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Doorknob Disclosures
The disclosure of a concern done at the very end of the appointment, almost as an afterthought, the provider is already one foot out the door
Why doorknob disclosures happen
Patient could be embarrassed of their health concern
Patient could be afraid of the monetary component that is paired with treating their concern
They have already convinced themselves or assumed they are okay despite their concern
They are scared of what their concern could mean or could be
Relational or Transactional Communication
The communicators within the situation exert mutual influence on each other
What effects the relational communication process?
Social norms - i.e., “Doctors are mean, and patients are dumb”
Therapeutic privilege
Prerogative to withhold information if physicians feel the information would do more harm than good
Characteristics of Caregiver Centered Communication
Providers talk more, patients talk less
Patients listen more, providers listen less
Providers often ask closed-ended questions
Characteristics of Patient Centered (Collaborative) Communication
Emphasizes dialogue
The patient is a central construct
Believes the goal of patient-provider communication is to focus on overall health and fulfillment
Actualizes patients into the role of decision makers
The 3 factors people consider before disclosing information
Can I predict the outcome of the information I share will be?
Can I predict how the person will respond to me?
Can I share this information effectively?
Positive Facework
Communication behaviors that protect our positive face (our self that wants to be liked by others)
Negative facework
Communication behaviors that protect our negative face (our self that wants to be independent and free of restraints)
Voice of Lifeworld
A way of communicating that is primarily concerned with health and illness as they relate to everyday experiences
Individual level of identity understanding
Personal identity characteristics that help define a person: Gender, sexuality, age
Social/Group level of identity understanding
Social identity is characterized by the perception of group membership: Teenager, Gen Z, millennial, college student
Health level of identity understanding
This level is characterized by an individual, their illness, and that individual’s alignment towards that illness: Identifying as a victim vs as a survivor
Stage One
Supernormal Identity, “My illness will not stop me from being myself”
Stage 2
Restored Self, “This journey has been brutal, but I’m still me. I’m still independent of my diagnosis.”
Stage 3
Contingent Personal Identity, “This journey has been rough AND has changed my life. This really does affect my day to day.”
Stage 4
Salvaged Self, “This illness is now a part of me”
Attending to the negative face =
Higher patient satisfaction
Why do people not cooperate with medical advice?
It is foreign or expensive
They disagree with the assessment
They predict the treatment will not work, or not work well
The treatment may have unpleasant side effects
What are the characteristics of informed consent?
The patient must be fully aware of risks, benefits, and options
The patient must be deemed capable of understanding and making their own medical decisions
The patient must be aware they can refuse or stop treatment at any time
Voice of Medicine
Style of communication focused on controlled empathy and concern for accuracy and speed
Advantages of Interdisciplinary Teamwork
Multiple perspectives
Involvement in decision making
reduces costs
biopsychosocial
Disadvantages of Interdisciplinary Teamwork
Takes extra time
Groupthink
similar to hivemind, people are quick to accept the first suggested solution because they are not confident enough in their own ideas
Professional Prejudice
“My profession is better than yours, so my opinion means more than yours does”
Ambiguity
There is only one door, one option, but you’re unsure what lies beyond that door
Ambivalence
There are two doors, or options, but they look the exact same and you don’t know what to pick
Uncertainty Management Theory
Uncertainty is a fundamental and pervasive part of the human experience and information can help us increase, reduce, or maintain that uncertainty
Theory of Motivated Information Management
People use information to manage their uncertainty discrepancy
Uncertainty Discrepancy
The tension between the amount of uncertainty we are experiencing and the amount of uncertainty we want to experience (which can be more OR less)
Common information management stratgeies
Information seeking
Information avoiding
Cognitive reappraisal
Passive method of managing uncertainty
The individual does not go looking for uncertainty management in any capacity, it just happens to find them
Ex. Being stressed about an upcoming test and then just by chance you happen to overhear someone who has already taken the test say it was super easy
Active method of managing uncertainty
Seeking out some way to soothe your uncertainty, but this method does not require interaction between people
Ex. When you’re unsure of something, you Google something
Interactive method of managing uncertainty
Seeking a person out, trying to find an information provider to ease you
Ex. Having questions about an assignment and choosing to go see your teacher to clarify
Communication as a tool for managing uncertainty: Seek Relevant Info
Information seeking can increase, decrease, or maintain uncertainty
Information seeking can be passive, active, or interactive
Communication as a tool for managing uncertainty: Avoid relevant info
Direct avoidance
Selective attention
Withdraw, suppress, discount
Communication as a tool for managing uncertainty: Cognitive reappraisal
Think about uncertainty or the situation differently
Reappraise
Level of issue importance
Desired level of uncertainty
Meaning of uncertainty
Communication as a tool for managing uncertainty: Seek Social Support
Supportive others can help increase, decrease, or maintain uncertainty
Provides validation, source for venting, networking, and minimizes social uncertainty
Disadvantages include less control and more relational uncertainty
Intersectionality
