Catching Flies: Approach Matters



Catching Flies: Approach Matters






A spoonful of honey will catch more flies than a gallon of vinegar.

—Benjamin Franklin

Although the origins and exact meaning of Franklin’s phrase are debated, it is generally understood to be a cautionary statement used to convey the notion that approaching someone with words of kindness and understanding is a more successful way to bring them around to your way of thinking than using caustic or acidic statements. If we think about our own interactions when we have disagreed with someone, be it spouse or parent or child, we inherently know this to be true. How do we feel in a discussion when someone comes at us in anger or bitterness? How do we feel when we are cut off mid-sentence? How do we feel when we are speaking and the other person is rolling their eyes or sighing? For most of us, it becomes very difficult to want to understand the other person’s point of view. We feel defensive. The listening, understanding, empathetic part of our brains shut down. We tend to become only that much more entrenched in our way of thinking, no longer willing to consider discussion.

This is what can happen if we don’t approach our vaccine-hesitant patients with empathy, with a welcoming way, and with words that unite as we try to understand their point of view. They will sense our irritation, they will feel spoken down to, and they will be less likely to hear and accept the vaccine education that we are trying to offer. I know that this is easier said than done. When we find ourselves having a conversation with a vaccine-questioning patient for the fifth time that day, it can be difficult to hide the frustration we feel. But we must. If we want to give ourselves the best chance of success, we must go into each conversation remembering that patients are coming to us as their trusted provider, that they are not trying to make our lives more difficult, and that they are just trying to do what is best for themselves and for their families. They are looking to us to help them make sense of what they are hearing about vaccines on their Facebook feed or from their family and friends.


HOUSTON, WE HAVE A PROBLEM

Science and medicine in the United States currently have a public relations problem. A study by the Robert Wood Johnson foundation and the National Institute of Mental Health, looking at polling data of public trust in physicians between 1966 and 2014, shows a significant decrease in public trust over the decades. In 1966, 73% of Americans expressed great confidence in leaders of the medical profession compared with only 34%
in 2012. A 2014 Gallup poll found only 23% of Americans have great confidence in the medical system as a whole.1 And although the public generally trusts scientists to understand and communicate the science in their area of expertise more than it trusts others who may comment upon scientific progress (such as the media, business leaders, and elected officials), that level of trust is still not very good. A PEW study looking at public trust of medical, climate, and genetically modified food scientists showed that, for example, only 35% of adults had “soft trust in medical scientists to give full and accurate information about the effects of the MMR vaccine,” and medical scientists were the most trusted of the three groups. “These findings,” the study states, “suggest that the authority of scientists to speak on matters directly relevant to their expertise is often met with some skepticism.”2

The reasons for this mistrust and skepticism are multifactorial and much of it is out of doctors’ and scientists’ control. Physicians have less time to spend in each office visit, which often leads to decreasing opportunities to develop a close rapport with patients and families. In addition to the time barriers we encounter, the electronic medical record puts an actual physical barrier between patient and physician. A doctor’s time is eaten up with administrative tasks, and our ability to act in the best interests of our patients is sometimes hindered by insurance company roadblocks. Health care costs are rising, but we are not necessarily seeing much improvement in chronic disease or mortality rates. Even though satisfaction with one’s individual provider remains relatively high,1 we are losing public confidence as a profession. For their part, scientists participate in work that, by its very nature, puts forward assertions that are sometimes found to be faulty or, at least, not reproducible. To a public who may not understand the importance of viewing scientific studies on the whole and not individually, and who may not see the benefit of Edison’s purported statement, “I have not failed 10,000 times…I have succeeded in proving that those 10,000 ways will not work,”3 this can erode trust in the scientific process.


LANGUAGE MATTERS

In thinking about the divide between medicine, science, and the public, let’s look at something that we do have control over—words. The language that we use when talking to patients likely plays a role in our successes or failures in getting our vaccine messaging across. Given the aforementioned uphill battle that we are fighting with respect to the confidence and trust that patients have in physicians as a whole, the words that we use in trying to explain the science and data behind the safety of vaccines take on great importance. I certainly don’t lay all of the blame for eroded confidence (or even the majority of the blame) at the feet of scientific language, but I do feel we have to acknowledge the role that our language plays. Communication is key. The Independent Monitoring Board of the Global Polio Eradication Initiative sums up the issue, noting concern over “the Global Programme’s weak grip on the communications and social mobilization that could not just neutralize communities’ negativity, but generate more genuine demand. Within the Programme, communications is the poor cousin of vaccine delivery, undeservedly receiving far less focus. Communications expertise is sparse throughout and needs to be strengthened.”4

The words we choose can either make patients feel comfortable with the information we are providing them or put an unintentional distance between us. When we go to medical school or graduate school in the sciences, we essentially learn another language—the language of Science. It is a hybrid of Latin, Greek, German, French, and
other languages that takes us 4 or more years to learn and is peppered with acronyms (NSTEMI, EMDR, ARI, COPD, etc.) that are even difficult for those of us in the sciences to keep track of. When explaining scientific information to patients, we must speak in a way that is, of course, respectful but also accessible and understandable to someone who doesn’t speak our language. By providing them with easily digestible information, we can help win back their confidence.

