Evaluating health stories in the news

If you aren't familiar with it, check out the web site Health News Review and blog Health News Watchdog (both newly redesigned). The site monitors and reviews health stories in the media and calls out stories that may be misleading or confusing to readers. This is an important endeavor. Part of the dynamic of communication between patients and physicians is the information that patients get from mass media sources. If that information is poorly explained, it may set unrealistic expectations in the mind of the patient, creating an additional communication challenge for the physician who now has to educate the patient and refute other claims, while still hearing and respecting the patient's concerns. So what the mass media says, and fails to say, is important. And the more voices calling out the sensationalistic and regurgitated press releases the better.

Methods for studying physician communication

The October issue of Wisconsin Medical Journal features an article from our team at the Medical College of Wisconsin and the innovative methods we used to study physician communication and parent outcomes across the entire state of Wisconsin. The article also features early results from our 4 year statewide study. You can check out the article here.

This statewide study required the cooperation of multiple agencies, as well as the efforts of staff from multiple disciplines. But ultimately we were able to demonstrate that it is possible to conduct a statewide communication study using methods that are both effective and efficient.

When the nurse wants to be called doctor

The New York Times had an article this week about the growing number of health care professionals, other than physicians, earning doctorates. This creates a debate about who gets to call themselves "doctor." But beyond titles, a larger debate looms about who should treat patients first and who should be in charge of coordinating patient care. If roles are unclear, it opens the door to confusion in communication between patients and providers. For patients, there is an increasing number of professionals they can approach for their care, but may also be confusion about who they should approach for care and what training they have. For health professionals, as long as titles have some ambiguity, they can't make assumptions that their patients know their role in health care. Providers have a responsibility to clearly explain their role to the patients. That explanation may be a great prompt for conversation about how the patient's care will proceed.

Improving communication about clinical trials

This week's ACRP Wire highlights an article from the American Journal of Public Health which examines the problems with communication about clinical trials. Misinformation and miscommunication about the nature and the risks of clinical trials, specifically HIV vaccine trials, is inhibiting enrollment in these trials. In order for these trials to succeed, it is important to have the support and participation of high-risk groups and communities. But to get their participation, researchers have to improve how they communicate with community members and stakeholders. Improved communication will facilitate greater trust of the clinical research professionals, as the community will be able to see that they are working towards the same goal - improved health for the entire community.

Communication in the hospital

I have been away from the blog for a longer period than normal for a very difficult reason. My dad was in a serious motorcycle accident on August 3. He will recover but faces a very long recovery and rehabilitation.

I flew out to Portland the day I found out about the accident. I spent a little over a week with my mom at my Dad's bedside and witnessed physician communication, not in theory, but in practice. Two thoughts have stayed in my mind.

1. Be accessible. Perhaps I am naive, or perhaps it is because I work with primary care providers, but I was shocked, and at times annoyed, at how long we would go without even seeing a doctor. Now, I know the doctors are getting reports from nurses and residents and are aware of what is going on. I am also aware that if there was an immediate problem, the doctor would be right there. But I also know what a difficult situation my mother and I were in, and how many questions we had, and it was upsetting, at best, that we often had to chase down a physician to talk to someone about my dad's condition.

2. Be aware of timing when delivering difficult news. There has been some research on how physicians should break bad news, but I am talking more about timing and delivery. When we finally managed to get some face time with one particular doctor, a day after my dad had been transferred to a new facility, the doctor launched into a litany of possible problems and then dropped the bomb, "Oh yeah and he might be paralyzed. But we don't know yet." Paralysis is a very difficult thing for a love one to think about, especially a week after the accident when no one else has mentioned this possibility before. To just drop that into conversation, and try to say, "oh, but we don't know yet," is insensitive. But beyond that, it is ineffective communication because I can tell you my mom didn't hear much of the rest of what the doctor said after that. And I'm not saying he was wrong to say it. If that is a possibility, it should be discussed. But it could have been handled and communicated better.

Hospitals are there own world. Communication in this world is a particular challenge, given the anxieties, emotions and uncertainties. And as I have now seen firsthand, there is still room for improvement.

Medical myths

CNN had an interesting article a couple weeks back about the longevity of medical myths and how both doctors and patients need to occasionally step back and question their assumptions. Science is about comparing beliefs with evidence, and this extends to the things we've long believed to be true.

