A prescription for better communication

Celebrity health and endorsements

2012-01-18T18:45:00.002-06:00

A lot has been written about Paula Deen this week. Deen is a Food Network chef known for her Southern cooking, which is often heavy in butter, cream and sugar. Deen announced this week that she was diagnosed three years ago with Type II Diabetes. This by itself perhaps did not raise a lot of eyebrows, though some commented that Deen could have helped a lot of people in the last 3 years by being open about her illness and modifying some of her recipes for her audience. But it's a medical condition and if Deen wants to keep that private, that's her prerogative. What did raise eyebrows was that she announced her condition and at the same time announced an endorsement deal with a pharmaceutical company that promotes a diabetes drug. This generated a lot of reaction about celebrity and responsibility.

Most of the arguments about this seem to stem from the fact that Type II diabetes is affected by an unhealthy diet and the effects of diabetes can by lessened with a healthy diet and exercise. So does Deen, a celebrity chef, have a responsibility to promote a healthy diet instead of a drug? Does she have a responsibility to her viewers to discuss how the foods she cooks may affect their health? Does the pharmaceutical endorsement change her responsibility? Or should we just let the celebrity chef be a chef?

A bald Barbie?

2012-01-16T18:17:00.002-06:00

What started as an online petition is stating to make national headlines. Two women started a petition addressed to the Mattel company to create a bald Barbie, a toy they say will be a symbol of support for girls undergoing cancer treatment or who experience baldness for other reasons. Mattel has been non-committal, saying they receive numerous suggestions for new dolls. But what support of the petition perhaps points to is the strong desire that patients have to affirm and even normalize their experience, especially the experiences of young patients and their families. A doll may not seem like much, but it may carry great symbolic value to a child who doesn't feel normal.

Cancer by another name

2012-01-11T18:04:00.002-06:00

A Discover Magazine article examines the fear that the word "cancer" raises and whether it might be reasonable to stop calling certain diseases cancer. Specifically, the author and researchers at Dartmouth contend that patients with very treatable cancers, that is, cancers that will not progress, overtreat their cancers because of the fear of cancer. The reason for this is perhaps in how people perceive risk, and how people manage their anxiety about risk. Cancer sounds scary,and people are inclined to treat it aggressively in order to manage their anxiety about the unknown and to feel a certain amount of control over a scary situation. But overtreatment carries its own medical risk and can increase patient anxiety, even when they are undergoing treatment to manage their anxiety over the disease.

It is an interesting question: would changing the name change the perception of risk?

Talking to children about genetic test results

2012-01-09T18:44:00.002-06:00

Genetic screening presents a unique communication challenge, in that the results do not only affect the person being screened, but may also have implications for family members who share that person's genes. The Wall Street Journal Health Blog reports on a recent study of how and what parents tell their children about screening results for the breast cancer gene. It's not surprising that typically children's reaction are in proportion to what they are told. But this study starts an important ongoing communication conversation that physicians, genetic counselors, and patients need to be aware of. Physicians and genetic counselors need to be aware that when they are counseling a patient, the words may get passed on to others. And patients need to consider what their family members want to know before discussing genetic tests.

Is this ad campaign too shocking?

2012-01-05T18:11:00.002-06:00

The Washington Post On Parenting blog draws attention to a public health campaign in Georgia that is getting a lot of attention. The campaign uses stark interviews and images of obese children to draw attention to the childhood obesity epidemic. Some critics complain that the ads miss the mark, because they emphasize the bullying that accompanies being an obese child, rather than the serious health implications. Other critics think the ads are exploitative of the young children participating in them.

What do you think? Does this campaign miss the mark?

Evaluating health stories in the news

2011-11-30T18:08:00.004-06:00

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

2011-11-06T19:10:00.002-06:00

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

2011-10-03T18:18:00.002-05:00

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

2011-09-15T18:38:00.003-05:00

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

2011-08-24T18:22:00.003-05:00

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

2011-07-27T19:40:00.003-05:00

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

2011-07-25T19:37:00.002-05:00

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

2011-07-14T20:10:00.002-05:00

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

2011-07-12T20:11:00.002-05:00

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

2011-07-11T18:27:00.002-05:00

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

2011-07-07T19:32:00.002-05:00

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?

2011-06-27T18:49:00.003-05:00

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

2011-06-23T18:25:00.002-05:00

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

2011-06-13T18:07:00.002-05:00

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

2011-06-10T18:14:00.002-05:00

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

2011-06-08T20:14:00.003-05:00

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

2011-05-26T19:56:00.003-05:00

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?

2011-05-19T20:20:00.003-05:00

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

2011-05-18T18:56:00.002-05:00

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

2011-05-16T18:27:00.002-05:00

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

2011-05-09T18:49:00.004-05:00

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

2011-04-18T18:18:00.002-05:00

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

2011-04-12T18:33:00.002-05:00

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

2011-04-07T18:38:00.003-05:00

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

2011-03-21T18:40:00.002-05:00

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

2011-03-16T18:20:00.003-05:00

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

2011-03-07T18:36:00.002-06:00

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

2011-03-06T16:07:00.006-06:00

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

2011-02-10T17:41:00.001-06:00

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

2011-02-04T18:47:00.002-06:00

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

2011-01-27T19:00:00.002-06:00

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

2011-01-20T19:28:00.003-06:00

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

2011-01-06T18:11:00.002-06:00

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

2011-01-03T18:26:00.004-06:00

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.

A third party in the relationship

2010-12-06T18:22:00.001-06:00

The New York Times Well blog raises an interesting question about the relationship between a physician and a patient: Do physicians need a chaperon when performing invasive procedures?

The presence of a chaperon during invasive procedures is intended to protect both the physician and the patient. But It raises a question of how this could potentially impact the relationship. If either or both the physician and patient feel a chaperon is necessary, does that imply something about the level of trust in the relationship? Or does the presence of a chaperon simply indicate caution and not a lack of trust?

