Cambridge, MA — We were talking this weekend about what it would be like if every product had to list its risk information the way pharmaceuticals do. Pringles and Oreos would warn of everything from acne to obesity; tooth decay to diabetes. Footballs would warn of concussion, contusion, and breaks and sprains of all kinds. Cars would have to say you’re more likely to die in a fiery crash compared to placebo (would placebo, we wonder, be walking? Or complete captivity?)
The rigor of fair balance only exists in healthcare. Its goal is to protect people at incredibly vulnerable moments in their lives. But in practice, it tends to only stand in the way of real communication, creating the dynamic of expert vs. novice, lawyer vs. layman, all in an industry where no “vs.” should exist at all.
Dr. Angelo Volandes and Dr. Aretha Davis have long been frustrated with the barriers in communication created by all the formality in healthcare. Their singular goal is to get people to really talk to one another. It’s what’s known in the medical profession as The Conversation, that moment in care when a doctor or social worker takes the time to sit down with someone facing a very serious diagnosis and explain, in plain English, what it all means in order to understand what treatment the person really wants.
Often that conversion is skipped entirely. Other times, it’s dashed off in a brisk, jargony way that most people struggle to understand.
Instead of having The Conversation, doctors try to predict what their patients would want. A pattern of assumption that Benjamin Moulton and Jaime S. King called “highly inaccurate” in a recent summary of the research, published in The Journal of Law, Medicine & Ethics. Patients, they said, are “routinely asked to make decisions about treatment choices in the face of what can only be described as avoidable ignorance.”
The problem is perhaps the greatest at end of life. That’s where Volandes and Davis are concentrating their advocacy effort. They’ve developed a series of videos that show people what to really expect from both disease and treatment, to help them make more informed decisions about the kind of care they want.
Their very first film featured a patient with advanced dementia. She was dressed and styled as if ready for church, but the film also showed her inability to converse, to move about on her own, or even to feed herself. They conducted an ad hoc trial with a group of nine other doctors. All were given a verbal description of dementia and some were shown the video. Participants who saw the video chose comfort care (which aims to maximize comfort and relieve pain) compared to 64% of those who only heard the description. The results were even more significant when they were able to test with real patients a year later (90% of video viewers chose comfort care vs 22% who received only the verbal description)
Volandes and Davis have continued to build out videso that show the real experience of many types of disease and care. Some of the videos – like one on CPR – made patients much more likely to want intervention or aggressive treatment. Others, like the dementia video, helped them to decide at what point they’d rather stop aggressively trying to extend life.
The work of Volandes and Davis is obviously focused on major, life-changing diagnosis. But, the problem they point out – that the jargony formality of healthcare impedes real communication – is a truth across the industry.
In the experience of Volandes and Davis and the research of Moulton and King, there are definitely some learnings that could push us to always do better and to deliver on the principles of The Conversation, knowing that the actual conversation won’t happen for every patient:
- Show, don’t tell: Seeing a real person’s experience with a drug or treatment entirely changes a person’s understanding of what to expect.
- Translate: Yes, we have to use the legal words, but those don’t have to be the only words. Test each communication against this simple criteria: Could you comforably say it in a conversation with another human?
- Bring it into real life: It’s not just about how something works in the body, it’s about how it works in the work day or around the dinner table, alone or surrounded by friends.
- Help people understand what the options are: What happens if you do nothing? What if this step is too big for me? It’s not just about the competitors, it’s about the real choices.
- Rethink every assumption: We think we know more than we really know about what it’s like on either side of that exam table. Better communications come from continuing to learn about what different types of doctors and patients really need to promote more lasting decisions and true learning.
We tried to think of an example of a healthcare brand really delivering on these principles. The closest we came is Tylenol. From their original “feel better” campaign to the positioning of their newest Simply Sleep product (don’t take more medicine than you need), they’ve worked hard to translate medical communication into simple communication and bring it into real life.
What other brands or campaigns do it well? Or, at least, are trying hard to?
Posted by: Leigh Householder
