Large sets of quantitative data are irreplacable resources in medicine and public health. But there are many important questions large data sets weren’t designed to answer, questions where on-the-ground research is needed. In this episode, I sample some crucial contributions ethnography has made to what we know about the influence of context on thinking, communication, and health.
Medical and public health professionals rely on large sets of quantitative data for nearly everything. But there are many important questions large data sets were never designed to answer. Ethnographic and anthropological approaches can provide needed on-the-ground perspectives to what we know about people, and communication, and health. In this episode, I sample some of what ethnography teaches us about why context matters to our thinking, our talk, and our health.
Hi everybody, this is “10 Minutes to Better Patient Communication” from Health Communication Partners. I’m Dr. Anne Marie Liebel. If your organization cares about equitable communication with all patients, there are some foundational concepts it’s important to understand. That’s why I wrote the course Foundations of Equitable Interpersonal Communication in Health. It gets at the fundamentals everyone needs to know, it’s video-based, self-paced, and for all patient-facing employees. Learn more at healthcommunicationpartners.com.
Earlier this week I was in a group of clinicians and non-clinicians using ethnographic approaches to understand clinical issues. We were looking at a data set, it was qualitative data collected on communication between teams in a trauma unit. The data was rich, it was evocative, and the discussion yielded some vivid insights.
I was happy to be talking about ethnographic approaches because I use them! I use ethnographic tools and orientations to understand issues of language and of education. That’s what you hear about in this series. One of the traits I appreciate about ethnography is that it allows me to get granular, find those important distinctions that large data sets can miss. Distinctions that are so valuable right now, too.
If you’re wondering about how ethnographic approaches might differ from what you typically see or hear, in one of my earliest podcast episodes, I give a quick sampling of what ethnographic research helps illuminate about the impact of context on our thinking, our talk, and our health. Here’s that episode.
I was coaching a physician on making his patient education more effective. We talked about the many constraints around patient education. He was understandably frustrated, as many physicians are, over the short amount of time he has with each patient.
His voice raised at one point, and he sounded exasperated, saying: “I can’t follow my patient home!”
There are many ways to interpret this phrase. It has stayed with me as I continue to work with providers on communication, education, and health literacy. Today, I invite you to think a moment with me about home, as we consider the impact of context in health communication and education.
Though ‘context’ is a broad term, home is certainly an important context in all our lives. Whatever home looks like, wherever it is, whatever it means to each of us. And as usual, I’ll close with some practical advice for how you can keep context in mind, during your next patient encounter.
Context matters to us when we interact as people. What is appropriate or valued in one interaction is not in another. We all change our language, even just subtly, according to various contextual factors. To understand people’s health-related actions and words, it is helpful to consider the influence of context. I’m an educator, so I have a sense of what that means in education. And over the last few years, I’ve been learning more about how context influences different health and health care conversations. You’ll hear me pull from studies that are taking linguistic and anthropological perspectives on the study of language. This involves looking beyond the immediate context—the individual – to family, community, and organizational settings.
Context shapes our communication
The language we use depends a great deal on context. That’s not surprising, but it’s important to remember. When we talk, or even when we read, we are interacting with other people and with our environment. When we interact through spoken and written language, we do it in a specific place and time.
For instance, we can quickly change our language to communicate the same idea to different audiences. Switching between the different people in our lives, we communicate differently.
A medical educator and I were talking about this impact of context on language. She offered me a hypothetical scenario:
“Consider when you come home from work on a typical day. Maybe you’re a parent, and you and your young child are talking about your day. You might say, ‘Mommy helped someone who was very sick today.’ And then your spouse asks about your day, and you say, ‘Oh yeah, I was in the OR for hours doing an appendectomy.’ Then your cell phone rings and it’s your colleague recapping and reporting on the patient. You get into an entirely different kind of talk.”
Same event. But different people, so different language.
Communication shapes our context
What’s more, language and context are in a mutual relationship. Yes, we use the language we use because of our contexts. Yet our contexts are what they are partly because of the language we use in them. For instance, the patient encounter is the patient encounter partly because of the kinds of language used in it. Those predictable questions and answers. The expected flow of conversation. Language is part of what makes the patient encounter what it is.
I’ll give you an example: Imagine everything in your next patient encounter remained the same, except the language. Same people, same place and time, same stuff in the room. But let’s say you and the patient took turns telling jokes the whole time. It would no longer be a typical patient encounter. It would be fun, though.
Context influences our thinking
Our thinking is tied to context, too. Decades of research show that context matters to our thinking. This includes reasoning, as well as literacy and numeracy processes. This stands in contrast to the conventional view of our mental abilities as essentially fixed.
For example, on formal assessments, people can seem to lack the kinds of cognitive abilities they are able to demonstrate in everyday life.
More than a generation ago, researchers wanted to study reasoning in context. They chose to study arithmetic reasoning of American adults who were shopping in the supermarket. They found that, while shopping, adults from varied educational backgrounds were able to make virtually error-free price comparisons. However, given the same kinds of choice problems in a test, all of those people made many errors.
Anthropologist and educator Fred Erickson points out that: “Human reasoning seems to consist of skills that are reflexively constituted in the context of situation of use and purpose. This is a conception of thinking as sets of domain-specific and situation-specific operations rather than sets of general abilities.” (p. 529) It can be easy to overlook how much the cognitive dimensions of our everyday activities are shaped by the people we’re with, and the contexts we’re in.
Context influences our health
Finally, our health is related to context. You are likely aware of the social determinants of health, that body of research into the “socio-economic factors that affect health, including income, education, employment, housing, food security, gender, and race” (Social Determinants of Health, 3rd ed.) This body of work takes a close look at the relationships between our health, and the contexts where we live, learn, work, and play.
Critical considerations of these contexts have increased. Conversations across the health sector are moving away from reliance on the individual biomedical model, toward upstream causes of illness and disease. This includes identifying poverty, structural racism, and discrimination as root causes of health inequalities. Though researchers take up the social determinants of health in different ways, it seems to me there is at least one shared understanding: Health is not a level playing field.
So, What can you do right now to keep an awareness of context in your next interaction with a patient?
The next time you communicate with, or educate, a patient:
In whatever language feels natural to you, acknowledge to them that you know context matters. Where you are, the time pressures, and social relationships between you, all are contexts that make a difference. These matter to how you’re both talking, thinking, and feeling. So go ahead and say so.
Home—where we come from, and go back to at the end of the day–makes a difference to what happens between you and your patient in the encounter. And yet what happens between you in the encounter can make a difference –to you both–when you each go home.
So go ahead and ask your patient about their home. Something simple like, “How are things at home?” You may just be making polite conversation, but you may also turn up information that is clinically or culturally significant. Because home is a powerful context.
You have patients who linger in your imagination. Yes, they follow you home. So I’m not sure you’re not following your patients home. Choose carefully the parts that you hope linger in their imaginations when they leave you. I’m Dr. Anne Marie Liebel. This has been “10 Minutes to Better Patient Communication.”