The Health Care Conversation
When I speak about health care literacy and refer to 'the conversation', what exactly do I mean? The conversation is the discussion that takes place between a health care worker and a patient. A health care worker may be a nurse, a doctor, a receptionist at a doctor's office or a therapist. The health care provider may be giving instructions, taking blood or any host of other activities associated with patient care. And the patient? Being the patient is a role that all of us will play in our lives.
The conversation requires that two people come together to discuss a common issue, typically a health problem, and come up with an understanding or agreed upon task. For instance, the conversation may be between a doctor and a patient to discuss a proposed surgical procedure. Or the conversation may be with a nurse regarding how often to take a medication. Another example would include follow-up on a test or to see how effective a particular medication may be working.
Think for a second about the last time you met someone new and what took place in that conversation. Conversations always begin with positioning and posturing. We feel each other out to determine our levels of compatibility and trust. Once we've sized each other up a bit, we have a feel for socio-economic status, educational level and even ethos. We develop either trust that will allow the other person behind our social wall, or we develop a wall that will never allow that person into our private lives.
Now let's take a look at medicine. What's always intrigued me about the conversation in medicine is the fact that we're always trying to put the most educated person and the least educated person in a room and expecting them to come to some kind of agreement or conclusion within a brief visit. There's also a trend in medicine to use mid-level providers to deliver the message - providers who are less capable of explaining the message with clarity. And all of this is done in a business model that rewards us for doing things faster; the less time we spend with a patient the more patients we can see.
How then, in contemporary health care, can we expect good outcomes if we can't even have the conversation?
The video link in this post is a wonderful example of the problems and challenges that providers and patients have with the conversation. At first glance, the act of the conversation seems straight forward and simple. But as we delve into the subtleties of conversation we can see that there's so many ways in which the conversation can yield poor outcomes, and in some cases, even dangerous outcomes.
How can we have a better conversation? I believe that the starting point is that we each need to change roles. We need to look at the conversation from the standpoint of the other party. Some call it empathy. I call it good practice.
Jeffrey A. Oster, DPM