How do you think this would affect physician-patient communication? Will the communication somehow be different if both the doctor and the patient know that a third party has to come in and watch the procedure? How should physicians and patients discuss the issue of chaperons?

A new face of AIDS activism

2010-11-30T18:48:00.002-06:00

On the eve of World AIDS day, The New York Times has an article about the changing face of AIDS activism. Where advocacy was once dominated by those affected by the disease, specifically the gay community, now a growing voice of activism is found public health students. The student protesters are armed with knowledge and research about disease rates and what could and should be done to fight AIDS. And many of these students are using political protests to be heard, even protesting against a president they worked to get elected.

What do you think of this shift in activism? What role should political protest play in bringing attention to public health issues?

Communicating about religion in the hospital

2010-11-03T18:28:00.002-05:00

An article in The New York Times Health section featured an article today about an article in the Journal of Medical Ethics, considering Muslim religious beliefs and how those beliefs may impact the delivery of health care. Muslims differ in adherence, but maintaining modesty is an overriding ethic, and may even cause some to delay care if they cannot get in to see a physician of the same gender.

While it may not always be possible to accommodate all religious requests, respect and communication can go a long way to facilitate trust between the physician and patient. It starts by the physician simply asking, either in person or in an intake form, what their religious concerns are and what can be done to make them more comfortable. Those conversations can be a good starting point for discussing what can be accommodated and what is necessary. A conversation, rather than a directive, will help the patient feel heard and cared for.

Is candy evil or misunderstood?

2010-10-27T18:31:00.003-05:00

The New York Times Health section featured the Candy Professor, Samira Kawash, a writer and professor who researches the history of candy, and how it is sometimes vilified. The Candy Professor contends that candy has always been honest about what it is: a processed food, a treat, something for pleasure not for nutrition. But some people have a knee-jerk reaction against eating candy, or feeding their children candy, despite reaching for foods such as fruit juices and granola bars that have just as much sugar. Candy is seen as something forbidden, while those granola bars have a veil of nutrition.

It is an interesting look at how we make decisions about food, perhaps not always rational ones. It is also about communication and the messages we hear about candy and how that influences the decisions we make.

What do you think?

If the result is the one you want, does it matter how you get there?

2010-10-20T18:27:00.003-05:00

The New York Times Parenting blog points to an interesting new public service announcement running in New York. The PSA encourages moms to breastfeed. But the enticement is not the health benefits for the baby. The enticement to breastfeed is that many women who breastfeed lose weight.

So the question is whether it is appropriate to entice an audience to engage in a behavior for vanity? It's not unheard of. Anti-smoking campaigns have used the approach. And breastfeeding campaigns might also mention other reasons for breastfeeding that have nothing to do with the baby's health: such as monetary savings. If a health campaign is successful in getting an audience to engage in a health behavior, does the why matter?

Pink fatigue

2010-10-11T19:32:00.002-05:00

The New York Times Well blog had an article today about the growing number of voices expressing "pink fatigue." October is breast cancer awareness month and pink is everywhere. but some fear that the emphasis on marketing and cutesy products misses the point. Others feels the money could be better spent on actual breast cancer research rather than "awareness."

I can appreciate that this can be a difficult balance to find. You do want to raise awareness of the disease, especially since early detection can be helpful in treatment. Creative fundraising can bring in a lot of money. And it's nice for people to feel like they are doing something, even if it is just saving yogurt lids. But are we missing the point? At least one group is suggesting we need more than pink, we need a deadline. The National Breast Cancer Coalition has taken the pink gloves off and set a deadline to find a cure: January 1, 2020.

Despite the frustration, it appears the sea of pink is here for now. But let's continue to highlight research efforts as much as we highlight baseball players with pink bats.

How we talk about food

2010-09-27T18:11:00.003-05:00

Two stories from the last week have highlighted the complexities regarding communication about food. The Corn Refiners Association is looking a new word for high-fructose corn syrup, preferring the name corn sugar. But there are a lot of skeptics about the reason for the rebranding, as seen in the comments in the New York Times Health blog. While the Corn Refiners Association says they are looking for a more accurate name, some health advocates think the move is an effort to confuse consumers into thinking corn syrup is healthy.

The other story is about carrots. The baby carrot association is spending $25 million on a new advertising campaign to market the bite-sized carrots as a fun snack, even as fun as junk food. But it seems no matter how much health advocates push vegetables, it seems we are not eating them.

So why is communication about food so difficult? What strategies would you suggest to communicate about healthy food?

Communication through touch

2010-09-14T19:51:00.002-05:00

The New York Times Well blog has an interesting discussion today about a recent JAMA essay. In the JAMA essay, a medical student contemplates even and when it is appropriate to hold a patient's hand. Some of the Well commenters were mystified that a medical student would even need to ask if it is appropriate to hold a patient's hand and show compassion. But in the current medical culture, students are taught to be very aware of how actions, even as simple an action as holding a hand, may be viewed.

It is the reality of physician-patient communication, that the physician may always have some level of concern about communication being misconstrued. And this fear has the real potential to limit high-quality communication between physician and patient. All communication involves some risk, the risk of being misunderstood. But a physician taking a risk and offering a hand to a patient at a difficult moment can mean the world to a patient.

Learning to talk the talk

2010-09-06T18:08:00.002-05:00

Theresa Brown, a registered nurse and regular contributor to the New York Times wrote an article this week about nurses learning how to talk quickly in emergent patient settings. The style of speech values speed, with elements of persuasion, especially when trying to get a patient a needed bed in the ICU.

But the article does not explore the potential pitfalls of such rapid fire conversation. The possibility of mistakes was acknowledged, but more than mistakes, the rapid conversation can have long term implications for the health of communication between colleagues. Short, clipped conversation does not allow for collaboration or learning and working together to support and care for patients. Certainly there are time when this style may be very necessary, and it does fall on health care workers to learn how to communicate that way. But there is a time for longer, thought out conversations as well, even on a busy hospital floor. We are all better off if health care providers are able to develop multiple communication tools and styles and not just depend on one quick style to get all things done.

