Talking About Health; Why Health Communication Matters

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.

Health communication online for supporting fitness–SparkPeople.com

September 21, 2012

Today is my daughter-in-law’s birthday. September is filled with birthdays in my family. And we celebrate them. Not so much with cake. More with talk and support. Reminding each other of all the good things from the past year and all that we have to look forward to in the year ahead. That support makes all the difference in the world for living a fulfilled life. That must be part of the idea behind SparkPeople.com. I read about the online site when I was going through a pile of old magazines this summer. I do that now and then, tearing out pages for items I want to follow-up on and throwing the rest of the magazine away or–if it is not too destroyed–donating it for others to read. At any rate, I read about SparkPeople being a site where members find support for reaching fitness goals. So today I visited the site.

My first impression in joining is that the site has a lot of capacity for customization. I could [tho I didn’t] create my own personal page. Even without creating the personal page, I entered some information in a very quick fashion and the screen rolled over to content relating to my interests. The site is filled with color and images and all kinds of links. There are communities to join, friendships to make [the site says], stories of success before and after joining.

I wonder how long members, on average, spend on the site and how many weeks, months, or years they remain active members. I noticed that the site has a lot of advertising support. As far as I have gone, that apparently supports the site so that it is free to subscribers. So far anyway. I do wonder if the site is doing so much for so many topics that it might prove to be less depth than some would want. I also wonder about the name and how people would find their way to the site if they didn’t read about it in a magazine. Perhaps others have experiences with the site and will let us know more.

A stark reminder to check your prescriptions…closely

March 8, 2012

I heard the story about a pharmacy mix-up the other day that reminded me how important it is to inspect my medications closely before taking them. As the clip shows, a medication was given that looked the same in color and size, but very much was not the same. A cancer drug instead of fluoride tablets.

I found an error once. The pill was a different color than my prescription but the same size. So I looked closer and it wasn’t my medication. You can check your prescription by going to http://www.drugs.com/imprints.php and enter the number on your pill to be sure that it is what was prescribed according to the label.

What might happen when a pharmacist uses a conscience clause?

January 16, 2012

A conscience clause — when might a pharmacist feel conflicted about filling a prescription? The most commonly discussed event is birth control. Birth control pills, the morning after pill… these medications cause feelings of conflict between values related to pro-life and anti-abortion, and dispensing the medications.

The store, Target, supports a pharmacist’s rights not to fill these prescriptions. However, a pharmacist must direct a consumer to another Target store where the prescription can be filled. I can find no research that has been done to see how such conversations might take place or what happens when — as in the town where I live — there is one Target store. I don’t know if there is more than one pharmacist there. I don’t know if any of them object to filling these prescriptions. But if they do, what happens? How would I know? Who would tell me?

Old science, new science, and conflicting science about coffee and caffeine–and health

January 12, 2012

Shortly before the holidays, I heard Dr. Oz talking about coffee. He played a game with audience members and emphasized that coarsely ground, light roast coffee made with cold water and NEVER microwaved is best when aiming for the benefits of coffee. Benefits? I thought. Isn’t it interesting how different stories emphasize different results?

On the hunt for the science I went. In 2009, a study reported that 3-5 cups of coffee a day related to a reduced risk –65% less — for dementia and Alzheimer’s disease [http://iospress.metapress.com/content/d885346618q57103/].

I was reminded of my discussion in my book, Talking about health, about old science, new science, conflicting science, and no science. I went online in search of some more science to discuss the coffee and caffeine health benefits. I found the Dr. Oz story: http://www.drozfans.com/dr-ozs-advice/dr-oz-american-roast-coffee-prevents-colon-cancer-coffee-trivia/

An article in 1990 reports findings that the participants who reported drinking more coffee had a higher incidence of colon cancer [http://www.jstor.org/pss/20065645].

A study reported in 1993 found no relationship between more than 34,000 women’s reports of caffeine consumption and breast cancer [http://aje.oxfordjournals.org/content/138/6/380.short].

In 2007, a study found that 2 cups of black tea or decaf. coffee each day related to reduced risk for ovarian cancer, but regular coffee did not show this relationship. Again, women self-reported their behaviors [ http://onlinelibrary.wiley.com/doi/10.1111/j.1525-1438.2006.00773.x/full].

Also in 2007, a study found that drinking 2 cups a day of regular coffee greatly reduced — 43% — risk for liver cancer [http://www.gastrojournal.org/article/S0016-5085(07)00568-9/abstract].

What does it all mean? Talking about health means thinking about when a study was conducted, who particpated, and how the research was done. Self-reports are different from clinical studies. I don’t know of any clinical trials where participants are given coffee over time and compared to participants who do not consume coffee. So the research depends on individuals reporting how much coffee they drink. And then clinical reports about their health status provide a picture of what might be making a difference in the health of some compared to others. So when talking about health, don’t lose sight of the meaning of shorthand expressions like, ‘drinking 2 cups of coffee a day reduces your risk for cancer’…

How do nurses cope with the emotions of caring for terminal patients?