As communicators, it can be especially difficult to communicate evidence when it goes against commonly held beliefs. Describing the evidence in a clear, accessible way is the best place to start.

Communicating discharge instructions

An article in MedPage Today examines the importance of communicating discharge instructions to patients. Effective communication of discharge instructions can reduce readmission rates. Interventions and home visits can be especially effective in following up on discharge instructions. But the two studies featured showed low patient participation rates in follow-up programs are low.

It seems that the challenge is for physicians and nurses to communicate not one, but two things: 1. The importance of following discharge instructions, and 2. How follow-up plans can help with 1.

In addition to communicating clearly, physicians and nurses need to listen to patient and family questions and concerns in order to make discharge planning successful and reduce readmission rates.

More on advertising junk food to children

U.S. News and World Report reported on the food industry's response to the Obama administration's recommendation regarding advertising junk food to children. The administration advised setting nutrition guidelines for the kind of food that can be limited to children. A coalition of the nation's largest food makers has set its own, less stringent guidelines, to go into effect by December 31, 2013.

The guidelines and recommendations are all part of an ongoing discussion about the influence of media on children's nutritional habits. The discussion should continue, not just on a policy level, but on an interpersonal level as well. Parents, doctors, teachers and kids should have continuing discussion about how media tries to influence the decisions we make. Let's call it a lesson in media literacy, with a little health literacy on the side.

Tips for talking to your child's doctor

CNN.com and Parenting magazine had an article with tips for talking to your child's doctor. The tips included ways to use technology to help improve communication with the doctor, including using technology such as smart phone apps to help you track your child's health and immunization history. They also make recommendations for limiting the Internet research you do to reputable web sites, and using the information to guide the conversation rather than make a pre-diagnosis. The article provided some concise, useful and accessible tips for communicating with your child's doctor in an ever-changing technology and health care landscape.

New ways to interview potential future doctors

The New York Times had an article about new techniques that medical schools are using to interview potential medical students and future doctors. Rather than depending exclusively on test scores, grades and a single interview, some medical schools are using several smaller interviews, where potential students are asked to grapple with some of the issues facing the practice of medicine, including ethical issues and issues with insurance. The idea is to identify students with strong communication and interpersonal skills, skills which will be important to navigating the health care system. While grades are an important indicators of whether students will be able to handle the workload of a career in medicine, communication skills are an important indicator of how well the students will be able to provide care as doctors.

Communication in Hospitals

Check out this blog post from Rock Health about the difference effective communication can make in hospitals. Focusing on better communication helps patients understand discharge instructions, improves quality of care while in the hospital, and creates an environment where all the staff endeavor to provide better care. And with new, innovative tools for assessing and measuring communication, hospitals and clinics will have the resources to continue to emphasize this important aspect of clinical care.

Should junk food ads be banned?

The American Academy of Pediatrics released a preview of a soon-to-be-published study on childhood obesity. Commenting on the article, the authors and the Academy are advocating a ban on junk food advertising in programming aimed at children.

There is a lot of evidence linking the time children spend watching television and obesity. But less is known about the effects of advertising on children. What do you think? Should junk food ads aimed at children be banned? Would banning the ads do any good?

New graphic warrnings on cigarette packages

This week the Food and Drug Administration released new graphic warning labels to be displayed on cigarette packages in an effort to discourage smokers from lighting up. The new labels, the first major redesign of cigarette packaging in 25 years, were made possible by a 2009 law which gave the government and the FDA authority to regulate tobacco. Other nations have used even more grisly images than the new FDA labels for years, and their impact on smoking rates in those nations has been somewhat difficult to assess. It will be interesting to see the impact of these labels on smoking rates in this country in 2012, when the labels will be required, and beyond.

Communicating about vaccines

Last week, The Wall Street Journal Health blog published an article about two papers published recently which explored acceptance of vaccines. Acceptance of vaccines is not just a matter of science, but a complex problem of culture, an increased number of vaccines required, and lack of familiarity with the diseases the vaccines are intended to prevent. Physicians should not just dismiss parent concerns about vaccines, but listen to the concerns and engage in communication with the parent about the particular concerns. Physicians and public health officials should also be aware of emerging rumors and concerns about vaccinations.

Vaccines are most effective on a population level, but assuring the population is vaccinated or not is a matter of tailoring communication about vaccines to each parent and child.