In discussing vaccines with our patients, we often entreat them not to rely on what they read on Facebook or Twitter or what the “mommy blogger” they follow is telling them. We encourage them to “do their own research” and not take blog posts or news stories at face value. However, accessing primary source research studies and then understanding that research proves difficult for the average nonmedical, non-sciencetrained person. Currently, accessing many research articles requires signing up or registering with a research clearing house of sorts, such as PubMed and ScienceDirect. Often, these sites require affiliation with a university or other system that conducts research or payment to access individual papers, the cost of which can be prohibitive (for medical and nonmedical persons alike). A 2016 article in The New York Times states that “legally downloading a single journal article when you don’t have a subscription costs around $30, which adds up quickly considering a search on even narrow topics can return hundreds if not thousands of articles.”5 In fact, Harvard University, the article reports, with one of the largest academic library budgets in the world, is having a hard time affording the costs of journal subscriptions.5 And even if the articles are free, the requirement to prove credentials can be off-putting to someone without those credentials.

Although the scientific community is slowly beginning to make primary research articles more readily available through open access journals (like those under the umbrella of the Public Library of Science, or PloS, for example) and other means, the scientific information that is generally available can be very intimidating to the lay reader. In truth, if they are highly specialized articles, they are sometimes even difficult for general medical providers to comprehend. Take the following as an example. It is a segment of an article, titled “Innate Immunity and Toll-like Receptors: Clinical Implications of Basic Science Research,” which was published in the April 2004 issue of the Journal of Pediatrics: “These receptors bind molecular structures that are expressed by microbes but are not expressed by the human host, eg, lipopolysaccharides (LPS) or double-stranded RNA (dsRNA). Activation of these receptors initiates an inflammatory cascade that attempts to clear the offending pathogen and set in motion a specific adaptive immune response.”6

Asking a patient to read and understand this statement would be like asking those of us not trained in finance and accounting to understand the following phrase: “Apply to those EPS and/or EBITDA estimates an appropriate P/E ratio or EV to EBITDA ratio based on the following: Industry identification.”7

For me, and likely for many of you, the finance statement written above is confusing. I have no idea what it means. This is probably how many of our patients feel if asked to read scientific research studies. We need to be available to them to act as interpreters of the scientific information that they are now coming across. And then there’s the fact that the words we use in medicine and science often mean something entirely different to patients and the lay public. Take, for example, the word “negative.” In medicine, we say this to mean that a test result was normal. However, to most patients, the word “negative” has a negative connotation. It can create significant worry to hear that “Your test results were negative,” until results are further explained. Breaking down the data for patients in words and concepts that they can understand and that are meaningful to them will go a long way to helping them feel more comfortable with the information we are trying to present (Box 6.1).




A WAY FORWARD

Those of us currently in practice have not been given specific training on how to translate basic science research and medical concepts into common and easy-to-understand language. We have figured it out through trial and error. But scientists and researchers are beginning to recognize the problems that this communication break-down is causing. Denial of scientific facts, be it in the area of vaccinations, climate change, or evolution, among others, is real and is becoming increasingly common. In the public health sector, this disconnect is a particular problem as the “change agents who can make the biggest difference in improving health behaviors and social and environmental conditions are generally nonscientists outside of the health professions.”9 Consequently, research is being done and models are being tested to help find ways to successfully educate our future scientists in improved methods of communication and engagement with the public, as well as encouraging the news media to be more responsible to the weight of evidence when writing or talking about one of these “controversial” topics.10

Brownell et al. conducted a study on incorporating skills training for communicating science to a layperson audience in undergraduate and graduate students enrolled in the Immunology Program in the School of Medicine at Stanford University. The researchers found a positive impact on the students’ self-confidence in communicating science to a lay audience as well as an improved confidence in their basic writing skills.11,12 Susanne Pelger, in her article titled “Popular Science Writing Bringing New Perspectives into Science Students’ Theses,” found in similar research that “popular science writing offers a cognitive tool to widen science students’ perspectives, and hence, to promote their development of scientific literacy and achievement of scientific writing skills.”13 Still others have proposed the use of science liaisons, a job description currently requiring a PhD, PharmD, or MD. Science liaisons are typically employed in the pharmaceutical, biotechnology, medical device, and other health care industries to maintain peer-peer relationships with key thought leaders (physicians and researchers) at major academic institutions and clinics.14 Instead of working to develop relationships within the halls of science and industry, however, this
newly imagined liaison would serve to communicate and maintain relationships with those who don’t have a science background—the lay public, news media, and government officials.

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Mar 16, 2020 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Catching Flies: Approach Matters
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