family member is being ‘honest’ about whether they think we should take the job, go back to school, or in a million little day-to-day situations–like what to wear, what to eat, or what to do with our free time. We often try to reduce our uncertainty in these sitautions as well by communicating. ‘What do you want to do?’ ‘What are you doing to wear?’ ‘Do you think I should take this job?’ ‘What about the fact that we can’t sell the house right now?’ ‘They didn’t offer me any moving costs–can we afford it?’ So relational uncertainty emerges in a thousand different ways as part of having relationships. And it is a challenge to imagine how to balance the relationship needs and well, live our lives. So what happens when into the mix we introduce illness?
A diagnosis, whether it is terminal or not–as suggested by one of the participants in my last post–may spark the motivation to communicate. The diagnosis might be for a chronic condition such as heart disease, high blood pressure, high cholesterol, diabetes, or even HIV. It might be a broken leg or a sprained neck. Into each and every one of these and possibly thousands of other diagnoses enters uncertainty. “Illness uncertainty” is a big part of the uncertainy. But “relational uncertainty” is introduced into a diagnosis as well. To improve our communication about health, keeping both kinds of uncertainty in mind may help.
A diagnosis often leads us to want to reduce illness uncertainty about such things as ‘what is it,’ ‘what does it mean for my life,’ ‘how long will it last,’ ‘how will we treat it,’ and a host of other questions that may lead us to seek information to reduce our illness uncertainty. Sometimes, there will be no answers as we seek information, and so we have to “manage” our illness uncertainty by knowing that we have done what we could to answer our questions and perhaps by joining support groups online or in other ways putting ourselves in a position to keep up-to-date with any new information. What we don’t often think about is that in some situations, “increasing” our illness uncertainty may offer the most hope. As an emotion, hope let’s us look forward to a future that is a positive one and where we see ourselves able to achieve important goals. When we do not have certain information about our illness, that may provide a path toward hope if we frame it based on such comments as, “the doctor told me, ‘I don’t see any expiration date on you'”,–meaning that there is no answer to a question framed as, ‘how long do I have to live’.
In some of my past research, I have talked about the acute phase following a spinal cord injuury. During this phase, patients and families often are most reassured by communication that increases their uncertainty about the course of the diagnosis. Doctors not knowing whether a patient will walk again is a hopeful thing. At the same time that the patient and family experience hope related to increasing their illness uncertainty, they may experience sadness and fear and anger about a sense of increasing relational uncertainty. This is a case where friends and family may be very supportive in the beginning but seem to be less so over time. Communication may need to be more direct to reveal what is happening. If a friend asks, ‘what can I do for you?’ and the ansswer is always the same–‘nothing’–the friend may quit asking and quit coming around. There are many reasons that we don’t ask for help–and we can discuss those in the coming days–but if we remember that it may increase a friend’s uncertinaty about the relationship if we say ‘nothing’ and we obviously need help. And their lack of helping when we obviously need help may in turn increase our uncertainty about them. And both may contribute to illness uncertainty in negative ways–relating to a lack of tangible and emotional support–perhaps we can stop the spiral and communicate about our health and our relationship in more fruitful ways… not always to reduce uncertainty… but at least in ways to manage it.
