How health literacy can help your patient relationships

10 Minutes to Better Patient Communication

It’s our show’s 7th anniversary! Hear a story about a literacy trailblazer, and learn 3 steps you can take to improve patient relationships.

It’s our series anniversary! Yes, 10 Minutes to Better Patient Communication has been on the air for seven years! Oh my gosh! In today’s episode we’re gonna go back to where it started–with health literacy. And I’m gonna share a story that I think can help you improve your relationship with your patients.

Hi everybody, I'm Dr. Anne Marie Liebel, and this is 10 Minutes to Better Patient Communication, from Health Communication Partners, ranked #20 of Top 100 Podcasts in Social Sciences by Goodpods. Our online course, Equitable Patient Education, promotes high-quality clinical practice by helping prevent avoidable errors. Learners say, There's a lot of eye-opening information I hadn't considered before. For more information, visit healthcommunicationpartners.com or message me on LinkedIn.

Thank you for being here. Thanks for celebrating with us. It’s been an enormous privilege to have this show on the air for so long. Thanks for making this possible, because it’s you sharing and downloading that keeps us going. We were one of the first podcast series focused on patient communication, and I’m thrilled to say we’ve become one of people’s go-to sources, heard all around the world. Which as an educator means an enormous amount to me, because this is not easy stuff that you are choosing voluntarily to focus on.

With COVID and the increased focus on health equity and whiplash on DEI, we’ve been through a lot together. We’re way out of one-size-fits-all, easy, quick fix territory. This is deep work here, messy work, and that’s why you’re here. We’re seven years in, hundreds of thousands of downloads, which means many people like you also see that communication is important, and also know reflecting is key.

Reflection is a power move. If you haven’t reached out to say hi, please do! Again, message me on LinkedIn, email me, go to healthcommunicationpartners.com and click on contact. Because I’m proud of what we accomplished in these seven years and I’m excited for what’s to come.

It’s Health Literacy Month. Not coincidentally, this is the month I launched the show, because health literacy is a big part of what drew me into the health sector. So in today’s episode, I want to talk to you about the work of one of my favorite professors, Dr. Brian Street. Brian opened up so many horizons for me, changed so much of what I took for granted, how I understand literacy, how I relate to my students. He didn’t just do this for me. He did it for thousands of people around the world.

Your relationships to your patients are important to you on many levels. You know better patient relationships mean better outcomes for everyone. And patient care is what got you into this in the first place. So in today’s episode, I want to tell you a little bit about what Brian did in the literacy field that made that huge change.

For this story, we’re gonna go all the way back to the 1980s when Brian was doing his research that would transform the literacy field. The literacy field up until that point was dominated by researchers searching for a universal thing called “literacy” that was the same everywhere and for everyone, and if you have it you could use it anywhere, and get the same results, no matter who you were.

Brian Street had a different starting place. He decided to spend time with people from different social and cultural groups around the world, paying attention to the different ways actual people use language in their everyday lives, and what their reading and writing and listening and speaking meant to them. And what Street really found challenged decades of research and opened up new directions for all of us.

One of his findings was that, hmm, there’s not that one universal thing or skill that you could point to and say “that’s literacy.” On top of that, he found evidence that the whole idea that there ever had been one universal thing tended to be put forward by people in positions of power, like university-based researchers or policymakers–who tended to be from one particular social group and were often in a position to impose their values on other groups. When these researchers or policymakers made the definitions of what counts as literacy, for instance, maybe in a global health project, they held the ruler by which other people were measured, and sorted, and labeled. And this had consequences.

Where the attention was not, was where Brian Street was putting it. He wanted to understand what people were already doing with language, their words, the meaning they were already making, what this meant for them, how they already used their literacy to navigate life in sophisticated ways. Run households, run businesses. And Street found a lot of literacy of many different kinds, happening where other researchers found none. It turns out that when someone’s literacy didn’t fit a researcher’s or some test’s narrow definition, that literacy wasn’t counted at all.

That left literacy programs open to abuses of power. Turned out literacy could be used, and sometimes was–is–used as a cover for more political efforts.

