Sunday, April 22, 2012

More devices, less communication

What if all the new gizmos we have -- iPhones, Blackberries, and the like -- are actually degrading the level of communication we have?  That is the premise of an article in the New York Times by Sherry Turkle, entitled, "The Flight from Conversation."  What if that is carrying over, in a perverse way, into health care?

First, some excerpts from the article:

We live in a technological universe in which we are always communicating. And yet we have sacrificed conversation for mere connection. 

Over the past 15 years, I’ve studied technologies of mobile connection and talked to hundreds of people of all ages and circumstances about their plugged-in lives. I’ve learned that the little devices most of us carry around are so powerful that they change not only what we do, but also who we are.  

We’ve become accustomed to a new way of being “alone together.”

Human relationships are rich; they’re messy and demanding. We have learned the habit of cleaning them up with technology. And the move from conversation to connection is part of this. But it’s a process in which we shortchange ourselves. Worse, it seems that over time we stop caring, we forget that there is a difference. 

We are tempted to think that our little “sips” of online connection add up to a big gulp of real conversation. But they don’t. E-mail, Twitter, Facebook, all of these have their places — in politics, commerce, romance and friendship. But no matter how valuable, they do not substitute for conversation.

Now, look at this note from a friend, who has a friend who has been advised to have aortic valve surgery:

As I was talking to her, it became very clear that she has not utilized the primary resource available to her – the doctor in front of her. While ePatient Dave and others exemplify the ideal of the empowered patient, in my experience, this is uncommon. On average, American patients ask more questions about the new TV they consider buying than about their own health. Health care providers need to do a better job of communicating – without a doubt. But, this needs to be a conversation. And, in my experience, neither side is excelling in facilitating this conversation. I know AHRQ has made some attempts to promote asking questions of your doctor – but maybe a more robust effort to promote these conversations and, perhaps train patients to have them, would help to improve the quality of care. My friend is considering a second opinion. My question for her was how she will get any more out of this visit since she made so little of an attempt to extract information from her first visit.

An interesting parallel, no?


The Medical Contrarian said...

While conversations have their place in health care delivery, in my estimation they are over rated in terms of their effectiveness. Doctor - patient conversations are limited by limited attentions spans (of both parties) limited time, different word meanings, and imprecision of descriptors used to list but a few. The spoken word is quickly forgotten and memories of what was said will invariably morph in unpredictable ways.

I find that conversations are useful to start processes and to finish them. They are all but useless for the pieces in between.

Anonymous said...

To the Medical Contrarian, I wonder how one can establish a relationship with the patient without conversations. Is this not the underlying purpose of them, after all?

nonlocal MD

Dr.Theresa Willett said...

I agree that there needs to be more than just verbal dialog. Tech, and even low tech paper notes, should be used to support the issues at hand. It is not too much to expect patients to engage in the decision making on their own health. What we need to remember, though, is that many generations are still believers in 'doctor knows best' These are the folks who need the 'expert' to coach and coax them in the rules of this engagement. Maybe they don't know what questions to ask, so we need to guide that part of the discussion. If we can lead them to asking the questions that matter to them, rather than just listing off what we think we know, then they are much more likely to retain the information and pursue more questions over time. Time, of course, is the main barrier, but that is an already well documented problem!