The providers I speak with know that communication is central to their ability to do their jobs well. They know how much patient education matters to outcomes, short-term and long term. They want to get through to every patient, not just some of them.
I join my voice with those who make issues of patient communication and education central and integral, rather than marginal, to the work of health care. As much as I’m a fan of quick wins, I hear providers’ frustration with being given ‘one more thing’ to tack on their time with patients.
So here are three quick ways to improve your day-to-day patient communication…without tacking on one more thing.
1. Communicating during patient education
Frequently, when I am talking to providers about heath communication, or health literacy, we end up talking about patient education. That makes sense; there are many connections among these subjects. And I’m an educator. But physicians are often frustrated when their patient education doesn’t have its intended effect.
One physician put it to me this way:
“When we teach it to them, they show that they are understanding what we are doing. But they are going home and forgetting.”
Education is a complex endeavor. Time is short. And there’s a great deal at stake.
It’s important to recognize that, in any patient education scenario, you will have multiple simultaneous goals.
- Some will relate to patient learning, like going over the results of a test.
- Some are about your relationship with the patient and his/her family, like involving family members in SDM.
- Some are explicit organizational goals you don’t have a choice about (time, RVUs).
- Some are more tacit organizational goals, related to the kind of small-scale micro-politics going on in your practice situation (like how you handle the last patient, on a Friday, right before a holiday).
- Some are connected to your professional role (your duties), some are connected to the kind of professional you want to be (your dreams).
And there’s more. And I’ll help you.
This means some structure, some well-designed questions, and some support. And I have created them for you and put them together in a convenient and economical bundle.
This is not about adding one more thing to your already crowded day. It’s about improving what are you already doing, making your day better, and increasing your effectiveness.
No matter how much time each day you spend in patient education, no matter how you currently ‘do’ patient education: in this bundle, you will find something to make that education more effective.
- You’ll improve what you’re already doing to increase your effectiveness
- You’ll see what culturally and linguistically appropriate patient education can look like
- You’ll get educational principles that reach all learners
- You’ll view your own patient education differently
In short, it’s world-class research that’s easy-to-access. It’s an audiobook, an ebook, and exclusive supplementary materials.
You can get the Effective Patient Education Audiobook Bundle here.
2. Using metaphors and analogies to explain concepts
Metaphors and analogies are favored tools of poets — and doctors.
They invite us to see a person, idea, or object differently, by inviting comparisons. Providers use them often, to explain complex physiological phenomena to patients. They may even improve physicians’ communication.
So what’s the problem?
Sometimes they don’t work. They can even give patients the wrong impression.
Widespread attention has been given to “the usage of inappropriate or unfamiliar metaphors which are not locally or culturally relevant” in med ed, public health, and patient education.
A physician was talking with me about an article I wrote on metaphors, and he knew about these problems, saying:
“Metaphors and analogies are something we do casually, without much thought,” he said. “Sometimes the metaphor did not give the message you wanted it to give.”
Let’s try an example.
One 2017 study deals at length with the prevalence of military metaphors to describe cancer. But the authors also describe how cancer has been connected metaphorically to:
- “journeying, sailing or working”
- a “silent killer”
Consider the connections that could be made between cancer and anything on this list of other concepts. It’s not hard to imagine how each of these metaphors could have different effects on the patient!
What connections are you making in your metaphor? Are those connections adequate for sending the message you want to send? What might your connections be leaving out, or oversimplifying?
If you want to be helpful and instructive with your metaphor, it’s worth taking a close look.
This may be especially important (and harder to do) when it comes to metaphors that have become entrenched in your specialization.
This is about building critical awareness about your use of metaphor. It can be difficult to step back and notice what we’re taking for granted–but that’s what I’m here to help you do.
I’ve written a workshop goes beyond the benefits and challenges of using metaphors. It shows what you can do about them.
In this workshop, you will:
- differentiate between the two parts of a metaphor
- identify the cognitive and affective dimensions of metaphor
- identify and address barriers to understanding
- evaluate your metaphor in use (including how to show others that what you’re doing works)
It’s loaded with research – from across specializations. The result is an intense 1 hour experience where you break down your metaphor, find out how it works, and develop a process that will help you reach any patient.
3. Unearthing bias in everyday language
As you know, historically, Americans have experienced variable access to care based on race, ethnicity, socioeconomic status, age, sex, disability status, sexual orientation, gender identity, and residential location (AHRQ 2016 National Healthcare Quality and Disparities Report).
Health disparities are due to many factors that are man-made. One of them is implicit bias.
Implicit (or unconscious) bias is something everyone has. An author from the Royal College of Surgeons recently described in BMJ that implicit bias involves placing people in a ‘category’ when we first meet them. It is something we do “by mistake, without thinking, unconsciously—and that’s fine, that’s human nature. But the question is what we do with that.”
Similarly, a recent editorial in the Journal of Gerontological Nursing indicates that unconscious bias is “a universal trait and important for survival,” and that “even educated individuals with the best intentions can display” it. But biases also “can reflect a negative perspective that reveals one’s knowledge, beliefs and expectations about a particular group, such as older adults.”
As much as bias may be “human nature” or “a universal trait,” it is an obstacle, a blind spot –with some serious consequences.
Unconscious bias on the part of health care providers has been linked to errors in clinical decision making, as described in this recent BMJ paper. Disparities in care along racial and/or ethnic lines have been documented–even when the patient is a newborn, as described in this paper.
Looking closely at your language is one concrete way to address unconscious bias.
This is because there are subtle ways our everyday language can unintentionally disadvantage certain social or cultural groups.
30 years ago, Influential law scholar Charles R. Lawrence III wrote,
“Another manifestation of unconscious racism is akin to the slip of the tongue. One might call it a slip of the mind. While one says what one intends, one fails to grasp the racist implications of one’s benignly motivated words or behavior.”
I encounter health care professionals who actively confront discrimination and bias of all kinds.
I was giving a talk about addressing unconscious or implicit bias in our language, at Columbia University’s Mailman School of Public Health. At the end, one of the questions I received from a participant was:
“It sometimes takes a lifetime to create those biases, that sometimes become innate. How do [we] unlearn those biases?”
When it comes to language, it is remarkably easy to slip into autopilot.
If you are interested in taking your language use seriously, I’ve created an audiobook bundled with resources. So you can begin addressing unconscious bias in your everyday practice.
Based in decades of research on bias in language and policy, these materials share a commitment to health equity.
This bundle of audiobook, eBook, and supplementary materials will help you address unconscious or implicit bias in your language. No matter your specialization or patient population. You get practical, culturally and linguistically relevant advice and research-based tools, in an unfussy, conversational format.
All of these resources will help you improve your daily decision-making on an individual basis, while keeping an eye on the fact that large-scale improvement depends on addressing larger systemic and societal impediments to health equity.
Because if you’re like the providers I talk with, you want to help the patients in front of you…and the generations after them.