This has been one of the most challenging episodes I’ve ever done. Partly because we’re nearing our third year in the pandemic, and that itself is exhausting. I’m sorry I sounded exhausted on the last episode; I was. Partly because the news is so bad, I had to choose when to stop including items for this episode. And partly because, as always, I wanted to offer something hopeful and helpful, and it took me quite a long time to get there.
Hi everybody. I’m Dr. Anne Marie Liebel. This is 10 Minutes to Better Patient Communication from Health Communication Partners, an independent health-equity focused education and communication consultancy. If your organization needs expert help with any topic in this series, visit healthcommunicationpartners.com.
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So you know the bad news. Roughly 2000 Americans are dying per day, as many now as died at the height of the delta variant. Health systems are in crisis as omicron has COVID-19 hospitalizations at a new pandemic high. In the U.S., people in Black, Latinx, and Native communities have died and been hospitalized from the disease at 2 (or more) times the rate of the White population. And the US death rate per capita is one of the highest in the world, and the top among high-income countries.
What is possibly the most upsetting part of this is that many of the deaths were preventable. The numbers could have been lower. Lives could have been saved. And health communication is part of this story.
According to Dr. Linda Girgis, MD, the Editor-in-Chief of Physician’s Weekly, “People are not following public health recommendations for various reasons.” Let’s talk about some of those reasons that have to do with communication.
One is pandemic fatigue. People are tuning out. As I’ve written and podcasted before, our physical and emotional state impacts what sense we make of what we read and write. Pandemic fatigue is real, defined by the WHO as “distress which can result in demotivation to follow recommended protective behaviours, emerging gradually over time and affected by a number of emotions, experiences and perceptions.”
Another reason is misinformation. CNN recently reported that “A group of more than 80 fact-checking organizations from around the world has called youtube ‘one of the major conduits of online disinformation and misinformation worldwide’ and [they] want the platform to do more to address the problem.” Audio streaming service Spotify was under similiar pressure, with an open letter signed by more than a thousand members of the global scientific and medical communities, calling for them to implement a misinformation policy after the spread of misinformation through one of their most popular shows.
Communication from leadership does not seem to be helping. Recently, CDC director Dr. Rochelle Walensky was on Good Morning America to respond to criticisms from many Americans who remain frustrated by the CDC’s guidance around COVID.
Many health professionals feel similarly. I’m sure you’re aware how the CDC has been getting dragged on social media. This also has been a difficult situation to witness, as we know there are so many world class researchers at the CDC and how it is top notch and yet, some of the criticims have merit. Some of the folks criticizing the CDC are those who believe in it and want it to be the leader we know it has been and can be.
I’ve been following how different health communication professionals are feeling about the state of affairs. And it seems the worst thing that could happen is more of the same.
What’s interesting is that whatever the problems people are talking about that I hear in health communication, few people are saying these are new problems. There are far more voices saying the opposite; these are not new problems, but COVID is a new situation that’s bringing them to light. This suggests that when covid-related crises have passed, the problems will continue.
Many professionals who care about health communication are looking for ways forward, while they’re still busy dealing with new and existing pain points around COVID communication and education.
There are ideas about how to move forward. I’ll share some of those I’ve come across.
Be honest about our limitations. This comes from Dr. Anthony Fauci.
NPR reported that Dr. Fauci, speaking at the World Economic Forum’s Davos Agenda, said that scientists don’t know how exactly the pandemic will finally play out and that it’s important “to be openly honest about that.” Good idea! Here’s another one.
Center people. This comes from WHO Europe. In reference to pandemic fatigue I mentioned, they encourage decision-makers to:
- Understand people
- Engage people as part of the solution
- Allow people to live their lives, but reduce risk, [and]
- Acknowledge and address hardship [including] the profound impact the pandemic has had on their lives
And I have links to this WHO document in the show notes.
Here’s an idea from me: unearth your assumptions. Look at some of the taken for granted ways of working in health communication and question them. It may be that many of the established ways of working are still working. That some organizing principles are still holding up. And, we may find that there were some missing pieces, or some faulty assumptions to begin with.
Other people are thinking about inherited ways of working in health communication. Let’s turn to some examples.
Dr. Lisa Fitzpatrick, board-certified infectious diseases physician, epidemiologist, and health activist recently wrote in Forbes magazine that “The scientific community missed a once-in-a-generation opportunity to build trust and communicate the global relevance of science and research,” adding, “our health communication failures have deeply eroded trust in science, scientists and health policymakers.”
Yes, Dr. Fitzpatrick lays the blame on our shoulders, and sees the problems in ways of working – what health communicators typically do, or don’t do, saying, “we do not consistently dialogue with communities to understand their fears, concerns and misperceptions about science.”
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A similar point was made on this show, prior to COVID, by Dr. Renata Schiavo, Editor-in-Chief of the Journal of Communication in Healthcare and Senior Lecturer at Columbia University. When she was on the show pre-covid, she had this to say about health communication:
My main concern is that lots of the work we do in health communication continues to be a bit top-down. And we really need to bring in the voice of communities, and use participatory and human-centered design solution(s) to approach so many of these inequities that our communities experience.
What I’m getting at is this is a time to reflect, to continue to unearth assumptions about taken for granted ways of working. Now. In this messy, swampy set of crises within crises.
For help, I’m turning as I’ve done before to Donald Schön, and the quote that was the inspiration for the title of this episode. In Educating the Reflective Practitioner, Schön paints for us a very important image that I think could be helpful now. He says:
In the varied topography of professional practice, there is a high, hard ground overlooking a swamp. On the high ground, manageable problems lend themselves to solution through the application of research-based theory and technique. In the swampy lowland, messy, confusing problems defy technical solution. (P. 3)
I suggest that those of us in the field of health communication are facing situations in the swampiest, messiest lowland most of us have ever seen. So let’s look more closely!
These situations in those swampy lowlands of everyday practice have always been problematic. Schön reminds us that many such situations are problematic in multiple ways at once. And It’s not always clear what the problems are! Or the problems can look different depending on one’s position. And the lack of well-defined problems can be a problem.
This is my way of saying that murky, knotted, ill-defined, problematic situations are part of the reality of everyday practice.
How many ways of working in health communication are well suited to these uncertainties and instabilities? How many press us closer to messy details and lived realities?
It may be that some of the established ways of working are still working, and some are not. There may be missing pieces. There may be faulty assumptions. But my one piece of advice is reflexivity. A willingness to unearth the assumptions we’ve been making and take a good hard look at them, what they’re allowing us to do, as well as what they’re keeping us from doing. Even and especially those assumptions we hold most dear.
This has been 10 Minutes to Better Patient Communication. Audio engineering and music by Joe Liebel. I’m Dr. Anne Marie Liebel.