Teaching with patients, from the beginning

2010-09-02T20:10:00.003-05:00

The New York Times had an article today about a medical school program that is turning the traditional medical student schedule on its head. New York University is now exposing students to patients from their very first day as medical students, rather than waiting until they are third year students as many traditional programs do.

NYU is not the first program to introduce a patient element in the first year of medical school. But such efforts point to medical schools' awareness that the process of medical education can be emotionally draining. Students who lose sight of why they are training to be doctors may find themselves experiencing "empathy erosion." Patient contact from the beginning helps these physicians in training remember they are learning not to treat diseases, but to treat patients.

Battlefield humor and patient-physician communication

2010-08-24T17:07:00.003-05:00

Dr. Michael Khan explores the pervasiveness of "battlefield humor" in this week's New York Times Cases section. Beyond being dehumanizing, and just plain rude, demeaning humor used to describe patients may have a direct impact on communication with the patient and ultimately on patient care. If a physician automatically assumes that a patient's behavior is because of some character flaw, or because the patient is a "whale" or the patient's "crazy," the physician may miss a real symptom or indication. And the humor certainly creates a barrier to building a trusting relationship between physician and patient.

Physicians certainly work in a stressful environment and certainly not all of their patients are pleasant. But what are some alternative that physician might consider to this battlefield humor? How can communication scholars demonstrate the affect this humor has on patients?

When words, and friends, fail

2010-08-16T18:13:00.002-05:00

An essay in The New York Times today highlights the difficulty of going through a health crisis and having friends seemingly disappear. Psychologists are beginning to explore what people experience when they are witness to other's traumas. Part of the difficulty, is that words fail, and friends don't know what to say to a sick friend or how to help. The other difficulty is not so much a lack of empathy, but too much empathy. When a healthy friend can picture herself or her child as sick as the sick friend, it may give them cause to pull away from that friend in need.

Sometimes the right words and the right actions don't come naturally. But knowing our own fears and vulnerabilities may help us think twice and reach out to those in need.

The challenges of psychosocial research

2010-08-03T18:11:00.001-05:00

An article in the New York Times today highlights some of the particular challenges of psychosocial research. The article discusses the challenges of personality analysis, specifically as it applies to research of generations. Is it possible to analyze and assess a collective generational personality? Are there flaws in how researchers try to measure personality, behavior and attitude?

Measuring attitude is a difficult task, because even at its best, you have what the participant says and some sort of scale or means of interpreting what it means. There is a lot of room for error: the participant may just say what he thinks the researcher wants to hear, the participant may says what is socially desirable, the researcher may interpret the responses incorrectly or the researcher may think he is measuring one thing when he is actually measuring something else. This is why different mechanisms for validating behavioral scales are so important. The work is extremely valuable in that it can teach us something about ourselves and how we approach our world. But it is indeed a challenge.

Should you read your doctor's notes?

2010-07-19T18:30:00.002-05:00

The Los Angeles Times had an interesting blog post today about the notes that physicians write in patient's charts. The patient's chart ultimately belongs to the patient, and so one hospital system is starting a new project where patients can access the notes in their chart by a secure Internet portal. But will being able to read these notes cause more harm than good? Will physicians be as candid in their notes if they know the patients will read them later? But, the notes can give patients insight into their illness and how the physician is approaching it.

It is an interesting discussion and it is one that will only continue as more clinics and hospitals convert to electronic medical records.

Taking the patient into consideration when planning the medical home

2010-07-15T18:43:00.002-05:00

Dr. Pauline Chen's article this week in the New York Times shows what happens when doctors and health systems make plans, but fail to consider the patients needs or even the patients reactions. The article examine the concept of the "patient-centered medical home," a team-based, comprehensive approach to preventative care, facilitated by electronic medical records. It sounds like an efficient system. But some practices implementing the system have found that patients do not understand and even dislike the system that was put in place to center around the patient. Now practices are playing catch-up by setting up patient advisory panels and other mechanisms for patient feedback.

The findings of the early medical home models demonstrates the importance of patient buy-in to any type of medical practice reform. Without patient buy-in, medical care comes to a sudden halt.

Two important aspects of communication

2010-07-12T18:12:00.002-05:00

Our research team, even while plugging away on two population-scale communication research projects, is thinking about the future and how we can build on the projects we have already done. Our conversations led us to consider two important, but different, aspects of communication: content and conduct.

Content is the "what" that is communicated.
Conduct is "how" it is communicated.

It is especially important to consider both content and conduct when considering physician communication with patients. Is the physician giving correct information? Is the information appropriate for the stage of the conversation? But even if the content is correct, it is not enough if it is not communicated effectively. Does the physician use words the patient is likely to understand? Does the physician check in with the patient to see if the patient understands what is being said? Does the physician consider the patient's emotional reaction?

And so physician-patient communicators continue to seek way to measure and improve both the content and conduct of physician communication.

How hard should you try to convince a patient to do something?

2010-07-05T18:57:00.002-05:00

The Wall Street Journal Health blog reported last week on an editorial in the Journal of the National Cancer Institute. The editorial considered whether it might be more worthwhile to invest money into improving cancer screening technologies such as mammograms, rather than spending that money on getting more patients to get existing, imperfect tests. Some patients may have a rational, logical and well thought-out reason for turning down an imperfect screening test. No amount of education campaigns is likely to change that decision.