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

How does the media create compassion fatigue?

March 22, 2011

When we are traumatized by someone else’s trauma, we may experience compassion fatigue. While I discussed this in an earlier post in terms of vacations and leisure http://whyhealthcommunication.com/whc_blog/wp-admin/post.php?post=628], it is worth talking about in terms of so many images and messages relating to Japan’s earthquake[s], tsunami[s], and nuclear power threats… I daresay that anyone who has watched the news over the past week is experiencing compassion fatigue. How could we not be? The images are heartbreaking, frightening, and constant…

Susan Mieller, author of the book–Compassion Fatigue–[interview about the book at http://web.mit.edu/cms/reconstructions/interpretations /compassion.html] emphasizes the role of media in creating this condition. We have to focus on what we can do and not what we cannot do. We cannot go backwards and second guess decisions about how nuclear power plants in Japan have been maintained. We can do what we can do to help the Japanese people…even if it means watching ‘American Idol’ for a bit of distraction and downloading some music. We can try to understand the role of nuclear power in providing energy in the U.S. and seek direct answers about how the existing plants have been maintained…

Or will it be Pennsylvania trout that will be the canary in the mine for Marcellus shale?

February 22, 2011

There appears to be no shortage of articles about concerns relating to the environment and Marcellus shale drilling in Pennsylvania[e.g., http://blogs.wvgazette.com/watchdog/2011/02/16/is-the-marcellus-boom-a-good-idea/]. Fewer concrete examples exist of action in this area. One exception is the organization, Trout Unlimited. The organization is partnering with the State, where loss of funding and the economy has contributed to challenges in efforts to collect data regarding water quality in the State’s streams [http://www.tu.org/conservation/eastern-conservation/marcellus-shale-project].

Volunteers will be trained to collect water samples. That is an important first step. It is less clear what happens next. Where will the samples be evaluated? How will data be stored? It is important to plan for consistency and to identify now any problems related to evaluating the water samples. If we fail to plan now, then the findings will be suspect later. So certification of the folks collecting the water samples is important. But we don’t want their hard work and training to be lost in warehouses where samples stockpile with no one to evaluate and track them. We also don’t want results to be discounted because the assessment of samples isn’t consistent or valid…

How are asking these questions relating to health like a sleigh ride…?

February 13, 2011

Seven Springs… A horse drawn sleigh ride… There is something very spiritual about riding through falling snow deep into the woods. And it can almost seem as if you’re floating right into the horizon…

Questions about health and health care can be like that… They go beyond the focus on illness or disease. They often go to the horizon of working in health care… Nurses working with doctors… “What’s that like?” And doctors talking to patients.

Have you ever thought about what it would be like yourself to be a doctor? Imagine asking a doctor, “Does talking to patients make you nervous?” What about asking patients, “Do you have trouble making ends meet?” Or, “Do you need financial help?”

In each of these cases, the way the question gets asked makes it hard to imagine that anyone could answer them honestly…

Why would anyone become a doctor if he or she gets nervous thinking about talking to patients? Perhaps that isn’t the best way to think about it. Why wouldn’t anyone get nervous at the thought of talking to someone about something so important and so personal as their health?

If you were a doctor, how would you go about talking to your patients in ways that respect their religious beliefs? What about breaking bad news, like a cancer diagnosis–wouldn’t that make you nervous? Every conversation is a little bit like going forth into a snowstorm…counting on someone to guide the way but preparing to make the most of the trip…

Why is it hard to talk about our health?

January 4, 2011

A new year. After trekking from PA to Texas, I feel … excited about the year ahead. Yes, I sat in the airport with John on our journey to and from for many hours more than we expected to linger. Yet, through all of the waiting, it was remarkable to see all the families and all the strangers just working together to get along. Not that there weren’t frustrations. We saw one father, mother, and teenage daughter who just missed a connecting flight… as in, the plane was still sitting just outside the big plate glass window but had already closed the door.

girlpups1 I noticed something during the waiting in the airport. Whether I wanted to eavesdrop or not, the crowded conditions and the accessbility of cell phones presented me with endless conversations among family members. Mostly they were keeping each other posted on flight delays and revised plans. But in so many cases, there was talk about how someone in the family was feeling now or whether someone in the family was well enough to be present for the holiday or if there was any news about a loved one’s recovery. In one case, a distressed young woman was talking to someone close to her about a mother’s drug and alcohol recovery. We got up and moved out of the mass of people in this case to avoid hearing so much of what was clearly painful to her. She moved as far as she could from the throngs. But there was just only so much space.

It’s personal. That is why it is so hard to talk about our health… and yet, that is why we must…. In this new year, we will take a closer look at some of the ways we can cope with talking about our health when it is… personal.