Comm Comm

Communication Critical in Medical Care

We all know intuitively that communication is an important aspect of medical care.  Each of us can recall experiences where a doctor did a good or bad job communicating with us.  For me, the bad job was in the ER just before my mom was diagnosised with colon cancer when I was literally arguing with a doctor who wanted to send her home with antacids without doing any tests.  My 'perseverence' with that doctor resulted in a CT scan that showed the cancer. Boy was that an example of a doctor being unwilling to listen.  The good experience for me was the level of details received from my orthopaedic (Dr. Diefendorf) before, during, and after my rotator cuff repair surgery.  He told me what he was going to do every step of the way and then afterward showed me in pictures exactly what he had done.

Seems the medical community has gone from acknowledging the importance of communication in the abstract to practical implementation.   New applicants to medical schools are being asked to go through the Multiple Mini Interview (MMI) process, according to a recent New York Times article, "New for Aspiring Doctors, the People Skills Test."  The applicants have two minutes to review a scenario of an ethical conundrum and then eight minutes to share how they would handle it. They then repeat the same process with more interviewers.   According to the article, ""We are trying to weed out the students who look great on paper but haven't developed the people or communication skills we think are important", said Dr. Stephen Workman, associate dean for admissions and administration at Virginia Tech Carillion."

In an Atlantic Magazine article, "The Triumph of New Age Medicine" the medical community's research and attitudes about alternative medicine is explored.  It is a long article with many interesting angles, but I narrowed in on the effects of communication in the equation.  The article outlines the commonality of many alternative medicine treatments; "These include a long initial meeting covering many details of the patient’s history; a calming atmosphere; an extensive discussion of how to improve diet and exercise; a strong focus on reducing everyday stress; an explanation of how the treatment will unleash the body’s ability to heal itself; assurance that over time the treatment will help both the problem that prompted the visit and also general health; gentle physical contact; and the establishment of frequent follow-up visits."  Two aspects of this typical treatment scenario seem to make a difference 1) good provider/doctor-patient relationships  and 2) improvement of an overall healthy lifestyle. 

Looking at the first aspect in more depth, communication is the core to the development of a good relationship.  According to the article, "A 2008 study on physician-patient relationships found that physicians deemed “exemplars” based on their reputation and awards received were likely to create an emotional bond with patients; to convey to patients that their commitment to caring for them will endure over time; and to imbue patients with “trust, hope, and a sense of being known.”

Good to know that what we all intuit is now being taken seriously by the medical community.  Yet, we still have a ways to go.  As the Atlantic article concluded,  "Every single physician I spoke with agreed: the current system makes it nearly impossible for most doctors to have the sort of relationship with patients that would best promote health. The biggest culprit, they say, is the way doctors are reimbursed. “Doctors are paid for providing treatments, not for spending time talking to patients,” says Victor Montori, an endocrinologist at the Mayo Clinic. A medical system that successfully guided patients toward healthier lifestyles would almost certainly see its cash flow diminish dramatically. “Last year, 75 percent of the $2.6 trillion the U.S. spent on health care was for treating chronic diseases that, to a large degree, can be prevented or reversed through lifestyle change,” says Dean Ornish of UCSF. Who (besides patients) has an incentive to make changes that would remove that money from the system?"

Of course, as patients we can influence change by demanding better communication from all our medical providers, and, when we have the option, voting with our pocket books for better provider relationships.

 

 

Couch it in a Narrative

Harvard Business Review did a short blurb on reserach by Emily Moyer-Guse of Ohio State and Robin Nabi of UC Santa Barbara showing that a narrative is an effective form of persuasion.

The research study had 367 undergraduates view either a narrative or a non-narrative, news-style program about teenage pregnancy.  Those who saw the narrative self-reported that they would be more likely to use birth control, more so that those who saw the news-style program.  According to the research abstract, "Results suggest that entertainment education programming may overcome various types of resistance to persuasion for some viewers by masking persuasive intent and fostering parasocial interaction and identification with characters."

As I have said many times before, humans prefer stories.  It is easier to assimilate information, and, as this research show, be persuaded if communication is in the form of a narrative. 

Persuade with 5 Canons of Rhetoric

When you want to get somebody to change an attitude, belief, value, or behavior -- happens just about every day -- you need to employ the art of persuasion.  A quote from a student of mine:

“Thus, to change a person’s view, their belief or their actions is to slide through their ears and into their skull and embed yourself into their brain.” 

How does one do so?  Rhetoric, of course.  Since it has probably been some time since you studied the 5 canons of rhetoric, here is a short reminder.

1. Invention (inventio) is finding the means to argue your point.

2. Arrangement (dispositio) is the organization of your argument, such as the most common organization of problem/solution or lesser-used refutation.

3. Style (elocutio) is your choice of words and phrasing or how you put together your specific arguments.

4. Memory (memoria) is what you employ to help your audience remember what you tell them, such as repetition, catch phrases, and visuals.

