Shared decision-making is a common clinical goal, and numeracy is one mechanism that makes it work. What I’m sharing in this episode might help you feel less anxious about all of the above, and maybe even listen a little differently to your next patient.
Hi, everybody, this is 10 minutes to better patient communication from health communication partners. Since 2017, we’ve been giving you inspiration and strategies to improve engagement, experience, and satisfaction. I’m Dr. Anne Marie Liebel, a researcher, consultant and educator specializing in communication and education. This podcast makes space to dig into what it’s easy to take for granted about communication in our professional lives, especially in health care and public health, but increasingly across sectors because communication touches everything. We’re here to and get inspired, and most importantly, make the difference we got into our jobs to make.
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Right, we get to continue the kind of numeracy thread I’ve been on, with shared decision making. Because in SDM you’re talking about a lot of numeracy, right? You’ve got options, harms, benefits, you’ve got risk information. And you work hard at shared decision making for many good reasons, including, well, improving patient outcomes and clinical safety, also reducing medical errors and more.
So when people talk to me about numbers and numeracy, I feel the kind of emotional and ethical load that you might be carrying. There’s this sense of responsibility that comes across very strongly in these conversations. People saying, I have to explain this well. I’m worried my patients don’t understand numbers. I don’t want to overwhelm them. This is so important. What if it’s still too complex?
And I wonder if this tension might be because the more complex and becomes, the more clinicians worry about patients’ capacities. And I think much of what is behind these clinicians’ concerned about patient numeracy is genuine concern about your obligation to make sense of complexity. And I want to support that because this is hard work.
I found an article called Communicating numeric risk information to patients. And the authors say, “Clinicians often struggle to communicate risk information–or forego the task altogether due to various challenges.” And they add that “the challenges are real.”
Well, I can say from my position as a consultant in health communication and health literacy, there are challenges that make a whole lot of sense to give people pause. One of them might be the way that shared decision-making is commonly understood, and the influence that this might have on your practice.
In a 2022 article called The Submissive Silence of Others, Examining definitions of shared decision-making, the authors state that:
“While SDM is not consistently defined, it was striking to find that clinicians are constructed as active, whereas patients are viewed to be passive participants. The definitions construct SDM to be a gift that the clinician has the power to offer, and the relationship in the definitions appears asymmetric, in which only one party seems to speak.”
They add that, “clinicians may be influenced by definitions of SDM that reinforce the positionality of active speaker versus passive recipient.” And I’ll put a link to both of those articles in the show notes.
I wonder if maybe the complexity of the numbers that you have to deal with kind of plays into this active speaker, passive participant dynamic too. And that’s walking us into the world of health literacy and health numeracy, which have done enormous good for patient outcomes and the ways we think about health communication. There’s also been some unintended side effects. Health literacy and health numeracy still often get framed as risks, and that locates the difficulty within the patient. So patients become labeled low literacy, they get assumed to be poor with numbers, or at risk of misunderstanding.
So even well-meaning frameworks like health numeracy, health literacy shared decision -making might subtly be orienting clinicians to worry about what patients lack. And maybe that’s what I’m hearing.
I wonder if maybe the problem isn’t that patients can’t do math, but that we’re not encouraged to recognize math they already do. This isn’t about teaching patients numeracy; it’s about recognizing numeracy they already have, and using it in SDM. And for this, I want to mention again my professor Brian Street’s view of numeracy, which is numeracy as a social practice.
Briefly, this invites us to think about numeracy as a set of skills and tools and ways of thinking that we all choose from, to use in specific situations. When patients don’t engage with clinical numbers, it’s often not because they can’t, but because those numbers don’t yet connect to how they already use numbers to make sense of the world.
Where this is valuable for you in shared decision making is when you wish to explain a complex numeric concept, like uncertainty, risk information, comparisons, options, benefits, harms.
It shifts the question that you’re implicitly asking. Instead of asking, does the patient understand this percentage, you ask, how does the patient already understand percentages in their everyday life?
Your task shifts, too. It’s not simplification that’s your job, but translation. Making the connection, building the bridge. That’s what I want to talk about for the remainder of this episode: everyday numeracy practices.
Everyone, including your patients, already use these. And some of the underlying math concepts in them might surprise you. So I’m going to give you some ideas that I mentioned a few of these in prior episodes. I’ve got a few new ones too. But if you listen closely, you’ll hear patients are doing the work we’re sometimes led to believe they can’t do. Okay, here we go.
Food and cooking. So many examples of numeracy in food, whether it’s shopping, meal planning and budgeting, or the actual cooking. Underlying math concepts here involve ratios, unit conversion, linear scaling, and resource optimization under real -life constraints.
How about the weather? Estimating rain risk. Here, people are intuitively combining the forecast probability, like a 30 % chance of rain, with their personal experience, “It usually does rain, at least some, when they say 30%.” In math language, this is conditional probability and inference.
Another realm, where we all use numbers, is commerce and personal finance. Finance is math. So personal finance or household finance, budgeting, savings, loans, investing, insurance, debt, running a small business. All of these involve so much numeracy. The underlying math concepts include evaluating risk-benefit trade-offs, multi -step percentage logic, compounding, expected value, probabilistic comparisons.
Another very complex realm of everyday life, as far as numeracy is concerned, is travel and transportation. I love this example. Think of a gig worker managing a complex schedule when there’s surge pricing. We all know about this now, right? And mileage involved. They’re essentially doing advanced calculus in their head every day. This involves informal multivariable optimization with real -time uncertainty. This person balances expected values, path-finding, and non-linear trade-offs, basically solving dynamic systems problem without explicit math.
And another example that I wanted to include–this is for Brian Street because he loved the footie, right, soccer, but he also loved baseball. That fascinated him because of the fans and the literacy and numeracy practices of fans, specifically keeping statistics live at games. Because this is something he didn’t see before he came to the States. And if you don’t know about the way fans keep notes in batting, each batter’s plate appearance is logged in a little box on a scorecard grid. These numeracy practices involve proportion, estimation, pattern recognition, shifting probabilities. In short, lots of numeracy, and I could see why Brian would be fascinated by that.
One last area of examples I’ve talked about on this series before, but not really in terms of literacy, or not in terms of numeracy, is technology. I mean, for crying out loud, just take our phones, for instance! Not just having the phone and owning the phone and choosing phone plans, because that takes a lot of numeracy skills. But utilizing all of the apps and permissions on our phones. There’s so much there, but for now I’m just kind of mentioning it as a possibility, because phones and all of my other examples are pretty much emotionally neutral and cut across social groups.
I’m reminding you of how much numeracy we all take for granted in our own environments, and all the stuff we have to know in order to make computations, even in really mundane circumstances. This is just a sense of what numeracy as a social practice can help us see. And it’s really about what people do in everyday life, to get you thinking about ways to bridge the gap between clinical data and lived experience. You could use these non-medical numeracy parallels to translate abstract statistics into familiar decision-making frameworks. And I want to emphasize here, some of the importance is the context, right? You’re helping by bringing something new into an existing context. That is, you’re bringing your clinical numbers and values and reasoning into the patient’s known context of numbers and values and reasoning.
For more help with this, visit healthcommunicationpartners .com and click on contact. This has been 10 minutes to Better Patient Communication from Health Communication Partners. Audio engineering and music by Joe Liebel, additionally music from Alexis Rounds.