Getting More From Your Healthcare
I’ve often thought, if I could teach my patients one skill, they could use to extract the most value for their time out of me or any healthcare provider for that matter, what would it be? Well, for the time required to invest into it, such a skill would ideally be useful outside of a clinical context. Then the idea hit me.
Self-Expression.
Self-expression is your ability to communicate your inner experience (thoughts, feelings) to others (through your speech and gestures). It is so fundamental and if mastered will dramatically change your life.
What constitutes good self-expression?
Good expression involves accurately communicating your intended message in a way that minimises the chance of being misunderstood. Excellent expression would then do it in such a way that many people from widely different backgrounds would all receive the same message as it was intended.
So, clinically, where do we start? I’ll use a standard visit in my office to demonstrate some of the ways it works and give examples of how it can go wrong.
It’s basically a game at the intersection of Chinese Whispers and Charades.
When you step into the office but before you enter the treatment room, I have checked the notes of previous visit/s to ‘re-prime’ me on your case-to-date and prompt that data from long term memory into my conscious awareness. These notes contain 4 categories of information and break down like this:
Subjective - This is my recount of my recall of what you told me that you experienced. Then it is trimmed down to the most relevant details.
Objective - Here is where I put the results of the tests, I performed that I thought would confirm the conclusions I had from your subjective information.
Assessment - My conclusions and analysis of what you told me (subjective) and what I found (objective) get mashed together here into something cohesive that ties together my thoughts and impressions.
Plan - Finally, this is the record of what I did to address your problem and what I am going to do about it for you or have you do about it, for you.
As you can see there are several points where information can be distorted, incorrectly received, misrepresented, or misremembered. Here are a couple of specific ways Subjective information is affected:
Of all the fields above, you only get input into the first field. Subjective.
To make that even harder, I must write it on your behalf.
Often the volume of information is high and needs to be condensed.
It can be, at times, recorded at a point after the end of the consultation.
Part of the remedy for this, in my view, is to expand the daily, active vocabulary to give more accurate word choices. The better word choices we make, to express our inner experience, the more likely we are to successfully leave a correct impression. One that is most identical to the one we intended to share.
From a practitioner’s perspective, I am always refining the ways I communicate and interpret complex information so it can be taught to my patients in ways they can understand and retain over time to gradually improve their capacity to self-manage. To that end, I have found it helpful to continually work on speaking in universally digestible ways, that are less likely to be incorrectly interpreted. I have found these habits to be effective.
Reduce the amount of slang or jargon
Repeat words and ideas that need remembering
Pause and Pace speech
Reduce the instances I use synonyms in place of the "right word”.
That last point is a favourite thinking point of mine and is worth covering briefly.
Are there really any true synonyms? If every word has a specific meaning, aren’t they all technically non-synonymous? Are synonyms just a mental short-cut to reduce the number of words we need to actively recall daily? No, yes and probably.
When it comes to critical conversations, where it is paramount that we send and receive correct information. We should strive to use only the exact, right word for the situation and avoid a synonym that is ‘good enough’. By finding the exact right word and not a ‘good enough’ synonym your speech becomes more alive, memorable, and specific. The benefits of which, I think, are self-evident.
So how does this manifest in a clinical setting? Describing subjective experiences that are ripe for being misinterpreted, for instance: pain levels.
Actually, this is a special occasion because the easiest route to being accurate in your self-expression of pain is to use numbers. But let’s not get hung up on that technicality.
Often, it is far more helpful to give a number score than a phrase. Why? Because there is no synonym for 1 or for 5. One is always one. Also, because words tend to be reused to describe vastly different experiences. Most people have a range of instances they could choose to use ‘yeah it hurts a bit’ or ‘oh nah it’s not really painful, just annoying’.
You might say “but Russ, how do you know MY 4/10 is the same as YOUR 4/10 or someone else’s?”
Good question.
In my professional capacity my solution is three-fold. First, I get other numbers for other problems for both proven previous serious problems and innocent ones. Second, I get several numbers for a range of pain experiences, to get better context of what you consider each level of pain. The third part is to combine that data with what I can figure out about your experience, non-verbally.
Special Note: Often when I press a patient for a pain scale score, I can visibly see them recoil about committing to a number, like it is a test, or they are being judged.
In my clinic, there is no judgement, and you can change your score any time.
“If the number is too high, he will think I’m soft”, they think. This happens a lot.
Sometimes patients want to downplay their pain to give positive feedback on the previous treatment. Possibly because of an implied social pressure. But don’t worry you won’t hurt my feelings. In a clinical context I need that information to take the right action. If I am not doing the job, I also do not want to waste your time.
With all that said, what can be done?
Before your appointment spare a moment to think about how you’re feeling and how you will verbalise it.
Use numbers where possible when giving scales, even consider providing context if you think it is hazy.
Work towards using words for their specific use to extend your active vocabulary.
A final thought: The more clearly and discreetly you can articulate exactly what you mean, the faster it helps guide practitioners towards finding the right diagnosis and the appropriate treatment options. It will save you a lot of time and money in the process.
I started this article a while ago and it has taken me a lot longer to get to finishing than I thought it would. I am genuinely curious if you found this kind of content helpful and enjoyed the read. If you did, please drop me a line at southsidespinesport@gmail.com to let me know.
