Instead of reading, you could also just listen …
There is a need to reduce the complexity of our conversation.
Medical information is complicated, and therefore we need to reduce the complexity of our conversation.
The body is a composition of systems that are interdependent and interactive.
Any change in one aspect of the body can have far-reaching and (for the patient) often unexpected effects in other areas.
If we want to share the knowledge about a specific illness to empower the child and parent to make sensible decisions about their health, we need to find a way to break the complexity down into easy, digestible chucks.
And this is only the physical part of medicine, let alone the emotional and psychological aspect of any affliction.
Illustrating complexity
The translation of complexity into ordinary language is often an area where the interaction between doctor and patient or parent falls short of the goal of empowerment, especially in relation to paediatric patients.
These two illustrations show different approaches:
The left one demonstrates the details of the anatomy of the Eustachian tube. The aim was here to give an accurate image of the structures. It is full of detail, and both dissections show the same structure from different angles. Due to the complexity, both angles of view are not linked. The depth of detail and the fact that two images aim to show the same structure (the Eustachian tube) can confuse someone who is hearing about this structure for the first time.
In contrast to the right, one is a deliberate-simplified version.
This illustration is constructed to help with the conversation about the function of this structure.
In this case, some aspects are deliberately not “correct” in the anatomical sense.
This illustrates how we need to reduce the complexity of our visual aids as well as our words.
Before starting the communication
The literature about doctor-patient communication often focuses on difficult conversation. The test-case is mainly the delivery of bad news.
In any of the proposed strategies, building rapport with the patient comes before the act of presenting any medical information.
This blog has focused on the obstacles for forming the connection exclusively in the previous posts, and in the following posts I will share thoughts about how to achieve connection.
Finally, when a rapport between doctor and patient is built, the question remains: How actually to speak with the child and adult in a way, that they have a chance to understand the complicated topic.
Tuning down complexity
We need to “educate” patients and parents about how body-systems work. In those cases, we need to tune down the level of details for the patients, while maintaining the overall correctness. There are some basic steps to achieve this reduction of the complexity.
Simplified illustration of Eustachian tube
Coming back to the illustration above, the question is not “does the illustration catch all details” or even “is the illustration anatomically correct”, but “does the illustration highlight the principle we want to explain”.
It is designed to explain the relationship between the Eustachian tube and the nasopharynx, and especially the adenoids.
How to find the correct level of complexity
How can I test if the image serves the goal sufficiently?
I feel I have done enough, when the patient starts asking questions that are in line with the principle, I try to share with them. In that case, I can be certain, that the picture is achieving the goal, of supporting the conversation.
It is always very gratifying, when someone suddenly really seems to understand, what is going wrong and what would need to be done, and last not least, what they can do about the situation. This, to me, represents real “patient – empowerment”.
Strategies to reduce complexity
How do we achieve this?
I would suggest the following three steps to reduce the complexity of our conversation:
- Demonstrate the underlying principle behind the complexity
- Put the principle in a “black box setting”
- Translate the concept into an illustration from your recipient’s world
1. Demonstrate the underlying principle behind the complexity
As a preparation for adjustments, we first would need to ask ourselves the following questions:
A) About the condition
- What is going on?
- On the physical side
- as well as on the psychological side
- or family dynamic side
- What do the child and parents really need to know at this moment?
- The complex trajectories can be broken into what chunks?
- physiological background
- pathophysiological break down
- phases of disease
- treatment steps
- follow up
B) About their situation:
- What does the medical situation look like from the paediatric patient’s point of view?
- What does the medical situation look like from the parent’s point of view?
- What impact will they experience?
- What tools do they have available to manage their experience?
We need to understand the principle of the problem to be able to translate it.
There is a lot of analysis involved, to arrive at an individualized adjusted storyline.
2. Put the principle in a black box setting
Black boxes are beautiful things!
Things work without us knowing how! That helps to reduce the complexity of our conversation.
To use a Swiss made precision watch, we don’t need to understand the mechanics of it. We simply strap it on our arm and allow the internal mechanism to keep it wound up, and it will tell us the time reliably.
The same principle can be applied, when we translate and tune down medical complexity.
This “black box principle” shows:
- something triggers an action of a process/ in an organ/ by a system
- something happens during the process /in an organ/ in the system
- something is the result of this initiated dynamic
The patient only needs to understand the first and the last step. Any details about the mechanics of physiology and pathophysiology are mainly confusing and often not very helpful to the child and their parents.
The child and their parents do have some control over the input and therefore about the outcome of the bodily mechanics. These aspects would need to be highlighted.
3. Translate the concept into an illustration from your recipient’s world
A picture tells more than a thousand words. This is especially true when communicating complexity.
I am here not only referring to drawings, but as well to imagined pictures, that arise in the patient’s minds when we provide a catching description.
To illustrate what I mean with imagined pictures, let’s use the famous pink elephant.
When you read those words “pink elephant”, you immediately see it, although no drawing shows it.
This demonstrates that even by words alone, the world of images can be opened. This can be utilized to help with the explanation of medical complexity.
To make the illustration easily digestible, it should be from the patient’s own world.
This implies, that younger children would need different illustrations than older ones.
4. Using pictures …
Readily available drawings are valuable when a basic story is told frequently.
As an example of this, I will demonstrate my ENT-explanation sheet in a later post. The tangible picture has the advantages, that I can customize it with simple addition of some lines, customizing the drawing for the individual patient. That way, I provide a “conversation-note” for the parent.
On other occasions, the illustration can “only” be a picture in the patient’s mind that is triggered by words. The later is far more flexible for all necessary adjustments to the individual story. However, the later is less tangible and in that way offers less control for the doctor involved.
5. … and simple language
I typically aim to explain the condition and treatment plan to the child. Although I am aware that they do need their parents to support them along the way of the treatment, they are also autonomous persons, who have a right to understand what is going on (within reasonable limits). This is just a sign of respect towards them.
Directing my explanation to the child, makes it naturally easier for the parents, to understand, as I would need to use quite simplified language, pictures and planned steps. This approach also inevitably deals with the effect of parental anxiety during the consultation.
In a nutshell:
We need to reduce the complexity of our conversation, by using verbal or physical illustrations.
Communication lives on comments … fancy to share yours?