Communicating About Health

Chapter 2: The Landscape for Health Communication

• • I. Current Issues in Health Care
• • A. Early and Preventive Care
• • B. Health Disparities and Access
• • C. Navigating a Complex System
• • D. Communication Skill Builders: Navigating the Health Care System
• • II. Health Communication in a Changing World
• • A. Global Health
• • B. Changing Populations
• • 1. Ageing
• • 2. Racial and Cultural Diversity
• • C. Communication Technology
• • III. Communication in Managed Care
• • A. Conventional Insurance
• • B. Health Maintenance Organizations
• • C. Preferred Provider Organizations
• • D. High-Deductible Health Plans
• • E. Pros and Cons of Managed Care
• • 1. Advantages
• • 2. Disadvantages
• • IV. Health Care Reform
• • A. Universal Coverage
• • B. Single- and Multi-Payer Systems
• • 1. Single-Payer
• • 2. Multi-Payer
• • C. The Affordable Care Act
• • V. Summary
• • VI. Glossary
• • VII. Discussion Questions

Chapter 3: The Roles of Patients and Health Care Providers

• • I. Health Care Encounters and Power Differentials
• • A. Knowledge and Power
• • B. Unequal Talking Time
• • C. Sensitive Subjects
• • D. Dismissive Behavior
• • E. Transgressions
• • F. Why Do We Do It?
• • G. Communication Skill Builders: Building Trusting Relationships
• • 1. Break the ice.
• • 2. Don't avoid important but sensitive issues.
• • 3. Encourage and ask questions.
• • 4. Avoid assumptions.
• • 5. If you feel uncomfortable, say so.
• • 6. Make an explicit commitment to diversity.
• • II. Collaborative Communication
• • A. Reasons for a Shift
• • B. Model of Collaborative Interpretation
• • C. Integrative Health Theory
• • III. Partnership-Building Strategies
• • A. Shared Decision Making
• • 1. Care Providers' Expertise
• • 2. Patient Perspectives
• • 3. Puzzle Approach
• • B. Communication Skill Builders: Motivational Interviewing
• • 1. Set a respectful tone.
• • 2. Let the interviewee (decision maker) set the agenda.
• • 3. Gauge the decision maker's interest.
• • 4. Explore ambivalence.
• • 5. Listen.
• • 6. Elicit-provide-elicit.
• • 7. Weigh the merits of multiple options (including doing nothing).
• • 8. Partner; don't persuade.
• • 9. Roll with resistance.
• • 10. Gauge the decision maker's self-efficacy.
• • 11. Focus on small, incremental changes.
• • 12. Collaborate and empower.
• • C. Narrative Medicine
• • 1. Qualities of Narrative Medicine
• • 2. Functions of Health Narratives
• • D. Communication Skill Builders: Strategies for Care Providers
• • 1. Act interested.
• • 2. Set aside distractions.
• • 3. Allow silence.
• • 4. Ask “What else?”
• • 5. Avoid abrupt topic shifts.
• • 6. Pay attention to distress markers.
• • 7. Reassure.
• • E. Communication Skill Builders: Strategies for Patients
• • 1. Reflect on what's important to you.
• • 2. Create a brief health history.
• • 3. Write down and rank order your concerns.
• • 4. Don't overlook valuable resources.
• • 5. Help set the agenda.
• • 6. Take an active role.
• • V. Summary
• • IV. Glossary
• • V. Discussion Questions

Chapter 4: Patient Perspectives

• • I. Voice of Lifeworld
• • A. Feelings Versus Evidence
• • B. Specific Versus Diffuse
• • C. Bridging the Gap
• • D. Communication Skill Builders: Talking to a Care Provider
• • 1. Try the PACE method.
• • 2. Ask questions.
• • 3. Don't abuse the clock.
• • II. Health Literacy
• • A. Reasons for Health Literacy Challenges
• • B. Health Literacy and COVID-19
• • C. Communication Skill Builders: Assisting People with Health Literacy Challenges
• • 1. Create shame-free environments.
• • 2. Let patients know what's expected.
• • 3. Use metaphors to explain complex information.
• • 4. Evaluate messages for readability.
• • 5. Use the teach-back method.
• • D. Communication Skill Builders: Increasing Comprehension as a Patient
• • 1. Be explicit about your concerns.
• • 2. Ask three key questions.
• • 3. Admit it if you don't understand.
• • III. Health and Identity
• • A. Health, Identity, and Facework
• • B. Face-Threatening Health Concerns
• • C. Face-Consistent Health Concerns
• • IV. Invisible Illnesses
• • A. “You Don't Look Sick”
• • B. Communication Skill Builders: Calling Attention to Overlooked Concerns
• • 1. Document your symptoms.
• • 2. Resist the urge to minimize.
• • 3. Ask outright for serious consideration.
• • 4. Be patient with medical uncertainty.
• • 5. Try a second visit.
• • 6. If necessary, find a new provider.
• • V. Patient Satisfaction
• • A. Selecting Care Providers
• • B. Communication Skill Builders: Enhancing Patient Satisfaction
• • 1. Provide prompt attention.
• • 2. Build relationships.
• • 3. Take your time and educate.
• • 4. Welcome loved ones.
• • 5. Learn from patients' feedback.
• • VI. Cooperation and Informed Consent
• • A. Reasons for Noncooperation
• • B. Communication Skill Builders: Creating Mutually Acceptable Treatment Plans
• • 1. Engage in shared decision making.
• • 2. Listen for hesitancy.
• • 3. Ask about reservations.
• • 4. Encourage regular communication.
• • C. Informed Consent
• • 1. Infamous Violations of Patient Rights
• • 2. Informed Consent Laws
• • 3. Challenges Associated With Informed Consent
• • VII. Summary
• • VIII. Glossary
• • IX. Discussion Questions

