By Don Rubin, PhD (left) & Geri Lynn Baumblatt, MA
George is scheduled for his first colonoscopy tomorrow. He’s not looking forward to it. A week ago he received a fat envelope in the mail from an imaging center he’s never heard of. It lies untouched on his kitchen table.
His daughter Callie finds it a couple of days later buried under ads for carpet cleaning and pizza. Callie tells George he has to fill a prescription to drink the day before his “x-ray.” When he picks up the prescription at the pharmacy, the cashier says, “Any questions? Sign here.”
George grunts, signs, and pays his $10 co-pay. Then, just when he gets home from his job driving a school bus, he gets a phone call. To his ears, it sounds something like: "EastsideEndoscopyremindingyouappointmenttomorrow1:30comeinhalfhourearlyforpaper
Like one out of every 20 colonoscopies, George’s is deemed a failure due to poor bowel prep.
What could have prevented this?
After all, George did receive clear written instructions in a timely way. At the pharmacy, the clerk did give him a chance to voice any questions. And he did get a follow-up call the day before the procedure.
The Missing Ingredient: Listenability
First, no one prepared George to switch on his” internal radio” to tune in for an important message. A call came without warning, and the caller just launched into the instructions without alerting him to switch gears and get ready to absorb information.
Then, the caller didn’t check for understanding. No one helped George rehearse the new information until it was clear he had really taken it in.
And, although staff went through the motions of communicating with George, no one engaged him in a way that invested him in the colonoscopy process. Why should he even do the prep?
Improving Listenability & Engagement
Processing medical information over the phone is especially difficult. But listenability is important in every office consultation, medication review, and patient discharge. Check out this 30 second example of good listenability in an interactive voice response call. (©2015 Emmi Solutions, LLC. All Rights Reserved)
Try these Best Practices
Signposting: Reduce patient uncertainty about the interaction right from the start. Prioritize the information that patient needs to know right now, and give him or her verbal signposts when the most important information is coming up.
Instead of: At home, you’ll need to change your bandages daily, take your antibiotics, and check for swelling every day.
Say: I’ll go over the 3 things you’ll need to do to heal yourself after you leave the clinic. I’m sure you’ll remember all 3. First, you’ll need to take your antibiotic pills. Remind me what time of day you’ll take them. ...Great. Next, you’ll need to change your bandages every day. Can you tell me the most important thing about your bandaging? Finally, what’s important to remember about checking for swelling every day? Make sure every day you exercise your “ABS”: antibiotics, bandage, and swelling.
Use Metaphors that resonate with patients. For example, a polyp is a small growth in the colon. It can look like a like a mushroom with a little stalk. And like a mushroom, it may be harmless or it may be dangerous.
Ensure Good Digestion: Invite patients to ask authentic questions and to digest the information by talking about it. Use words and sentences that sound like natural conversation. For example, in normal conversation it’s good to repeat yourself.
So it’s okay, even helpful, to be redundant. Listenability is an antidote to the language rut health professionals sometimes fall into. Too often we recite routinized speeches, but don’t speak in a way that encourages people to process the information. Most patients — and not just those we might be tempted to dismiss as low-literate or ill-educated — prefer to receive medical information through verbal interaction. Let’s invest at least as much care in making our talk listenable as we invest in making our patient documents readable.
Try This: Before you walk into the consult with your next patient, visualize your next door neighbor or your Uncle Bob. How would you get Uncle Bob to understand and buy into the treatment? By visualizing a person you know and care about, you’ll find yourself naturally adopting a more listenable style. You can find one set of listenability guidelines in the Journal of Health Communication.
Don Rubin, PhD, is emeritus professor of communication studies, of language and literacy education, and of linguistics at the University of Georgia. He chairs the Georgia Alliance for Health Literacy, The listenability perspective is a foundation of the training he offers to telephonic nurses, to health insurance navigators, and to other public communicators.
Geri Lynn Baumblatt, MA, is the Executive Director of Patient Engagement at Emmi where she oversees the creation of multimedia patient engagement, education, shared decision-making, and behavior change Emmi programs and interactive phone calls. She hosts an annual October Health Literacy Month blog series for Engaging the Patient. She serves as an Editorial Board member for the Journal of Patient Experience. Emmi Solutions works with decision scientists, behavior change experts, patients, and clinicians; they draw on their research and experience to create content that helps patients engage in their care. Follow Geri on Twitter at @GeriLynn.