Learning patient language

The Journal of Medical Internet Research published a fascinating article on using data mining software to analyze patient and consumer health vocabulary. The resulting data can be used to create consumer health education materials. It's a great example of using technology to improve health communication, by creating materials customized to and readable by the intended patients.

High-tech and low-tech communication strategies

The Wall Street Journal had an article today highlighting both high-tech and low-tech strategies for reducing hospital readmission rates. Many hospital readmissions can be traced to poor communication when a patient is discharged from the hospital. Patients who do not know what they need to do after they leave the hospital to continue to get better are at a higher risk of returning to the hospital. Facilitating better communication about discharge instructions and creating opportunities for patients to ask questions before they leave, may facilitate better health outcomes for patients.

Dumb things to do at the doctor's office

CNN.com's "Empowered Patient" feature had an article today about the dumb things patients do at doctor appointments. Seven of the 10 items on the list has to do with poor communication. Patients fail to state their real concerns, fail to ask questions and are afraid to speak up when they disagree with their doctor. So much health communication research focuses on what physicians should do to improve their communication with patients. This article is a nice reminder that communication is a 2-way street. Patients need to be strong communicators as well.

Are you prepared for a zombie attack?

Perhaps the biggest challenge of a public health campaign is getting people's attention. Well the CDC certainly succeeded in getting attention with it's latest emergency preparedness campaign. The campaign kicked off with a blog about being prepared for a zombie attack and used that as a jumping off point for general emergency preparedness. The zombie blog has generated a lot of buzz, but only time will tell if the attention getting blog raises awareness of emergency preparedness.

Doctors' struggle to show compassion

Dr. Manoj Jain, an infectious disease specialist in Memphis, reflects on the reasons physicians struggle to show patients compassion in an article in yesterday's Washington Post. But while there have been studies showing medical student losing compassion for patients in the course of their training, there is evidence that compassion can be effectively taught in physician training programs.

Compassion can perhaps be taught to physicians and health care providers in any number of ways. But compassion may ultimately come down to teaching physicians how to effectively communicate with patients in emotional circumstances. Doctors may feel compassion but may have a hard time expressing it. But training in compassionate communication, helping doctors come up with what exactly to say to a patient, may help them express the compassion they feel.

Learning to communicate effectively in multidisciplinary teams

Innovative clinical research is dependent on multi-disciplinary teams to envision, design and implement complex research protocols. The varied backgrounds and approaches can also cause culture clashes with a team, when team members from one field have trouble communicating with team members from other fields. Each team member brings not only the knowledge of their field, but also the cultural norms and behaviors socialized into their field. Those culture clashes can cause more than frustrations; they can be a serious detriment to team function. Team communication and collaboration can be particularly difficult when team members seek to protect their own power, control and authority.

On June 8, I will be presenting an ACRP webinar that will examine how specific communication behaviors impact clinical research team function. Effective team communication enhances team functioning and can strengthen team members' attachment and commitment to the team. Therefore, the goal of the presentation is to identify potential barriers to communication and team function and develop strategies for overcoming barriers and maximizing benefits of multi-disciplinary clinical research teams.

The importance of communication in clinical research

I think I finally have the Association of Clinical Research Professionals convinced about the importance of communication in clinical research. I had the privilege to present at the conference for the second time last week in Seattle. When submitting my proposals the last 2 years, I had to somehow fit my passion for communication in clinical research into one of ACRP's educational categories that didn't quite fit. I have submitted under the "ethics in clinical research" and "clinical research education" categories, but neither really acknowledged the important role of communication in this field. I knew how important effective communication behaviors and techniques are to things like effective informed consent and productive team management, but I wanted a platform to share my experience and expertise with my colleagues. My proposals were accepted but I felt like a bit of an oddball at a conference very concerned with government and clinical regulations. But this year we seem to have had a breakthrough. I had a great turnout and great discussion in my session on using communication theory to improve informed consent. The discussion both in and out of the session was robust. Attendees seemed eager to learn practical tools for integrating better communication processes in the clinical research world.

But more than my presentation, I've seen more presentations and discussion about the role of communication in both the management and execution of clinical research trials. So much so, that in the call for proposals for the ACRP 2012 conference, ACRP has suggested the category "communication in clinical research." I am excited to be a part of the growing interest in this field. And I will definitely be in Houston in 2012!

