During patient education you are often dealing with medical or scientific concepts of great complexity. You already have ways that you like to break these concepts down for your patients. But when it comes to educating people, one size does not fit all. In this episode, you’ll learn 10 different ways you can break down a complex idea. So you can have different approaches for different patients.
Hi, this is 10 minutes to Better Patient Communication. I’m Dr. Anne Marie Liebel.
If you’ve got to explain something to a patient, how do you do it? If you have important information or complex ideas to share, how do you get it all across?
Multitasking, plus increasing EHR documentations requirements, often means less time with patients. And yet, how you spend this short time educating your patient has been shown to have an impact on numerous health outcomes, patient satisfaction, and patient engagement. But some quick planning can make for a lasting impact. That’s what today’s episode is about.
There are topics you explain frequently. This includes information and concepts, as well as processes–ways of doing, thinking, being. We can call this your content. It’s what you’re trying to get across.
This is about having different ways to get your message across. Because people learn differently.
So I’m going to give you 10 different ways to organize your content. As you listen, pick out the ones you lean on most frequently. Then do yourself and your patients a favor, pick another (or two). Try using a different organizational structure for the same content. Because, I’ll repeat, people learn differently.
Now these are organizational structures that are common in everyday experience – in our conversations, in arts and media, in popular culture, in logic and argument, and more. You will recognize all of them. But I also throw in a couple twists, just to expand your options.
Medicine relies on cause and effect relationships. Fortunately, we often think in cause and effect patterns in everyday life. Here’s an example from one study where a physician is explaining a metaphor he uses to illustrate the concept of inflammation–and the effect of a medication–using cause-and-effect:
“I explain that airways are like a plumbing system. Swelling of the tubes (inflammation) is like when the plumbing system gets obstructed, and prednisone cleans the tubing system.”
This is about probability, and reasonable expectation. Sometimes the conditional is phrased as an if/then statement, as it was by a physician in this study:
“If the cancer is still resistant to the cancer-fighting tools, other weapons are injected to attack the disease or to boost the body’s own defenses.”
- Part to whole – whole to parts
A nurse was describing to me a topic she addresses often. After surgery, she explained, there is often a small part of an incision that is “left open without a drain if possible.”
Apparently, “patients can be worried about ‘the hole.’”
Therefore, she frequently was explaining to patients how wounds healed. She did this in a part-to-whole structure, where the ‘parts’ were the multiple layers of skin. “It’s the bottom layer that’s first to heal. I tell them, the last to heal is the surface [layer].”
There are many ways time enters our thinking. Here’s a few: things may happen chronologically, they may happen sequentially, they may happen cumulatively. Now, chronologically is easy enough. But here’s a twist: consider that events occurring over time also includes over our individual and collective history.
Such a framing might look like ‘well, we used to x, but then this happened, so now we y.’
In Atul Gawande’s Better, he uses temporal organization to explain an innovation made by a friend of his. In the mid 70’s when babies who were born 2 months prematurely, or more, were considered to have not much a chance to survive, but his friend, for one year, decided to pretend like they did. He treated them like the were full-term babies, and that changed the field from that point forward.
You know that comparing involves two like items or ideas. Obviously metaphor, simile, and analogy are helpful here. Contrasting takes up the ancient practice of illustrating what something is by showing what it is not. Venn diagrams are possible here as well, when there are both similarities and differences in target groups.
Here’s an example from a physician, taken from a study on the use of metaphors and analogies in difficult conversations. And this example uses both compare and contrast (see if you can hear it):
“You know you can live with [ovarian cancer] for a long time. I mean, you can live with diabetes for 50 years. There’s a lot of diseases that we don’t cure, we just manage. Hypertension, right? We don’t cure it, we just give you a pill to take every day that keeps it under control.”
This physician compares ovarian cancer to diabetes, and then to hypertension. The contrast is between diseases that can be ‘cured’ and diseases that can be ‘managed.’
- General to particular
This may sound familiar, in terms of assessing or diagnosing. It’s common in everyday language as well. The pyramid (or inverted pyramid) is often used to indicate hierarchical relationships. But it can also be used to show that a specific case is (or isn’t) a reasonable or plausible example of a general phenomenon.
That was the case when I spoke with an exasperated nurse who was ‘on phones’ at a physician practice, during this past flu season. She told me:
“People say they got the flu. When I ask their symptoms – Do you have fever? ‘No.’ Do you have a headache? ‘No. But I’ve been throwing up all weekend.’ That’s not flu.”
The particular conditions of individual patients did not plausibly represent the general condition of ‘the flu.’
Another common organizational scheme, right? Spatial arrangements can be from top to bottom, back to front, left to right. But don’t forget near to far.
This is a physician’s response using a spatial orientation. It concerns a symptom cause in a palliative care consultation study,
“Down that pattern sort of across the knee and down towards the ankle is the L4 distribution and I think you’ve got pressure on the nerve and it’s making it numb.”
Sure, you use this already. As an OB-Gyn told me, part of her talk to moms in their 3rd trimester is:
“Most people have healthy babies. This is why I have you coming in all the time at 36 weeks. We’re checking you, and if we can get good care at this time, we can pretty much ensure all will go well at time of birth.”
Averages can indicate most common/least common relationships, as well as typical/atypical relationships, and “rules and exceptions.” It’s sometimes possible to talk about statistical significance. But don’t forget those outliers.
Tell a story – because narrative works! Researchers have long proved that as humans, we are hard-wired for story. Narrative medicine is a robust field. Providers’ narratives of practice are being published in medical journals. Patients’ narratives are increasingly recognized for the insights they offer.
So if your storytelling skills need a bit of a brush-up, I’ve got you covered.
Who’s your protagonist? Your main character? It could be
- your patient (or a family member)
- a part of the body
- the disease/injury
- some aspect of the treatment
- even you!
You set the stage, there is some complication, a climax, and a resolution.
But this is just one possible narrative frame.
Sometimes, stories start in the middle of things. Oftentimes, there is not a straightforward narrative, but a looping back or a digression. There can be a loss of ground, a surprise twist, or an unintended consequence. And it’s ok to resist the pressure for a happy ending, every time.
This refers to organizing material in categories or chunks that hang together conceptually. Sometimes you know the categories ahead of time (a priori); sometimes you discover them as you go. It’s the organizing structure I use in this episode. (Bet you figured that out already.)
An important caveat here: I am not gonna advocate you use some sort of a simple to complex arrangement. Despite its common sense appeal. The notion that ‘you have to walk before you can run’ simply does not account for many of the ways people learn. Even kids.
Such a breaking down can be helpful, after someone is familiar with a concept, to deepen their understanding. Like what I’m doing here. I’m showing you the simple (organizational structures) because you already know about the complex (teaching/learning process).
At its most basic, this is about organizing your thoughts so that you can present them to someone else. You could think of these as examples of sense-making structures, or common patterns of thought.
Which ones do you tend to lean on? Which ones will you try? And just a reminder – if at all possible also have a graphic, image, website, video. If not, have an extra pen in your pocket. Because multimodality helps.
If you are interested in taking your language use seriously, why not start with your metaphors? This workshop shows you how to break down the metaphors you use, understand their cognitive and affective aspects, and evaluate them in use. On demand, right here on Health Communication Partners.com.
This has been 10 Minuted to Better Patient Communication. I’m Dr. Anne Marie Liebel. Thanks for listening!