Moving from information transfer to information exchange in health in healthcare

Abstract:

This paper examines the challenges commonly practiced in the medical and healthcare settings, where transmitting of information are often inadequate through the use of one-way information transfer model. The case studies show how pervasive this model is in the healthcare milieus, patient encounters and health promotion programs.

The paper identifies the critical approaches to an effective communication and concludes by suggesting that all healthcare professionals move beyond traditional practices of information transfer (one-way monologue) to adopting information exchange (two-way monologue).

 

Gist of the paper:

Health education very often assumes that by providing information to the general public, the information disseminated is sufficient to produce improved health outcomes to the mass population. However this is a serious flaw in assumption as it disregards the social context and also assumes that the population itself have the power and agency to implement the change by acting on the information made available.

The authors have identified three main problems.

Firstly, individualist ethic. It suggests that personal healthcare is determined based on individual characteristics, behaviours and choices. As a result, the health programs developed focuses too much on personal factors for poor health and holding the patients personally accountable for their illnesses. Through moral shaming and faulting those individual themselves, these affected people will change according to the “societal norms” to the definition of a healthy body.

Secondly, privileging expert’s authority over own’s knowledge and perspectives. Very often, information in the form of expert languages were not passed down and explained to the patient. There exists a delineation of this “expert territory” where it sets a social hierarchy between the healthcare professionals and the patients. This leads to instances whereby the wrong prescription was given and too many false assumptions were made.

Thirdly, information transfer as a monologue. A very classic case due to the “existence” of hierarchal, one-sided relationship assumed by most health communication practices. The example given was an analogy to that of a teacher-student in the classroom environment. It is assumed that students (patients) considered to know nothing will act to what was taught to them.

 

So to better solve these problems and make the population live a healthy life, it comes down to these simple changes:

1. Instead of faulting individuals, health promotion campaigns could provide messages that contain sharing of real-life cases and realising the risks (not fear mongering!) if these lifestyles are not modified. The messages contains strong message of individual responsibility.

2. To achieve #1, thus, there needs to be an effective dialogue. A two-way communication instead of a one-way monologue channel. For example, doctors should use very simple layman’s terms (less technical jargon) and check if the patients understood what was explained to them. In addition, doctors should engage in actively with their patients which could facilitate to identity the actual cause of the illness and prescribe correct medicine. To aid the knowledge transfer, information on the related healthcare could be passed on through brochures (these days, hospital/ health ministry websites).

3. Doctors should listen to their patients regardless of their backgrounds. Doctors shouldn’t assume that their patients are clueless and patients themselves provide feedback about the medications or symptoms described. Through engaging and asking more questions to the patient, doctors could minimise greatly the medical errors.

 

My Take:

Working in the healthcare industry (partly), honestly this is quite a boring paper as it is *already* something I see at work everyday – where residents are greatly emphasised and trained not to commit those errors. The curriculum and training for medical doctors have long addressed the above mentioned shortfalls to better serve the patients and ultimately to make the population healthier. This paper would have been relevant say, 10 years ago.

Given that society are more educated and more informed, do you raise questions or counter questions to what your doctor tells you?

And, do you tell your doctor to explain things in the most layman’s terms especially when alot of technical jargon is used? Or do you usually accept what the doctor tells you, even when you don’t even understand what he/ she is talking about as a matter of personal pride of being an educated person?

I’ll end this with a quote from my previous director (though I’ll not say his name):

“Put down your ego, always listen to the patient what he has to say. You’ll never know, that the information he countered you back comes from a proven scientific research or even one that comes from a Nobel Prize person that you yourself never heard of before. And when you actually find them out, you’ll also learn new things in the process and make you a better and knowledgeable resident (doctor).”

– Prof C. S.

 

References:

Lee and Garvin. (2003). Moving from information transfer to Information exchange in health and health care. Social Science & Medicine 56: 449-464.

 

– exstarlight

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2 comments so far

  1. snowkinz on

    quite agreeable. there’s no point in going to the doctors and hearing them telling you a 20letter word and not describing what the illness actually is! especially in SIngapore when a normal neighbourhood clinic charge $50 when you have a fever. Imaging going to the hospital to checkup. hundreds of dollars and the doctor just fill your brain with bunch of 20letter words and you are left confused at home.

    i think that doctors MUST explain to the patients their illness, their symptoms, how the patient can cure, or get cured. doctors cannot wait until patients ask them. doctors should not exclude any information if the patients “did not ask”. I believe that the most important ethics of health care is to let the patient know everything that is wrong with them, and nothing should be kept from them.

    if doctors assume – with the education that this generation receives- that everyone knows general health knowledge learned in school, then it will be very harmful to patients who did not finish school when they were young!

    How about a doctor, who did not finish listening to a patient’s symptoms such as body and joints ache and just say that everything is normal and its impossible for a patient this young to have osteoporosis, and just give the patient some gel and send the patient out. what if the patient really have a fracture? or some muscular virus? and, it is not impossible for a young person to have an “elderly” illness.

    There are many news on doctors negligence. such as ppl dying, having stroke that could have been prevented. internal bleeding etc. If these doctors were more careful during consultation, so many lives could be saved!

  2. janisuhoshi on

    Thanks exstarlight for summarising the paper so well. Succint and to the point.

    I agree with Lee and Gavin (2003)’s take that “individualistic ethics” is a problem factor that hinders effective health communication. This factor holds the belief that personal healthcare is a responsibility of the individual by their characteristics, behaviours and choices. With this belief, communicators resort to “moral shaming” so people would alter their behaviours to comply with societal norms i.e. use of injunctive norms (Cialdini, 2007). As such, we see health advertisements holding individual responsible for their woes.

    In my opinion, the ‘faulting of individuals’ is negative and I find it particularly irksome when I see this in health promotion advertisements, notably the National Environment Agency (NEA)’s public service advertisement on dengue fever. In the advertisement, a child was bitten by aedes mosquito, fell ill and was admitted to hospital for dengue fever. The mother of the child was seen blaming herself for being careless and not doing more to prevent breeding of aedes mosquitoes at her home. There were a series of similar ads by NEA that put the mother of the household responsible for taking care of the family’s wellbeing. After seeing the ads, I had the impression that it was a woman’s sole responsibility to watch the health of the family members. I find this rather patriarchal and unbefitting to the present society that seeks more gender equality.

    I concur with Lee and Gavin (2003) that health promotion campaigns could make more effort in communicating the risk by sharing of real-life cases and not resorting to “fear mongering”. In the above example, instead of making it seem like it was the mother’s fault for breeding of aedes mosquitoes in her home, they can focus on how residents, neighbours, family members have worked together to prevent dengue fever. This will throw a more positive light on the communication and will make use of “descriptive norms” (Cialdini, 2007) to encourage positive behaviours.

    In response to exstarlight’s questions, yes I will raise questions or counter questions to what the doctor tells me. And that’s because I am educated about my right to know. I will certainly get the doctor to explain to me what my condition is in an easy-to-understand way (because I acknowledge that I am not medically-trained!). I feel doctors nowadays are more willing to explain because they see this as an obligation (and service) to let the patient understand their health condition.

    References:
    Cialdini, R. (2007). Descriptive social norms as underappreciated sources of social control. Psychometrika, 72(2), 263-268.


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