High quality health reporting

The Milwaukee Journal Sentinel was recognized today with a Pulitzer Prize for explanatory reporting for its series on a rare medical case at the Medical College of Wisconsin. The series, "One in a Million," told the story of a little boy with a mysterious illness, and the researchers at the Medical College of Wisconsin who eventually sequenced the boy's entire genome to find a diagnosis. The Journal Sentinel team used a mix of written and multimedia pieces to explain the complexities of this emerging science. This piece not only tells a compelling story, but also serves as an example of quality health reporting. It is not enough just to tell the story, but effective reporting, explains the story and places the story within a broader scientific context. I am very proud to work at a university where such innovative research is taking place. And I'm proud to subscribe to a newspaper that is willing to invest the time and effort to tell these compelling science stories.

Soliciting questions

One of the most effective communication behaviors can engage in to assure patient understanding is to simply ask if the patient has any questions. There are a couple different techniques one could employ to accomplish this task, some of which more effective than others. The first is to simply ask: Do you have any questions? But this is what is called a close-ended question, one that can be answered with a yes or no. To solicit more than a one word answer, use an open-ended question: What questions do you have for me? An especially effective technique, though more time-consuming, is a request for teach-back, in which the physician asks the patient to repeat back what was just said, as a way of soliciting patient understanding and any underlying questions. "You may have to explain this result to your spouse or family members when you get home, just to make sure I did a good job explaining this, can you repeat back to me what we just talked about. Making the effort to encourage questions effectively engages the patient in the conversation and enables them to be an active participant in their own health care. Meanwhile, the Agency for Healthcare Research and Quality, contends questions are the answer.

Managing anxiety when talking about clinical research

I am looking forward to presenting later this month on the topic of communication and informed consent at the Association of Clinical Research Professionals Global Conference. I am going to be presenting on several different communication behaviors and theories, but I think one aspect of my presentation that may initially be surprising, though I hope will resonate, is the idea of Anxiety-Uncertainty Management. Anxiety-Uncertainty Management is actually an intercultural communication theory that examines communication between members of a given cultural group, and a "stranger" to that culture. Anxiety-Uncertainty Management contends that communication is effective when someone is able to effectively interpret the words and actions of the other person. But when a person is a stranger to the culture, they may not understand the words and actions of the other person, and thus may become anxious and unable to process the new information that they are receiving. A little bit of anxiety can be OK, and it may in fact be helpful. But when anxiety becomes overwhelming, communication suffers. It is pretty easy to see how this might play out in clinical research encounters. A potential research participant, who is new to the world of clinical research, may not be able to interpret the words and actions of the research coordinator, and because they do not understand what is going on, they may become so anxious, they are unable to process new information, such as an informed consent discussion. So what can research coordinators do? In order to create an environment where effective communication can take place, coordinators should help potential research participants manage their anxiety. They can do that by explaining who people are, what their jobs are, and what's going to happen. Take the mystery out of the clinical research experience. Because if they are able to manage their anxiety about the situation, then they will be able to have an effective conversation about participating in research.

When recommendations change

The American Academy of Pediatrics released new recommendations today regarding children and car seats. As is often the case with science and medical research, new data emerges and the recommendations that were standard for years can change, seemingly overnight. I make note of this, not because of the change in recommendations, but how personally some parents seem to be taking it. A quick glance of the comments section on New York Times article show parents up in arms about the recommendations, and others chastising those parents for not being concerned enough about their child's safety.

For physicians and nurses who communicate such recommendations to parents, this reaction points to the importance of sensitivity when making recommendations. It is easy for parents to take recommendations as a personal affront to their parenting skills. A little sensitivity and validation of those feelings may go a long way in getting parents to thoughtfully consider a new recommendation.

When a physician is not a physician

The New York Times Well blog is running a series of articles from cancer researcher Dr. Peter Bach. But Dr. Bach is not offering his perspective as a physician or as a researcher, but as the husband of a wife facing breast cancer. It is a unique perspective: objective clinical knowledge and the raw emotion of seeing a loved one in poor health.

This week, Dr. Bach discusses the complexities and emotions of involvement in a clinical trial. It is one thing to objectively understand the reasons for a double-blind study, where a new treatment is compared to standard care. It is another to be the loved one of a patient hoping that your loved one gets the new drug and that it might be just a little better than the standard care. The article, and other that have explored why patients participate in clinical trials, demonstrates that it is perhaps impossible to be totally objective when discussing cancer research. Patients and physicians will always hope that they will be the exception.