The article points to a larger discussion of what the goal of physician counseling should be. Is the physician's goal to convince the patient to do what he or she wants the patient to do (i.e. get the screening test)? Or should the physician's goal be to simply counsel and educate the patient, and then let the patient make a decision? It is easy to say that the goal should be the latter, but in practice, this is difficult for both the physician and the patient. Physicians face the reality of practice standards and pay-for-performance schemes that say what tests a patient should get and when. And patients may not be willing to make difficult decisions or may make poor decisions no matter how much evidence is given to them. The task of counseling does not have any easy answers. But it seems that if 71% of women are getting a screening test, the reason the other 29% are not is not as simple as a lack of discussion.

The value of patient stories

2010-06-28T18:43:00.002-05:00

The New York Times Health section had a compelling article today about the value of patient stories and memoirs. Their value may not be in their literary style, many may in fact be lacking literacy polish. The true value of these stories may be the stories themselves. There is therapeutic value to the story, both for the reader and the writer. They inform us of the human condition, the very real emotional pain that goes into illness, and perhaps remind us of the need for empathy toward each other.

Learning to communication in multi-disciplinary teams

2010-06-21T17:41:00.008-05:00

I had the privilege to present at the ACRP Global Conference in April. You can now listen to the audio of my presentation about Communication in Multi-Disciplinary Teams here ACRP Presention.mp3

A tangible piece of the conversation with your doctor

2010-06-08T19:57:00.003-05:00

Things have been buzzing with our physician-patient communication research group. A new topic of interest is the use of brochures and handouts, a tangible piece the patient can take away from the conversation. Specifically, we are interested in looking at how brochures and handouts can be used to aid in the conversation. Perhaps brochures can help prompt comments from both the physician and the patient, as they read through the brochure together. And when the physician or the patient actually writes something on the brochure, it may help prompt recall of the conversation later.

What do you think? What makes a brochure or handout from a doctor useful? And what make it go straight in the garbage?

Having a communication plan

2010-05-26T20:05:00.002-05:00

Last week my team experienced a bit of a communication meltdown, which is only somewhat ironic considering we are communication researchers. So after some triage and promises to give each other "the benefit of the doubt," my thoughts now turn to how we could have better planned for communication disaster.

Those outside the field of communication sometimes dismiss it because they think that communication just occurs naturally, like breathing. But communication scholars and teachers are fond of saying that communication doesn't just happen. Communication is, among other things, a skill. If it is a skill, it is something that can be refined and improved with practice, and something that can be planned for, should things go wrong. The key is awareness and intentionality. Know how communication can go wrong on your particular team and think about what you will do if it does. Does your team respond better to discussions as a group or individual conversations? Do they respond to writing or face-to-face interactions? Thinking about your team's communication style before blow-ups occur will better equip you to address problems as they come up and even catch little problems before they become big meltdowns.

Communication theory in the informed consent process

2010-05-17T19:28:00.003-05:00

I learned so much from the ACRP Global Conference in Tampa last month that I am already making plans for what I want to present at next year's conference (and the fact that ACRP 2011 is in Seattle is extra motivation). I realized that I bring a particular skill set to the clinical research educational setting: my background in communication theory. I was not the only presenter who discussed communication at the ACRP 2010 conference. Several other speakers focused more on the soft communication skills, but I saw a need for a discussion of how communication theory can inform the most important conversation that takes place in the research encounter: the informed consent.

One of the theories I am going to integrate into my presentation next year is Uses and Gratifications Theory. The theory is usually used in studies of people's media use and habits, but I believe it is an important consideration when having an informed consent conversation. It is tempting for research staff to think of potential research participants as empty vessels waiting to be filled with information. But every potential participant brings their own agenda to the conversation and will seek, find and attend to selected information. It is a valuable piece of information to consider when informing potential participants about participating in a particular study. I look forward to the opportunity to bring communication theory into the research professionals conversation.

The other revolution started by "The Pill"

2010-05-11T18:37:00.003-05:00

This article is a week old, but I still wanted to point it out. Last week was the 50th anniversary of FDA approval of the birth control pill. Approval of the birth control pill is credited being one of the events that led to the "sexual revolution." But as this article points out, the approval of the pill started another revolution, a revolution at the FDA. At the time of the pill's approval, the FDA started to take a strong role in post-market surveillance, that is, continued observation and research of drugs after they have been approved. With the pill, we also saw the beginning of the FDA's direct communication with patients, rather than communication from the FDA to patients via physicians. The approval of the pill also followed the expansion of the process of clinical trials to show safety and efficacy of a drug, procedures that are now commonplace. It's an interesting piece of research history and shows how we came to the regulations researchers now face today.

A message that resonates

2010-05-03T18:28:00.002-05:00

I had the opportunity to present a poster and brief presentation on communication in multi-disciplinary research teams both at the Association of Clinical Research Professionals Global Conference in Tampa and at my local Southern Wisconsin ACRP chapter. I am passionate about communication education and count it a privilege to be able to share my knowledge with my clinical research colleagues.

The thing that is most encouraging to me is that this message of improving communication skills within the context of research teams is resonating with research professionals. The research professionals I met understand the importance of communication to effective team functioning. They have learned that communication is a skill that can be improved and it is encouraging that these professionals are seeking to improve their communication skills. I hope to continue to teach and encourage my clinical research colleagues about the importance of effective communication in the team work environment.

Learning to communicate in multi-disciplinary teams

2010-04-19T18:48:00.003-05:00

I am privileged to be presenting at the Association of Clinical Research Professionals Global Conference later this week. I will be presenting a poster and a brief presentation about a topic that combines my interest, experience and expertise in the fields of communication research and clinical research: communication in multi-disciplinary research teams.

Multi-disciplinary research teams offer many advantages, the most compelling of which is having a broad range of perspectives to bring new and innovative ideas to the research table. But each of us educated in a specific discipline are taught to approach questions and problems in a certain way. When required to work with people who are educated another way, potential conflicts arise. Understanding the potential pitfalls to working with multi-disciplinary teams is the first step to maximizing the benefits of these teams. Team leaders need to work to create a supportive environment, where all members feel safe to share new and innovative ideas that may be unfamiliar to the rest of the group. Ongoing conversations about roles in the team, as well as making a conscious effort to learn from your teammates, will head off some of the potential misunderstandings.