We have many different identities that are distinct from one another but have overlap and influence on one another, refers to the interaction between multiple, ongoing identities
Social Determinants of Health
Where persons are born, grow, live, work, and age
Socio Economic Status (the combination of income, education, and employment level, like a math problem) Affects Health
Affects access to healthcare services
Creates potential differences in environmental exposures
Creates potential differences in health behavior
Socio Economic Status (the combination of income, education, and employment level, like a math problem) and Health Communication
Patients often ask less questions and reveal less about their health concerns
Patients are often less satisfied with medical care and are less likely to benefit from written materials
Patients often have difficulties in negotiating treatment decisions
Sex
Biological and physiological differences that define male and female
Gender
Socially constructed rules, behaviors, activities, and attributes that a given society considers appropriate for men and women (or others)
Heteronormativity
The assumption that people’s romantic and/or sexual partnerships are with someone of the opposite sex
Race vs Ethnicity
Defined as a social identity vs defined as a cultural identity
Disability
Any condition of the mind or body that makes it more difficult for an individual with the condition to do certain activities and interact with the world around them
Disability and Health Communication
Less likely to report quality interactions with health providers
Report struggling to use health communication technologies such as virtual appointments
Person first language
Linguistic choice aimed at reducing perceived and subconscious discrimination. Some do not prefer this type of language, but most do
person with autism vs autistic person
Communication Accommodation Theory
People often mirror each other’s communication styles in order to portray liking
Concordance
Shared attributes between doctors and patients such as race, gender, age, or education
Convergence
Individuals who view each other as similar, often leads to easier and more satisfactory communication
Health Disparities
Differences in the quality of care received by minorities and non-minorities who have equal access to care AND when there are no differences between these groups in their preferences or needs for treatment
Potential Sources for healthcare disparities
Organization and operation of healthcare systems
Ex. Types of systems, types of people, structure of systems
Patient’s Attitudes and Behaviors
Patient’s own opinions or prejudices that prevent their medical care from occurring
Provider’s biases, prejudices, and uncertainty when treating patients
Health Equity
The attainment of the highest level of health for all people
Driving factors for health disparities include
Economic Status, Neighborhood and Physical Environment, Education, Food, Community, safety, and Social Contact, and Health Care System
Explicit Bias
Bias in which people are consciously aware, leads to blatant discrimination
Implicit Bias
Bias that is activated automatically without conscious awareness, leads to subtle expressions of discrimination
Social Support
The provision of behaviors that directly or indirectly indicate being cared for
Perceived Support
The idea that someone could give you the support that you need (Do you have someone you can call?)
Enacted Support
The actual actions someone has enacted to support you (That time your mom made you soup when you were sick)
Supportive Communication
How we communicate that we care, there are 5 types
Instrumental Support
Involves sharing tasks and resources
Ex. Exercising together, cooking and sharing meals, giving gifts, doing chores
Informational Support
Involves seeking and sharing information
Ex. Studying together and sharing class notes, giving advice
Network Support
Connecting people to others
Ex. You connecting your family member to people who share their experiences, going to AA, or going to a place like Reddit or another online forum for support
Emotional Support
Involves comforting someone in distress, emotion focused
Ex. supportive messages, physical touch, active listening
Esteem Support
Helping someone feel competent and valued
Ex. Saying or telling someone affirmations
Buffering Hypothesis
Social support heals indirectly by reducing stress (stressful event → social support → less stress)
Any kind of social support will help reduce stress
A stressor is NECESSARY for social support to be useful/helpful
Main-effect model
Social support is helpful regardless of the presence of a stressor
A stressor is NOT necessary to make social support helpful and have a positive impact, it is always useful
Optimal matching model
People benefit the most when they get the type of support that fits the situation
Car breaks down → instrumental support: here’s money for a new car → very helpful
Support Gaps
The best outcomes are thought to result when the quantity of received support matches the quantity of desired support
Support deficit: Received support < desired support
Support surplus: Received support > desired support
Low-person centered message
Directly acknowledges and invalidates emotions, there is recognition of the upset but no validation of the feelings or emotions
Moderately person-centered message
Indirectly acknowledge and validates emotions. Might say things like “I know it’s hard” but never “I hear you”, this is the most common form of person-centered message.
High-person centered message
Explicitly acknowledges and validates emotions, recognizes uncomfortable feelings and then talks about how to move forward
Stigma
“An attribute that is deeply discrediting” that reduces an individual “from a whole and usual person to a tainted, discounted one”
Stigma 2.0
“Negative attitudes held about individuals who are perceived to possess a trait deemed negative by the community at large, as well as those with whom these individuals are associated.”
The psychological responses to uncertainty that explain stigma
To distinguish themselves
To protect themselves
Because they have trouble differentiating the person from their trait
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