Communication, according to the Oxford English Dictionary, is the action of sharing or exchanging information or ideas. What the dictionary does not say is whether communication includes the concept of understanding the message the informant intended to relay. Without adequate understanding the message being communicated is lost or misconstrued, sometimes with unintended consequences.
Of course, there are those who would claim that the opposite is also of value. Some might argue that misleading communication is an art well exercised by politicians to meet their own ends. As the American author Lionel Trilling said, ‘where misunderstanding serves others as an advantage, one is helpless to make oneself understood’. Examples of that were certainly seen last week during the battle over NHS pension arrangements.
However, the language used to communicate a message is equally important as the ideas being expressed. A favourite expression of mine is ‘words mean what words say’. Naturally, it is a paramount prerequisite for good communication that both the communicator and the listener understand the meaning of the words being used. I assume that Tim Loughton MP, was not being deliberately misleading last week when he said ‘I shall be speaking about it more fulsomely later.’ Referring to a report on missing children, he probably meant to give the impression that he would speak ‘in detail’ or ‘at greater length’, and that is possibly what most people took to be his meaning. However, the word ‘fulsomely’ is ambiguous. Properly interpreted as ‘lavishly’ or ‘extravagantly’, it can also convey ‘insincerity’ to the point of being insulting. To some listeners, his message would therefore have been received in a completely different manner to that which he probably intended.
Doctors need to be good communicators if patients are going to understand the health issues being discussed. For the majority of patients, there is no point in the doctor hiding behind erudite phrases, words in Greek or Latin, or medical jargon full of acronyms, if it is hoped that the message will be understood. According to recent studies, 43% of Americans have a literacy standard below that necessary to understand health issues (see www.nchealthliteracy.org for more details). In the United Kingdom, the figure is thought to be around 12%; although these figures assume that the message is being conveyed in a language suitable in respect to its origin, dialect, complexity and accuracy as befits the recipient. The phrase ‘health literacy’ is increasingly being used in reference to such matters.
‘LSD? Nothing much happened, but I did get the distinct impression that some birds were trying to communicate with me.’ The poet, W H Auden, was clearly speaking of his experience of using an hallucinogenic drug when it said that. Nonetheless, for many people, even the most caring of doctors can leave them feeling confused and uncertain. For them, a trip to see their GP or specialist may be as equally puzzling as Auden’s encounter with his feathered friends.
The problem is not just about whether someone can read and write, or whether they speak the same ethnic language as the doctor; our population is increasingly an aged one, and even very intelligent people start to lose cognitive ability as they get older. Defined by the World Health Organisation as ‘the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions’, health literacy must be taken into consideration and appropriately addressed if we are to achieve the desired health outcomes for our communities. Doctors must remember that patients will not always say that they do not understand; for their part, patients must not be ashamed or intimidated, and must tell the doctor if they do not understand what is being said. Getting the health communication wrong can be costly to the individual and society, in terms of deteriorating medical conditions, more expensive medical treatment, prolonged hospital stays, and increased risk of death.
That said, the French poet Charles Baudelaire once declared that ‘It is by universal misunderstanding that all agree. For if, by ill luck, people understood each other, they would never agree.’ Perhaps that is an apt statement for tautologous political circles, but not one for an effective health service. Unlike Sofia Coppola’s film, health messages should never be lost in translation.
(First published in the Scunthorpe Telegraph, Thursday, 28th June 2012)