The benefits of multi-disciplinary teams far outweigh the potential pitfalls, but being prepared for the pitfalls makes success all the more likely.

The problems patients have with reporting symptoms

2010-04-13T19:07:00.002-05:00

The New York Times reported on a New England Journal of Medicine article about how patient-reported data about drug side effects can be a tremendous source of information. But physicians and patients often have trouble discussing potential side effects because of limited time in consultations and limited understanding of what side effects and their causes may be.

So we have a great potential source of data about emerging drugs. But we have a communication gap in getting that information from patients to doctors to researchers. Many hope that opening new lines of communication for patients to report symptoms they are unsure about to others may help facilitate the reporting process. Information coming directly from patients will increase understanding of new and emerging drugs and technologies. And giving patients another means of expressing their concerns helps the patients be heard as they pursue their own health care.

Picturing life after cancer

2010-04-08T18:27:00.002-05:00

The New York Times is working on a compelling project to collect stories and pictures of cancer patients. Cancer survivors are encouraged to "picture life after cancer" by submitting photos and thoughts about what life means after cancer. You can see the first of the submissions here.

The power of the face in communication

2010-04-05T18:51:00.002-05:00

The New York Times had a very interesting article today about research on the importance of the face in conveying non-verbal messages and how even those without control of their facial expressions can read facial messages. While those who are not able to control their face cannot mimic facial expression, they can adapt and still learn to read and respond to non-verbal cues. Further research will explore how these adaptations can be used with other groups who struggle with non-verbal cues.

When a physician becomes the patient

2010-04-05T18:31:00.002-05:00

I want to direct readers to the latest article in the New York Times "Months to Live" series. The article features Dr. Desiree Pardi, a palliative care doctor, who when faced with the end of her own life, decided to defy the usual advice she gives patients and fight the cancer until the end. The article explores the complexities of physicians' advice and how things change when the physician becomes a patient. I definitely recommend reading and contemplating.

Listening to private calls to gain insight in therapy

2010-03-25T18:06:00.002-05:00

The New York Times Cases article this week examined how therapists sometimes get an unintended look inside the patient's life, by the phone calls they take. Therapists now find themselves able to gain insight beyond what is said in session, by how patients react to cell phone calls from children, spouses and others.

But I can't help but feel a little odd about this. I know the patient shouldn't expect privacy if they take a call in front of his or her therapist. But is it OK to put those conversations on the analytical table? Should the patient retain some control of what the therapist and patient talk about or should the therapist be free to bring up something that is observed? Maybe they do this already and cell phone calls are just another observation.

This is just one example of how technology is changing clinician-patient communication. What are others?

Patients finding support on social networking sites

2010-03-24T18:39:00.002-05:00

The New York Times had an article today about a new Pew Center for Internet and American Life survey about how patients with chronic illnesses are finding new ways to cope online through social networks. Patients who once felt isolated now have a forum for sharing questions, hopes and ideas for coping with the particular complications of an illness. Fellow patients are able to relate to each other, in a way that their physicians may not be able to, simply because they physicians have never experienced actually living with an illness. Patients describe being in a neighborhood or a member of a community. Now even people with rare illness can have a support group, though they may never meet in person.

You can check the survey and data out here.

What doctors and patients are NOT talking about

2010-03-16T18:38:00.002-05:00

The New York Times Well blog had an interesting article today about the issue that physicians and patients appear to not be talking about: a patient's weight. It is a difficult, but important, conversation to have. Weight plays a pivotal role in so many health issues. But physicians seem to not be bringing it up with their overweight patients. Some physicians may be embarrassed or may feel ill-equipped to make proper recommendations for weight loss. Some may just be discouraged that the advice will fall on deaf ears. Whatever the reason, failure to bring up this important health issues can have a real impact on the clinical relationship between physician and patient, as well as the interpersonal relationship. Patients know when they are overweight and if a physician doesn't bring it up or help discuss strategies for weight loss, the patient may feel like they are not getting the care they need. The weight-loss conversation may be difficult, but the alternative is worse.

Changing hospital culture to improve patient safety

2010-03-11T18:16:00.003-06:00

Dr Pauline Chen's Doctor and Patient column this week explores how hospitals are trying to increase patient safety by encouraging disclosure of errors, so that physicians and administrators can learn from and improve on systematic errors. But Dr. Chen explores the difficulty directors of these types of disclosure problems have encountered. It takes more than just encouraging error disclosure, you have to change an entire hospital culture of that has come to fear mistakes because of fear that it will damage a long sought after career or result in a malpractice lawsuit. The article demonstrates that you cannot change an entire organizational culture by changing a policy on paper. This kind of shift in attitude will require long-term educational efforts and open dialogue about the importance of patient safety and how disclosing errors helps achieve that safety goal. Organizational culture does not change overnight. But ongoing, effective communication, can help achieve new cultural goals.

Seeking help for a rare illness by going where the researchers are

2010-03-10T18:35:00.002-06:00

Along with an article about an FDA orphan drug conference last month, The Wall Street Journal also explored how one mom is using the conference as a chance to seek treatment for her daughters by going where the researchers are and talking with them face-to-face. The purpose of the conference is to encourage researchers to pursue funding and research for orphan drugs, that is drugs for very rare diseases. The FDA has set aside substantial money for orphan drugs, but few researchers pursue it. So the FDA has hosted conferences to encourage researchers to seek the funding and help them with the application process.

But the conference isn't just attracting researchers. It has also attracted one persistent mom, who visited the conference to pursue research to find a treatment for a rare illness affecting her twin daughters. The conference helped "demystify the process" for this mom and the researchers, but also showed what can happen by actually meeting and talking to each other.