5. Delivery (pronuntiato) is the non-verbal aspect of communication including voice volume and articulation along with facial expressions and gestures.

What I commonly see is that people will put significant effort into the first canon of invention, but very little effort in the remaining four.  It is easy to just come up with the reasons of why somebody should do as you suggest, but that is not enough.  If you employ all five principles, you will be much more effective at persuading others.  Why?  Because people on not just influenced by logic (logos), but also by pathos (emotion or passion) and ethos (credibility).

So the next time you want to persuade, remember there are 5 canons of rhetoric, and use them all.

 

Your Look Commands

Speech recognition technology has come a long way.  I now use Dragon Dictation on my iPhone to send texts to others.  It is as least as accurate as my touch typing.  It is refreshing to have a different way to interface with technology.

The future holds yet another way to interface -- with our eyes.  It sounds straight out of an action flick to me, but there are prototype computers with eye-tracking technology that move the cursor based on eye movement.  "Pointing with Your Eyes, to Give the Mouse a Break" in the NY Times gave details on this technology.

The computer prototypes are a joint effort between Tobii Technology and Lenovo. Real versions won't hit the shelves for about two more years.  According to the article, eye tracking technology has been around for awhile and used for people with special needs.  The innovation it to make it practical and cheap enough for mass consumption.

I look forward to trying  it out (pun intended).

 

Social Network Research from WSCA

At the recent Western States Communication Association (WSCA) Conference two panels “Social Networking and Beyond: Computer Mediated Communication and Community” and “Relational Communication and Social Networks” contained interesting research on how people are using social networking.  The overarching theme is that people are using social networking as a means of simultaneously forming and communicating their personal identity and relationships.   I have briefly summarized some of the research and provided links for you to dig further if you are interested. 

Valerie Barker from San Diego State University discussed research comparing Mixi Diary vs. Facebook.  She looked at Japanese vs. American young women’s uses of these social sites.  Mixi is popular in Japan like Facebook is in America.  She notes that there are differences:  Mixi is used primarily through mobile devices.  On Mixi the network of friends is smaller with more of a sense of privacy and a closer experience than Facebook use among American young women. Motives for using the social sites include social identity gratification (bolstering a sense of belonging) and social compensation (making up for offline unhappiness). 

Ahlam Muhtaseb from CSU San Bernardino shared research entitled “Mobilizing Online: The Internet, Political Involvement and Community Participation of Arab Americans”  Ahlam found that from a convenience sample of 185 Arab Americans, 75% were users online users and 25% were non-users.  Users showed a greater propensity for community participation, in particular political involvement with a statistically valid correlation between users and voting.

Makenzie Phillips from Boise State University researched social networking sites for surveillance in romantic relationships and found that 83% of respondents are engaging is some type of surveillance behavior.  Jealousy and entitlement were predictors of surveillance behavior.

Karen Lollar from Metropolitan State College of Denver has been tracking Denver neighborhood's use of social sites, such as Neighborhood Link for the past 10 years and shared how neighbors are interacting differently online. She has discovered that most online topics match what neighbors discuss face-to-face, such as pets and local civic issues.

Erin Koppel from University of Arizona looked at 2008 Pew Internet data on social networking use to determine if relationship initiation and relationship maintenance was related to age and found only a negative correlation between age and relationship management online. She noted that this counter-intuitive result could be because of the nature of relationships that exist on the site.

Lynne Webb (and others) from University of Arkansas researched how ethnicity was enacted on Facebook and found that of the 488 open profiles they studied, 29% showed some ethnicity, primarily through quotations or applications.  Webb noted that Facebook does not give space in the profile set up for people to share anything about their ethnicity.

There is such a wealth of information to be studied as social network sites become a pervasive form of communication around the world.  Delving into how communication remains the same and changes as the medium changes will be of great research interest in the coming years.

 

 

Speech Recognition, Getting Closer to Mainstream

As an individual who prefers the spoken word over the written word, I have been longing for the day when I could have my eloquent phrases automatically turned into flowing text.  When working on my master's thesis a few years back, I purchased iListen for Mac in hopes of typing less.  After 5 or 6 attempts, I gave up.  Too much trouble.  But, in the technology industry, a few years makes a lot of difference.

In the WSJ article "Get Ready to Speak to Your Phone -- and Be Understood" Ben Rooney gives us an update on the technology. The company that has been behind the technology all along, Nuance, is still the one making technological advances.  (Nuance - NASDAQ: NUAN closed at 20.32 today, near the 52-week high of 20.97).  The Nuance technology is behind Dragon Naturally Speaking, GM's OnStar, and many mobile phone's predictive text.

I did just a bit of research and discovered that the first speech recognition technology came from IBM in 1961 -- the IBM Shoebox.  It was literally the size of a shoe box and had nine lights.  As you spoke a digit 0-9, the corresponding light would shine. Now we are accustomed to basic speech recognition for voice dialing, call routing, and simple data entry, such as credit card numbers.  Windows Vista added Windows Speech Recognition, though it is positioned as "Accessibility Technology."  Let me know if you have used this technology on a daily basis, and if so, what you think of it.