Chapter 5: Care Provider Perspectives

• • I. Care Provider Preparation
• • A. Historical Perspective
• • B. The Role of Communication
• • C. Communication Training and Integrated Approaches
• • D. Socialization
• • II. Systems-Level Influences on Care Providers
• • A. Organizational Culture
• • B. Time Constraints
• • III. Psychological Influences on Caregivers
• • A. Emotions
• • B. Mindfulness
• • C. Confidence
• • D. Satisfaction
• • E. Communication Skill Builder: Dealing with Difficult Patients
• • IV. Stress and Burnout
• • a. Causes
• • b. Healthy Strategies
• • V. Medical Mistakes
• • a. Why Mistakes Happen
• • b. What Happens After a Mistake?
• • c. Managing Medical Mistakes
• • d. Disclosing an Error
• • e. Communication Skill Builders: Responding to Medical Mistakes
• • VII. Summary
• • VIII. Glossary
• • IX. Discussion Questions

Chapter 6: Diversity in Health Care

• • I. Intersectionality Theory
• • II. Socioeconomic Status
• • A. Implicit Bias
• • B. Communication Gaps
• • C. Structural Inequities
• • D. Limited Access to Care
• • E. Logistical Challenges
• • F. Communication Skill Builders: Building Trust with Underserved Patients
• • 1. Diversify your team.
• • 2. Engage in shared decision making.
• • 3. Be careful not to shame.
• • 4. Show concern explicitly.
• • 5. Explain your thinking.
• • 6. Invite open communication.
• • III. Gender and Sexual Orientation
• • A. Words Matter
• • 1. Gender Identities
• • 2. Sexual Orientations
• • B. Sex, Gender, and Health
• • 1. Marginalization
• • 2. Fear of Judgment
• • 3. Overlooked Concerns
• • 4. Missed Opportunities for Social Support
• • C. Communication Skill Builders: Talking Respectfully About Gender and Sex
• • 1. Use preferred pronouns
• • 2. Avoid deadnaming.
• • 3. Don't ignore the topic.
• • 4. Don't be nosy.
• • 5. Don't judge. (just mentioned in other CSB.)
• • 6. If you mess up, apologize and correct yourself.
• • IV. Race and Ethnicity
• • A. Distrust
• • B. High Risk and Low Knowledge
• • C. Limited Access to Services
• • D. Underrepresentation
• • V. Language Differences
• • VI. Disabilities
• • A. Health Passports
• • B. Communication Challenges and Approaches
• • 1. Word Choices
• • 2. Intrusive Questions
• • 3. Overhelping
• • 4. Reluctance to Address Sensitive Issues
• • 5. LOUD and Sloooow
• • C. Ableist Language
• • D. Communication Skill Builders: Avoiding Ableist Language
• • 1. Take stock of your implicit biases.
• • 2. Befriend a wide range of people.
• • 3. Think about the words you use.
• • 4. Practice alternatives.
• • 5. Point out underlying assumptions.
• • 6. Be an ally.
• • 7. If you mess up, apologize and do better.
• • VII. Age
• • A. Children
• • 1. Adult Involvement
• • 2. Caring for the Rest of the Family
• • B. Adolescents
• • 1. What is normal?
• • 2. Sensitive Topics
• • 3. Social Isolation
• • C. Communication Skill Builders: Talking With Young People About Illness
• • 1. Let the young person set the tone.
• • 2. Cover the information bases.
• • 3. Ask questions and listen.
• • 4. Go easy on medical terminology.
• • 5. Be honest.
• • D. Older Adults
• • 1. Aging Population
• • 2. Ageism
• • 3. Impact on Health Communication
• • 4. Communication Patterns
• • VIII. Summary
• • IX. Glossary
• • X. Discussion Questions

Chapter 7: Cultural Conceptions of Health and Illness

• • I. Culture and Health Communication
• • A. Culture-Centered Approach
• • B. Reflective Negotiation Model
• • II. Cultural Conceptions of Health
• • A. Health as Organic
• • B. Health as Harmonic B