You have information that will help your patients be healthier. But what about when you have differences of opinion on what healthy means? In this episode, I’m diving into these differences. And you’ll learn how to keep differences from getting in the way, when they occur between you and your patient.
As providers, you have information that will help your patients be healthier. You hope to communicate it in a convincing way, so it will enter into patients’ thoughts and actions long after the patient encounter.
But what about when you have differences of opinion on what healthy means? When it becomes clear you don’t share the same understanding of living a healthy life, or of being as healthy as possible?
Aside from dictionary definitions of the term ‘healthy,’ there are many different everyday meanings of the word. Today I’m diving into these differences. I’ll show you how to keep them from getting in the way, when they occur between you and your patient.
Hey just a reminder, I made an audiobook bundle for you. It’s called Effective Patient Education. It’s a bundle of an 80-minute audiobook, a 40 page ebook if you want to follow along, research references, and additional resources, all exclusive, all made by yours truly. It’s inexpensive and you’ll be helping support this podcast series and your own learning. Available for immediate download on healthcommunicationpartners.com.
For years, many researchers and professional organizations have embraced health as a relative concept. Our understandings of health are culturally mediated. Many health researchers have documented the health perspectives of marginalized or non-dominant groups.
When we’re considering whose “healthy” is it anyway, it may be helpful to recall that we each draw on a range of ways of understanding the body, science, procedures, insurance, nutrition, and more. These understandings are shaped by our knowledge, and our experiences with the bodies we care for and with the health care system.
Importantly, we have learned how to process this knowledge and experience in our communities. These communities include our professional communities, as well as our families, neighborhoods, and multiple other social groups we consider ourselves a part of.
Another way of thinking about this is that there are large overlapping circles of influence on our ideas of health. For a great example, I have a link to a study of women’s health in a Haitian community in Florida. The researchers illustrate beautifully that we all have ideas about health and health care and that they come to us from many places.
It’s also important to remember that these ideas are not fixed or homogeneous, but flowing and shifting. They form our conceptual basis as we read, write, talk about, think about, listen to, process, and act on what it means to be healthy in our communities. These ideas may or may not correspond to the latest medical knowledge, but they make sense to us who hold them. Obviously we know our own ways of thinking better than we know anyone else’s.
But differences in ideas can feel like barriers to communication. when it dawns on you that you’re not on the same sheet of music as the person you’re talking to, it can really bog down the conversation.
Also, we sometimes shift our focus to a person’s perceived weaknesses, based on what we think is or should be normal. That is, when we’re not hearing from a person what we think is basic, or fundamental, that perceived lack or gap can become our focus. One medical educator made a particularly powerful analogy for me, as we were speaking about this very topic. He said,
“Take parenting. We have these snapshots in our heads of who our child should be, how they should behave and respond to our questions. And then we have the reality of what’s in front of us. And when we get frustrated is when the disconnect is there. It’s not the child, it’s the disparity between the expectations [and the reality].”
It can be easy to think that the ways other people—like, patients–understand their bodies or act upon health information as problematic. Especially when it’s not what you think is or should be normal, or basic, or fundamental.
Effective Patient Education Audiobook Bundle
This bundle of audiobook, eBook, and supplementary materials will help make your life easier. And it might change the way you think about patient education. No matter your specialization or patient population. You get practical, culturally and linguistically relevant advice and research-based tools, in an unfussy, conversational format.
But these ways can be a valuable source of information and insight. I did an earlier podcast episode about how patient misconceptions can be advantageous in the clinical encounter. What you don’t want are possible perceptions of difference to get in the way of a productive patient/provider relationship.
To be clear, I am keeping to those instances where someone is not in danger. Of course you have a professional obligation and an ethical imperative to help in every way you can. And this means doing no harm, as well as doing all you can to keep people from harming themselves or others.
But you’re well aware the lines are not always so clear. Cultural norms are, by definition, subjective. What seems healthy to one group may not seem healthy to another. Whether it’s the foods you eat and how you cook them, or leisure time activities, or everyday routines.
I’ll give another example – I was consulting on a research project about different cultural ideas toward health, as they were reflected in children’s literature from different world cultures. This is because the ideas or values of a social group can be reflected in their stories. This includes those stories told to children. Let me tell you, it was super interesting! There are different cultural attitudes toward nutrition, no surprise there. But one of the most enlightening for me to see from my American perspective has been different cultural attitudes toward poop. And since we’re on the subject, if you haven’t yet heard my podcast episode on ‘pee-pee’ here it is. Wow that was an interesting set of sentences, wasn’t it?
As a health care professional, making your expert information relevant to the patient starts with knowing what’s important to this person and her/his life. This involves seeing others’ bodies and health as they see them.
And considering what “healthy” means to your patient.
You’ve heard this from me before: begin with what people already do, believe, have, and think, regarding their health. The points is for you to understand their understanding. You don’t have to like it. You’re listening for how people are making sense of their health and then, you’re building on this—to enlarge their understanding.
Part of the burden of being the expert includes seeing the sense in another person’s ideas about health, so you can begin building bridges between their ideas and yours. I wanna talk about this bridge for a moment.
make no mistake: the purpose of building this bridge is not so your patient will cross over to you.
You are both on that bridge. Looking at patients’ knowledge and ideas as a ‘gap’ between you can make it seem like your position is the one that needs to be reached. Then what counts as “progress” is really how far patients can make it in your direction. This is not what we’re talking about here. (Nor does it sound very SDM.)
This is about talking across different ideas of health. This means allowing even a little bit of space for different definitions of health, different ways of getting healthy, and different ideas about what it means to be healthy. It’s not about discounting or replacing someone else’s definition with yours, but acknowledging their position and working with it.
This involves understanding what your patient values about their lifestyle and their health. Including what they are already doing to maintain their health, to strengthen their health, and to improve the health of their families.
I’m not saying to go stereotyping or lumping together patients in a certain social or cultural group. Nor do I mean you’re somehow supposed to custom fit everyone differently.
What makes more sense is for you to bring to your practice an awareness that there are diverse cultural possibilities in the meaning of ‘health’ that might relate to your patients. Then allow yourself to get to know the patients themselves, and some places they might fit, in terms of how you already work with other patients in your practice.
How do you start where your patients is, and begin to build that bridge?
Don’t assume. Find out what healthy means to your patient. Like:
- “What is important to you when it comes to being healthy?”
- “We all can have different ideas about being healthy, and I want to know what matters to you.”
By meeting people where they are, you go far toward giving them appropriate support and actionable advice.
I won’t be the first to encourage you to place patients’ complaints in the larger context of their personhood and their lives. This includes what ‘healthy’ means to them. Especially when this is not what ‘healthy’ means to you, nor what you wished ‘healthy’ meant to them. This has been 10 minutes to better patient communication, I’m Dr. Anne Marie Liebel.
PS – I’ve been unable to find the exact location of the gorgeous mural in the photo, but I believe it is in Brazil. I’ll keep ya posted!