In this speaking activity, we will discuss effective strategies for honest communication in health settings.
Think about the ways that people in different parts of the health system may have different priorities and how they can effectively communicate across lines of difference.
Focus on word economy, clarity, and directness.
CASE 1:
You are a primary care physician at a not-for-profit health maintenance organization (HMO) that serves 500,000 members, paid for by capitation, a monthly premium paid to the HMO by the members’ employer, Medicaid, or Medicare. The premium revenues create a budget to care for the entire HMO population.
Susan Jackson, a 28-year-old office worker, has consulted you about headaches. For the past month, she has had frequent headaches at the end of the work day. The headaches are much less frequent on the weekends. She describes the headaches as dull, mild to moderate pain that feels like tightness or a band around her head. She is otherwise healthy. Her neurological examination is normal. She identifies clear stressors at work.
You explain that this is a classical pattern for tension-type headaches and give practical advice on what to do. You predict that the headaches will improve as Susan learns to master the stressors and to build more relaxation into her day. Susan thanks you, but says that a friend who had headaches received an MRI, which showed a tumor that required surgery. With some urgency, she says, “Unless you can guarantee that there is no possibility whatsoever that I have a tumor, I want an MRI. What harm can an MRI do?”
You know that the likelihood of a tumor is vanishingly low, and that established standards of care do not recommend imaging studies in a situation like Susan’s. There is no medical contraindication to getting an MRI, but you know that it would cost between $1500 - $2000, which would come out of the budget for the HMO population. You reflect on what to do and how to explain your thinking about the MRI to Susan.
CASE 2:
Ashkii is a Navajo patient who visited the clinic to discuss hematochezia (blood in stool). Like other Navajo patients, Ashkii views advance care planning as a dangerous violation of the traditional value of κ'é, which is a social ideal that emphasizes respect and positivity. Providers who communicate negative information are often viewed as wishing misfortune on the patient, and patients sometimes prefer that providers communicate with family members instead of informing them directly. After hearing about Ashkii’s symptoms, Dr. Smith thinks that Ashkii should receive a colonoscopy under anesthesia.
How should Dr. Smith discuss Ashkii’s treatment options?