More on therapeutic misconception

The ACRP (Association of Clinical Research Professionals) Wire has another article on the important topic of clinical research participation and the therapeutic misconception. It is worth the continued discussion.

Therapeutic misconception and participation in clinical research

In her column this week, Dr. Pauline Chen touches on a serious concern for clinical researchers: therapeutic misconception. Clinical research is dependent on the voluntary, informed participation of research participants. Researchers, coordinators and institutional review boards, put a great deal of time and effort into making sure that potentially participants are fully informed about the nature of their participation in research, including the fact that they themselves may not directly benefit from participating in the trial. But when potential participants face serious, life-threatening illnesses, they may view participation in the trial as their only hope, even if the researcher tells them there is only a small chance they will benefit. Dr. Chen's column ultimately explores the ethics of hope. Is it OK for researchers to enroll participants who are enrolling with unrealistic expectations, despite the researcher's best efforts at informed consent? Is there any way to prevent unrealistic expectations? Should we prevent unrealistic expectations if they give hope?

Physician and patient perspectives

The Wall Street Journal Health blog highlights two recently published surveys that point to the different perspective of physicians and patients. The differences highlight how different perspectives can affect the quality of communication between physicians and patients. A little perspective-taking, or thinking from the other person's view, can go along way in facilitating communication.

Looking for health information online

The New York Times had an article today about where to look for health information online and the dangers of hysterical hypochondria and subtle misinformation. Many of us want to research our own health issues before visiting our doctor, and the Internet can be a great source of information. But it is important to weed through the special interests and the hype to reach more objective information. Today's article points the reader to some good sources to get past the hype.

Worry about aging doctors

The New York Times had an article earlier this week about aging physicians and concerns about their abilities. It is a delicate social and communication task to talk to someone who has dedicated their life to a career that it may be time to give it up. Hospitals and governing bodies are wondering if the solution is to require reaccreditation or some other testing once physicians reach a certain age. But requirements for accreditation among physicians are not uniform and are difficult to enforce with any meaning. But whether testing is required or not, fellow physicians may find themselves in the position of having to discuss declining abilities with another physician. It is not an east conversation, but an important one.

Fear of colon cancer screening

The New York Times Well blog had a post today about the reason many people do not get recommended colon cancer screening: fear. The fact that so many cite fear as a reason for not getting or putting off the test presents a communication opportunity for physicians talking to their patients about colon cancer screening. Physicians should not downplay a patient's fears. but rather anticipate and validate emotions the patients may be feeling about the screening test. Take a few minutes to explore the emotion: is it fear of finding cancer or fear of complications from the test or something else? Communication can be the difference between a patient getting a needed test and not getting it.

Meanwhile, here's what Dave Barry had to say about getting a colonoscopy.

Finding the right metaphor

The ACRP Wire, the newsletter of the Association of Clinical Research Professionals, had an interesting article today on a study which looked at how language affects research participant understanding. The metaphors research coordinators use make a difference in participant understanding of concepts such as randomization. A metaphor that described randomization as similar to the flipping of a coin evoked the idea of winning or losing, while comparing randomization to the chance an expectant mother may have a boy or a girl was better understood.

The study points to the importance of effective communication, targeted to the literacy and health literacy of the potential research participants involved.

Communication research and education in 2011

2010 was a productive year for both my own research efforts and the research efforts of my multi-disciplinary team. 2011 holds just as much promise for exciting research projects.

On my list for 2011:

Informed consent: I am working on proposals for several projects exploring the role of communication in informed consent discussions. Informed consent is important to both health care and clinical research. Patients and potential research subjects are dependent on informed consent discussions and documents to educate and inform them about the risks and benefits of procedures, so that they may make an informed decision. But if they do not understand what is discussed, their consent cannot be truly informed. There is great potential for improved communication to facilitate informed consent.

Working in multi-disciplinary teams: I had the opportunity this year to speak to several different groups about communication in multi-disciplinary teams. This year, I will be expanding the topic to explore the specific task of coordinating the writing of scientific papers when working and communicating with multi-disciplinary research teams.

Communication theory: Once again, I will have the opportunity to teach an Introduction to Communication class at Marquette University. Though I am primarily a researcher, I value the opportunity to get into the classroom and introduce students to the complexity and possibilities in the field of communication. I get energy to continue with my research when exploring the basics of communication with students. I look forward to what this year's students will teach me.

2011 should be busy, but it is rewarding to keep moving forward in my field and to share my knowledge along the way.