I am ready for speech recognition to be mainstream.  I imagine telling instead of typing this blog.  I imagine explaining an entire problem to an automated tech support line and getting a relevant answer.  What do you imagine?  How long will we have to wait?

Technology Can Be Turned Off

Technology can be turned off. That is a reminder from Sherry Turkle director of the MIT Initiative on Technology and Self from a USA Today article, "2010: The year technology replaced talking".  According to the article "Americans are connected at unprecedented levels — 93% now use cellphones or wireless devices; one-third of those are "smartphones" that allow users to browse the Web and check e-mail, among other things. The benefits are obvious: checking messages on the road, staying in touch with friends and family, efficiently using time once spent waiting around. The downside: Often, we're effectively disconnecting from those in the same room."

Just like any other tool, these technology devices that help us communicate and share information with anyone, anywhere, anytime, are only as effective as the tool user.  Sometimes we forget that we are in control.  Yes, we can turn off the devices.  Yes, we can use them to be more efficient and fun when we want or need them.  But, they do not need to degrade the quality of our communication with other humans.  Used well, they can increase the quality of our communication with others.  It is only when we forget that they can be turned off or ignored that it becomes a problem.  And, that is a human problem not a technology problem.

Data on Learning to Speak

80,000 hours of video and 120,000 hours of audio recording.  That is the massive amount of data collected by MIT Media Lab's Human Speechome Project to analyze how one child learns to speak.  You can see a visual of the data on Forbes.com to get a feel for how words are gained over time.  Just clicking through the words and seeing the relationship between caregiver use and child use impresses me with the power of being able to collect such data.

"The Speechome team believes that this unique dataset may shed light on basic questions of language acquisition, at least as they pertain to one child. Why did he learn words in the order that he did? Why did he start putting certain words together into proto-sentences before others? In what contexts did he effectively use words? How long after he comprehends a word does he first use that word? How did the structure of everyday life at home influence language development? The research team at MIT is in the process of analyzing the audio and video recordings with the ultimate goal of addressing these questions." according to the Forbes article Speech in the Home.

Immersive Communications

Alcatel-Lucent's Bell Labs has announced an application called immersive communications that combines physical, virtual, and augmented reality into one.  Forbes covered the story in Bell Labs' Super Virtual Conferencing.  The idea is that geographically dispersed people on a variety of mobile devices can have a virtual conference in which they all appear and sound to be in the same room.  Think video conference plus virtual reality and make it mobile.

The concept is enticing, though it may take a few years before we see it in use.  One-to-one communication has become mobile as has mass communication, so it is easy to see that small group communication would follow that trend.  In terms of video, again we see that throughout mass communication and we are beginning to see it with one-to-one communication as smart phones get video capabilities. We also see extensive use of land-line video conferencing in large organization, so it is not hard to imagine those systems folding in a mobile element.

What is harder to imagine is the virtual reality component.  The element of all participants appearing and sounding to be in the same room.  As a communication scholar, this is the most exciting element because it uses technology to replace the look and feel of human contact. 

In an article Anywhere, Anytime Immersive Communications, authors T. Van Landegem and H. Viswanathan outline just why and how this new form of communication will occur.  

I look forward to seeing you immersively some time in the next decade.

 

 

Whisper to the Brain

Neurology is now being applied to persuading others through communication.  The NYT article, "Ads that Whisper to the Brain" reveals techniques used to discover what activates the human brain when somebody watches a commercial. 

Researches use electroencephalographs (EEGs) to measure brain waves that become more active when people have heightened attention to determine if they are engaged by the commercial. 

According to the article, "Neuromarketing’s raison d’être derives from the fact that the brain expends only 2 percent of its energy on conscious activity, with the rest devoted largely to unconscious processing. Thus, neuromarketers believe, traditional market research methods — like consumer surveys and focus groups — are inherently inaccurate because the participants can never articulate the unconscious impressions that whet their appetites for certain products.

If pitches are to succeed, they need to reach the subconscious level of the brain, the place where consumers develop initial interest in products, inclinations to buy them and brand loyalty, says A. K. Pradeep, the founder and chief executive of NeuroFocus, a neuromarketing firm based in Berkeley, Calif."

What does this mean for consumers?  Well, first off researchers haven't made the connection between brain wave activation and the purchasing  of products, so it may be a mute point.  But, the effort to influence consumers through communication is as old as time.

What is helpful is to be aware of the power of communication, both as a broadcaster and a consumer.  What you say and how you say it influences others.  And what you see and hear influences you.  Being aware is the key.  Being aware, you can acknowledge the sudden hunger that arises after watching an Oreo ad, or the desire to become involved after hearing a compelling political message. Being aware, you can acknowledge the influence of persuasive communication on yourself.  As for the subconscious thoughts, well, you still have the power to choose your actions.