We are grateful for and in awe of high-tech innovations that have improved diagnostic testing and treatments. Technological advances have changed how we diagnose and treat diseases, which has resulted in people living longer and in some instances being cured. What can get overlooked when dazzled by shiny objects is the process by which thoughtful and informed decisions about care are made. This interactive communication process remains in the domain of low-tech. Without clear communication, it would be difficult for a patient to understand their health status and risks and benefits of treatment choices, which could lead to unintended and regrettable consequences.
So how does one educate patients in health literacy and communication skills?
I guess you can say I tried to answer that question in the late 1990’s by creating Writing is Good Medicine, a program designed to help cancer patients describe their experiences in facing a serious illness. I would encourage participants to share their writing with the cancer care team. It turned out that issues expressed in a writing exercise often served as “ice-breakers” for candid conversations about side effects of treatment, quality of life considerations, life expectancy and the psychological impact of illness on themselves and loved ones. This low-tech intervention produced valuable information for planning of care.
Writing is Good Medicine was a precursor to the medical humanist model that was launched at Southwestern Vermont Regional Cancer Center in 2003. In that program my medical humanist’s notes documented the patient’s perspective of their illness for the cancer care team. The notes, too, served to open channels of communication.
Fast forward 10 years to developing SpeakSooner: A Patient’s Guide to Difficult Conversations, another low-tech communication tool, whose foundational concepts can be traced back to the Writing is Good Medicine program and medical humanist’s notes. All of these interventions emphasized the patient’s perspective and served to prompt candid conversations with healthcare providers about what may have been misunderstood or unspoken.
So, who among us is going to promote pen and paper?
I would say in the 21st century that writing down and opening conversations about one’s questions and concerns will gain traction as the low-tech tool to help bridge the communication gap and facilitate making informed decisions about care. I’m all in for interventions that prepare patients to place themselves at the center of care.