Peer communication and the pressure to snack

2010-03-03T18:54:00.003-06:00

There have a been a couple articles in the last couple weeks in The New York Times about snacking, including this Well blog article earlier this week about a recent article in Health Affairs. What I found interesting about these articles is not the data about how much children and adults snack, but the personal stories about parents who feel pressure to comply with the snacking culture. Parents may try to speak up about the endless supply of snacks at club meetings, soccer games and school, but may quickly retreat from the position when ridiculed or scorned by other parents. The stories give dramatic insight into how interpersonal and group communication impact health behaviors. As health care providers and health communicators create messages about health behaviors, they have to keep in mind the influence of peer groups. Otherwise, the messages, no matter how well crafted, may fall of deaf ears.

Trusting other patients for medical advice

2010-02-25T19:16:00.002-06:00

The Wall Street Journal had an article today about how pharmaceutical companies are starting to rely more on true patient testimonials in their advertising efforts. The use of patients taps into the growing influence of a peer-to-peer networks and also comes at a time when pharmaceutical companies have faced criticism for use of celebrities and physicians in their advertisements.

What do you think? Do you think the use of patient testimonials is appropriate in the marketing of pharmaceuticals? Do you think it is effective?

Snow day at the hospital

2010-02-24T19:21:00.002-06:00

I appreciated this article from regular Well contributor Theresa Brown about a snow day at the hospital. People in Wisconsin are a hardy bunch, but every once in a while, the public schools get a snow day. And I watch my friends workplaces close that day, while my academic medical center always stays open. Admittedly, I am sometimes tempted to be crabby about this, because I'm not clinical staff. I mean, I'm a psychosocial researcher! What's the point in me trudging in?

But while the work I do is not the same as a nurse providing comfort, I see the importance in moving forward with our research, despite atmospheric forces.

Besides, that's what the county bus system is for.

Doctors and patients divided about new guidelines

2010-02-16T17:33:00.002-06:00

There was considerable confusion last fall when the United States Preventative Services Task Force changed its recommendations regarding mammogram screenings for women age 40-49. Several months later, a report in the Annals of Internal Medicine, as reported by The New York Times, says that there is a divide between physicians and patients regarding following those recommendations. Physicians are more likely to follow the guidelines, which recommend women start routine screening at age 50 and be screened every other year, while patients are more likely to want more frequent screenings as previously recommended.

The disparity points to the continued communication challenge, as physicians and patients must clearly convey their desires and reasoning for screening procedures.

Bad advice on medical dramas

2010-02-15T18:40:00.002-06:00

CNN reported today on a new study that shows that medical dramas on television do a poor job depicting how to treat someone with a seizure. It isn't the first time that medical television shows have been criticized for how they depict medical situations. But it does raise the question about how much influence these shows have. Many viewers realize that the dramas they are watching are fiction. Actual medical care is as undramatic and calm as possible.The television writers and producers have to make these things more dramatic to make them worth watching.

But do the television writers have a responsibility, even if they are writing fiction? They have a tremendous audience, and one of those viewers may encounter someone experiencing a seizure or in need of CPR. It is conceivable that a viewer will act as they have seen the doctors act on television. Does the writer have a responsibility to medical accuracy, even at the cost of drama?

Maybe, medical reality can be as dramatic as fiction.

Whistle-blower nurse acquitted in Texas

2010-02-11T18:05:00.002-06:00

A troubling legal case pitting two nurses against a doctor and sheriff came to an end today. Anne Mitchell, a nurse who anonymously reported a physician to the Texas Medical Board, found herself facing indictment for "misuse of official information" a 3rd degree felony which carried a possible 10 year sentence $10,000 fine. Mitchell said she was only trying to protect the safety of her patients. Today, a jury took less than an hour to acquit Mitchell of the charges.

The case, and the implications of it, are far from over. But the case points to what can, in rare cases, be a tense relationship between nurses and physicians. Physicians and nurses both have obligations to protect the health of their patients. But if either is more interested in preserving their position and authority than in protecting the patients, then the other person is put in a difficult position no matter what they do, and ultimately, everyone can get hurt.

And again we see that in the dynamics of health care delivery, where humans with all their flaws, egos and mixed motives are delivering the care, there are no easy answers.

Different priorities

2010-02-09T19:11:00.002-06:00

The New York Times had an article this week about a paper in the Journal of General Internal Medicine examining what is sometimes a great disparity between physicians and patients: medical priorities. Physicians and patients often have different priorities for medical encounters, as well as different priorities for care of chronic conditions. The article is concrete evidence of the many anecdotes of failed patient-physician encounters. Physicians are failing to communicate with patients about the broader implications of symptoms and illnesses. Patients are failing to communicate their concerns and the reasons for their concerns. There is no easy answer to this dilemma, other than increased listening. But we all know, that is no simple task - for doctors or for patients.

A journal retracts an article but they can't change minds back that easily

2010-02-03T19:21:00.005-06:00

This week The Lancet formally retracted an article published in 1998 that suggested a link between vaccinations and autism. The article has been highly publicized and had cast doubt about the safety of vaccines among many parents. The ideas in this article and subsequent research have circulated for 10 years and it will likely take more than a retraction in a British medical journal to retract the idea in the minds of many parents and many in the public. A New York Times article suggests the retraction may be little to change skeptics minds at all.

It is like the old story often used in Sunday School lessons about gossip. The setting sometimes changes, but at the crux of the lesson a minister and the town gossip go to the top of the church steeple and the minister cuts open a down pillow and scatters the feathers to the wind. He then asks the town gossip to gather every one of the feathers. It is, of course, impossible. Once the words are out there, they cannot be gathered back.

Research is about innovation. And innovative ideas are often put in the public before they are fully understood. I don't think this should stop us from exploring innovative research. But all of us who do research must realize the power of our words. Once we put the words out there, it is nearly impossible to take them back.