If you didn’t have what those in power considered to be enough of, or the right kind of, literacy, you could be labeled illiterate, lacking, with connotations of being backward, poor, unfortunate, even uncivilized, somehow not prepared for the modern world. This, in turn, could be justification for all sorts of actions taken by the powerful, those holding the ruler.

Now, Street and his colleagues were not the first to point out this dark reality. They did connect it to some other powerful insights. Street and his colleagues found that there wasn’t a single universal thing called literacy that other researchers had been promoting. Language and literacy were not specific traits that people had, either, or even a single set of skills they used, as much as sets of social activities. Practices or processes that people engage in, every day, in different contexts, all throughout our lives. And these practices or processes vary by context, instead of being that one identifiable, true, universal thing held by some.

I can’t overstate what a transformation, what a game change this was, and still is, in literacy studies. Now there’s thousands of studies that approach literacy as a social process, including in health literacy. So if you’re looking for these studies, look for the phrase “social practice” or “social process” in addition to “literacy” and it’ll get you there.

However, this one-universal-skill way of thinking about literacy, and health literacy to an extent, is still the dominant way. The idea that you’ve either got it, or you don’t and you’re lacking. It’s still everywhere. You could probably start to imagine how thinking about patients that way and thinking about literacy and health literacy that way could cramp your relationship.

Let me give you an example. I said it’s our seventh anniversary. Way back in the beginning of the series in 2017, I did an episode about a nurse manager who, right before she went in to see a patient, glanced at their chart and saw that the patient had taken a screening that indicated that she was illiterate. And that one word threw her off completely.

I want to stop on that for a second. The result of that screening stunned this nurse manager. There’s the power of that label to throw her off her game. The power of that label to make the patient who is standing in front of her suddenly seem so different.

Too different.

The relationship suffered to the point that the nurse did not know how to approach her. The gap between them suddenly became her focus. Instead of everything else she knew about this patient, everything that made her a great nurse, everything that connected the two of them in that moment.

This is what we’ve inherited. It’s not that nurse’s fault, and that’s why I’m telling you this story. It’s very hard to shake off this dominant narrative. I had to get a doctorate to begin to do it! But I’m going to give you three things you can do to help shift the narrative–in your head, and with your patients.

1. This first one could be handy at any point when you feel like things aren’t going the way you want to, and you kind of want to reset, and catch your breath for a moment. You could acknowledge out loud that the way we speak in medical settings is particular. It is its own language. And it often doesn’t have much in common with the way anybody talks outside of these medical spaces. Remind yourself and your patient that you are doing your best to stay aware of that.
2. A second thing you can do is tune your spidey sense. Watch out for anything that feels too top-down, too exclusively one-sided. Or the conversation is too much one way. And no the irony is not lost on me that I’m saying this to you in a monologue podcast episode, do better than me, right? If it feels too much like there’s only one party here with something important to say, remember: this is a legacy of that way of thinking that’s generations deep. You know you have got important information to share, you know your patient does too, but this top-down view has been in place for a long time, and it’s hard to shake.
3. Thirdly, make sure you’re sharing the floor. One way you can do that when you’re teaching a patient something they need to know, or remember, or decide on, start with talking about what they are already doing to be healthy, including what they’re reading, writing, viewing, and discussing.

If you want more support on this, talk to me about our course, that Equitable Patient Education online course. It shows you mistakes that can be made in six common educational scenarios, so you can identify these obstacles, and disrupt this kind of thinking so you can reduce barriers.

And give yourself some grace. Challenging a dominant narrative, you might run into some interference from other people, even in yourself, because you might be going against the grain. And not being in the patient role, but in the, well, powerful person role, by nature of our jobs, we are challenging a system that we’re a part of. But we can do it. We can do it.

People are doing it. My clients are doing it. You want help? Give me a call. I’m Dr. Anne Marie Liebel, and this has been 10 Minutes to Better Patient Communication from Health Communication Partners. Audio engineering, music by Joe Liebel, additional music by Alexis Rounds, and it’s our anniversary!

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