Reflecting on the connections between health disparities and communication

10 Minutes to Better Patient Communication

National Minority Health Month is an opportunity to reflect on the connections between health disparities and communication. It’s essential to lean on research and outside expertise when communicating. But I share what might be an unpopular opinion about the role of expert recommendations in our communication efforts.

It’s National Minority Health Month, so we’re going to talk about health disparities and communication, and the relationship between the two, and I’m going to tell you something you can do today the next time you are communicating.

Hi everybody, I’m Dr. Anne Marie Liebel, and this is 10 Minutes to Better Patient Communication from Health Communication Partners. Our online course, Equitable Patient Education, promotes high-quality clinical practice in patient education by helping prevent avoidable errors. Learners say, “There’s a lot of eye-opening information I hadn’t considered before.” For more information, visit healthcommunicationpartners.com.

And if you didn’t hear the news, we got ranked, yay! We made it to number 20 on the Top 100 Social Science Podcast Series on Goodpods, woohoo! And I think really it’s because of last month. I have to say I got so many nice messages about the episodes we ran in March. We had three sets of interviews from women differently positioned in the health sector (Dr. Taquina Davis on understanding the impact of religious beliefs on patients' decision-making; Dr. Ann Ancona on encouraging critical thinking in health professions students; Dr. Erin Basinger & Dr. Margaret Quinlan on Anti-fat bias in reproductive health). I’ll go ahead and drop those links in the notes. But if you like what you hear, leave a review on your listening platform of choice, message me on linked, or send me an email AnneMarie at h-cpartners .com.

Like I said, it’s National Minority Health Month, and you already know that this is a show about communication. Patient provider communication, yep, that’s where we started. Also, we branched out to more interprofessional communication and other workplace communication, whether it’s written, spoken, or digital. You’re already aware of many, many documented health disparities, right? We almost can’t mention minority health without also talking about disparities in access and quality and outcomes. So I’m not going to rehearse those. But I am going to review some of the relationships you probably already know between minority health and communication and disparities.

We know there’s more than 20 years of research tying poor communication to disparities. I want to first start with written communication and a shout out to my public health friends who are doing great jobs engaging communities early in the communication process. And you’re testing the form and the content of your communication campaigns. Also health literacy people! Absolutely this field leads the way here reminding us all how the accessibility of information has a great deal to do with how it’s written, right? What words and images are being used, and that considering the intended audience is essential.

As many as nine in ten Americans struggle with complex health information. And I’m one of the many people who hold this is largely because of the way that health information is written! The content in digital tools like apps, patient portals, devices, and websites is often written in a way that is inaccessible to most Americans. Add to that, 24 million Americans are not considered proficient in English and that’s the language used in most digital health environments, which is how most people get their health information now.

Let’s review some stuff in patient-provider communication. An American Journal of Public Health study summarizes some of the ways that patient -provider communication can unintentionally advantage or disadvantage some groups of patients. For example, “by providers approaching patients with a dominant or condescending tone, that decreases the likelihood that patients will feel heard and valued.” Also, “by failing to provide interpreters when needed.” Also “by doing more or less thorough diagnostic work,” or “by recommending different treatment options for patients based on assumptions about those patients’ treatment adherence capabilities.” I’ll drop the link in the show notes to that study as well.

And to a report from NPR, which says nearly 1 in 5 LGBTQ adults has avoided seeking medical care for fear of discrimination, which we know is often conveyed through communication. Just on this very show, just last month, communication researchers Erin Bassinger and Maggie Quinlan reported on the negative messages that fat people receive during conversations with their providers about reproductive health. Definitely a link in the show notes.

So, I want us to remember this: words and silences in clinical interactions can erode equity.

I’ll say that again: words and silences in clinical interactions can erode equity, even and perhaps especially when we don’t notice them. And communication can be tough to notice because we’re doing it all the time.

This tough to notice aspect about communication was mentioned just recently at the White House Minority Health Forum. It was a live broadcast on YouTube, and I’ll drop the link to that video in the notes. And there was a statement made by Eliseo Perez-Stable, who you may know is the director of the National Institute of Minority Health and Health Disparities at the National Institute of Health. He talked about communication as something we can take for granted. Yeah, that’s legit. We can take communication for granted. We’re doing it all the time. And he pointed out that, “There is a science behind it. It is a skill you get better at when we prioritize it and value it.”

And you do value it. You care deeply. You are working hard at making good things happen, seeing improvement. You’re already thinking deeply and reflecting on your communication and studying your own communication. It’s the stories that you’ve shared with me over the years–how hard you’re working to connect with patients. And what an honor it is to hear these stories, to be privileged with these moments inside your day-to-day practice. You tell me your gripes and complaints and also what you’re up against, what worries you at night.

And it’s clear to me you are knocking yourselves out to treat patients equitably. You’re engaging them, you’re involving communities, you’re not just dropping stuff on them, but you’re collaborating. And you’re also listening to each other. You’re sharing knowledge. I also hear you telling me you’re looking at data. You’re reading research. You’re keeping current. You’re listening to podcasts. Hey, shout out to Dr. Raj Sundar and his podcast, Healthcare for Humans. If you haven’t checked that out, please do. It’s just outstanding.

You’re in many ways turning to expert knowledge, to inform your communication, and this is, of course, super important. But as much as there’s this kind of discourse of the right word for the right patient at the right time, from what I’m getting from you, there’s an understanding that there’s not going to be one right answer most of the time. That we get that we’ve got to turn to experts. It’s essential, it’s important and we all need to do it.

Someone on Twitter put it this way–I’m sorry I just can’t call it X, so here we go–someone on Twitter put it this way, and I thought I would take this up and talk about it because it helps me make a point that’s a subtle one that we don’t always get. They were making a point about “being consciously aware of whether our judgments, opinions, preconceived assumptions, and beliefs are forming the basis of our communication, or whether it’s tried, tested, and proven recommendations that have worked successfully with past or current patients.”

And when I read that, I was like, Okay, I get it. This person’s reminding us not to just kind of go off the cuff and write or say what we think or feel or guess. They’re recommending we turn instead to proven recommendations.

I definitely think we should turn to proven recommendations, but I’m not sure it’s an either/or. I don’t think it’s either our judgments, opinions, assumptions, and beliefs or proven recommendations, but that both are working at the same time.

We are all necessarily using judgments, we’re working with assumptions, we’re working with beliefs, and it’s important to be aware of both of them–both our kind of like inside knowledge, and also outside knowledge. Yes, it’s important, it’s crucial for us to lean on expert knowledge. Consider that how we take that knowledge up and use it in the specific scenarios in our local contexts is a matter of our professional judgment. We’re necessarily exercising this judgment.

Hey, and don’t also forget what we bring to the table. We bring knowledge and experience to our communication practices. Subject matter knowledge, knowledge of local people, practices, contexts, policies, materials. This knowledge is is also crucial along with outside expert knowledge.

So these two knowledge bases, inside knowledge and outside knowledge, can and should both inform our communication design. This is what I teach people to do, so if you’re interested, you can take one of my courses or you can contact me. Visit healthcommunicationpartners and click on Contact. This has been 10 Minutes to Better Patient Communication from Health Communication Partners. Audio Engineering and Music from Joe Liebel, Additional Music from Alexis Rounds.

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