The role of simulated patients in medical education

2010-02-02T18:09:00.000-06:00

Dr. Pauline Chen's Doctor and Patient column last week focused on the role of simulated patients in medical education. The article sheds light on a practice that few outside medical education get to see. The simulated patients and situations can be quite complex and allow medical educators and students to practice procedures in a safe, standardized environment. Standardization is also important in assuring that students are trained in the same way, creating an environment where best practices can be reinforced from the beginning of a student's education.

Of course, simulated patients and medical scenarios can only go so far. There is absolutely no substitute for real-life experience. But students and teachers are finding that the simulated patients can provide a valuable place to start gaining that experience.

The limitations of communicating risk

2010-01-21T18:20:00.003-06:00

The New York Times Well blog had an article earlier this week about how elite athletes continue to use performance enhancing drugs, despite the known risk. One study mentioned in the article compared attitudes to non-athletes and were astonished at the difference in attitudes toward taking risks if it will enhance performance. Elite athletes are more willing to take huge risks.

Practitioners and physicians would do well to keep in mind that risk tolerance is not universal. Some people may have different motivations for taking risks. If the motivation is strong enough, say the motivation to win an Olympic gold medal, no amount of communication may talk that athlete out of a big risk.

Measuring what it takes to be a good doctor

2010-01-19T20:00:00.002-06:00

Dr. Pauline Chen's Doctor and Patient column in last week's New York Times explores the tests that act as gatekeepers for those who would pursue a career in medicine. The tests are used, in part, to determine who has what it takes to be a doctor. But do these test miss some key component of personality when it comes to measuring who will be a great doctor? Or is knowing the right answers on a test more important than any measure of personality?

Putting off difficult discussions

2010-01-12T19:05:00.002-06:00

The New York Times had an article earlier this week about the difficulty physicians have with discussing end-of-life care treatment with terminal patients. The conversations are difficult, but important, and include such decisions as aggressiveness of treatment, resuscitation and hospice. Guidelines dictate that such discussions take place when the patient has a year left to live, so the patient can make decisions along with their families. But many physicians fail to have those conversations until much later. It is easier to suggest more treatment than to have a difficult conversation with a patient about his or her impending death. But failure to have those conversations may result in more aggressive treatment than a patient desires and death in a hospital when a patient would have preferred the comforts of home. While the conversations are difficult, physicians who learn to have these conversations help their patients live their last days as they wish.

The power of non-verbal communication

2010-01-04T18:52:00.002-06:00

As a teacher, I love light bulb moments - the moment when you can almost see a visible light turn on a students face; the moment an abstract concept becomes concrete. The New York Times Cases section has such an article today: a first year resident learns the power of non-verbal communication in conveying caring to a dying patient. Effective, compassionate communication goes beyond learning the right words from a textbook. Real communication requires seeing, feeling and giving time.

The toll of malpractice

2010-01-03T14:17:00.002-06:00

Between the holidays and teaching at Marquette University I have still had time to keep an eye out for insights into physician and patient communication. The New York Times had an interesting article last week about the emotional toll a medical malpractice case can take on the physician involved. While the article does not offer any solutions to how malpractice cases are handled or how they should be handled, the article does offer insight into how the cases affect physicians and how the possibility of future malpractice suits affects how physicians communicate with their patients everyday.

Respect and patient-physician communication

2009-12-15T17:58:00.002-06:00

The New York Times Health section had an interesting article today, written from a doctor's perspective, about the power of names. The question is: how should physicians and patients address each other? Should physicians insist on being called "Doctor"? Should patients insist on being called Mr. or Ms.? Is a title a show of respect or detachment? When a physician or patient calls the other by his or her first name, is it a way of demeaning the other? Are we over-thinking all of this? The article generate passionate response from both physicians and patients.

The fact that the issue of titles is a concern at all shows the inherent difficulty in effective physician-patient communication. Both parties wield a certain amount of power: one of expertise in a field, one of ultimate control of their body and where they take it. There is a need for respect in this communication relationship, but also a need for intimacy. How do you balance formality and respect with the intimate nature of physician-patient communication and clinical exams? And what do you call each other when you do it?

Intimate acts of care

2009-12-09T17:13:00.002-06:00

Registered Nurse Theresa Brown, a regular contributor to the New York Times Well section, offers insight into the intimate acts nurses perform in the care of cancer patients. The essay demonstrates that communication between nurses and patients goes beyond words, to intimate moments of touch, comfort and care.

Giving as an act of healing

2009-12-01T19:06:00.002-06:00

The New York Times Well blog reviewed a book that explores the health rewards of giving to others. Giving to others isn't a medical cure for anything, but is presented as a means of helping patients cope and gives them hope. The book and the article cite some of the science and questions behind the idea of giving as a means of healing. But in this case, the science isn't as compelling as the stories of patients who have gained from giving to others. And we will all do well in this season to remember that the joy of giving is a joy unto itself, regardless of the benefits.

The Cancer Lounge

2009-11-30T18:46:00.002-06:00

The New York Times had a compelling article last week about the cancer recreation lounge at Memorial Sloan-Kettering Cancer Center in Manhattan. The lounge is a place for patient to both forget about their cancer and talk about their cancer freely with other patients who understand. It is a compellling read about the waiting involved in cancer treatment and the simple joy a card game can bring.

Tension at the Thanksgiving dinner table

2009-11-23T18:39:00.002-06:00

The New York Times Well column this week reflects on the tension that sometimes joins the family at the holiday table. In particular, issues surrounding food, portions, control and preferences, can cause anxiety when families join together for a big meal. The article illustrates that health messages are not always healthy and that the messengers aren't always health professionals. We should all remember there is power in our words.

New breast cancer guidelines and possible confusion

2009-11-16T18:58:00.002-06:00

New screening guidelines by the Preventative Services Task Force of the Department of Health and Human Services may start a lot of conversations in exam rooms across the country. The Preventative Services Task Force is recommending women be screened for breast cancer starting at age 50, with follow-up mammograms every other year. This is a change from previous guidelines and and is opposed by many cancer associations, which recommend annual mammograms starting at the age of 40.

The contrasting guidelines will likely be a source of confusion for some patients, faced with the decision to have a mammogram. It will be all the more important for physicians to provide effective counseling and ongoing dialogue with patients to help them make the decision that is right for them.

The importance of a name

2009-11-03T18:29:00.004-06:00

The New York Times had an article today about the intangible importance of having a name for a disorder and how patients claim ownership of that name. The issue is being raised by a group of patients unhappy that the term Asperger's Syndrome will be removed from fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Asperger's Symdrome is a mild form of autism, in which children and adults often are socially awkward but many are verbal prodigies and highly skilled in specific expertise. But inconsistent diagnosis and a move to depict mental illnesses as falling on a spectrum rather than "they-have-it-or-they-don't" mentality have lead the editors of the D.S.M.-V to place what is known as Asperger's on the autism spectrum. But patient advocates are concerned that losing the well-known and well-accepted term will make others reluctant to seek treatment if they exhibit mild autism spectrum symptoms.

The American Psychiatric Association is expected to post a draft of the new terms and diagnostic criteria and solicit feedback from the community. There will likely be a lot of it, and the feedback will give the authors insight into how patients see themselves and their community.

The physical environment and communication

2009-11-02T18:32:00.004-06:00

The New York Times blog on aging, "The New Old Age," had an article that illustrates how interpersonal communication isn't just about two people talking, but is also about the environment and circumstances surrounding the interaction and the relationship. The article takes a look at Continuing Care Retirement Communities or CCRC, where residents can enter into an independent living apartment and be moved within the same building to an assisted living floor when the time comes. Intuitively, these facilities seem like a great idea: residents can make friends while they are still independent and mobile and when they require more assistance they will still be able to remain in the same community. But studies and observations are finding that moving within the same facility doesn't mean relationships stay in tact. It seems physically moving, even if it is only to another floor of the same building, can disrupt interpersonal and community relationships.

What do you think? Is there a way these facilities can better accommodate communities as individuals' needs change?

Cancer and Halloween

2009-10-27T18:10:00.003-05:00

I don't have much to add to this. Dana Jennings, a reporter for The New York Times, has chronicled his life with prostate cancer for the NYT Well blog. This week, he wrote about Halloween and the ghosts of cancer. You can find his eloquent post here.

Being a doctor and a patient

2009-10-26T19:35:00.002-05:00

As part of their ongoing series on the 40 year war on cancer, The New York Times did a profile on the M.D. Anderson Cancer Center in Houston, Texas. Among the stories were the unique perspectives of both a nurse and a physician who faced a cancer diagnosis and treatment in the place where they have cared for so many patients.

The article touched on how being a patient might affect a physician's perspective:

“A common question people would ask is ‘Are you a better doctor since
you’ve been sick?’ ” Dr. [Martin] Raber said. “My first answer is that I
thought I was a good doctor before. I was worried about being a worse doctor.
Having lived through these biopsies and all these tests, would I be hesitant to
order all these things patients need because I had experienced them and knew
they were not pleasant?

“Then I realized I am not better, but I am a different doctor,” he said. “I
talk to patients differently. I understand more of what their situation might
be.

“My life was very different than it was before that day in the CT scanner,”
Dr. Raber said. “It’s not the life I thought I would have. But my life is still
really good."

Communication about cancer screening

2009-10-22T18:18:00.003-05:00

Yesterday, the American Cancer Society announced a shift on their position on certain cancer screenings. The Cancer Society said that American medicine has over-promised on the benefits of screening and some screenings over-diagnosis disease while missing other deadly diagnoses.

While there is healthy debate about the Society's decision itself, from a health communication perspective it reinforces that medical professionals need to take time to engage in discussion with their patients about the real risks and benefits of screening exams. Many patients expect medicine to be certain, where in reality uncertainties abound and not every decision is as simple as "You should get this test when you reach this age." Clinicians need to understand how each individual patient understands and assess risk and other health information. There is a growing body of research examining both how individuals understand numbers (numeracy) and how they assess risks and benefits. But the research is meaningless unless physicians and patients engage in continued dialogue and education about the goals of care, treatment and screening. Continued conversations won't necessarily make the decisions about screening quicker or easier, but they have the potential to ensure that individual doctors and patients the decision that is right for them.

How do food companies define health food?

2009-10-20T17:47:00.003-05:00

The Food and Drug Administration has sent a warning to food manufacturers about the criteria they are using to label foods "healthy." The FDA is concerned that too many healthy labels without clear criteria for defining what is healthy may confuse consumers. And some obviously unhealthy foods have been defined as a healthy using the manufacturers own standards.

The article about the warning made me chuckle, if only because I immediately thought of my least favorite commercial on television right now. I yelled at the television the first time I saw this commercial. Something to the effect of "You've got to be kidding me!" That's right, Kellogg's is trying to market Froot Loops as a healthy food. "They make your tummy happy." Sure, fiber is good, but I don't think health is Froot Loops best selling point.

What do you think? Does the FDA need to step in and set standards for what manufacturers call healthy food?

Fellow inmates provide hospice care in prisons

2009-10-19T16:55:00.001-05:00

The New York Times had a compelling article about the growing geriatric prison population and how some prisons are starting hospice programs to provide care for the aging population. Some of the programs use prison volunteers, other prisoners to visit and provide comfort to the dying prisoners, who may not have family members who will visit in their dying days. The programs appear to have a dual benefit, both for the dying prisoners and for the prison volunteers. The dying receive some comfort at the end of life; the volunteers make a human connection with another person and learn to express empathy and emotions many have buried for a long time.

There are some challenges with programs like this, especially the risk that dying prisoners will pass pain medications the volunteers, who can sell them to the general prison population. But the prison volunteers can provide a compassionate ear in a way that a guard or nurse simply cannot.