Way back before I was born, as the media and marketing was in their adolescence, Canadian communications theorist Marshall McLuhan coined the phrase, “The medium is the message.” He argued that in communication, the way a message is delivered is just as, if not more, important as the message itself. (Got that from one of my favorite college courses on journalism and politics.)
As with many theories, this one has a broader application beyond the general rules of communication. For our purposes, I would say it is particularly true in healthcare. We already know that trust is a factor in getting messages out and reaching populations that fundamentally don’t trust the healthcare systems. It’s why community health centers are such a good idea and why healthcare professionals often seek to enlist help from religious and community leaders.
But it is bigger than that.
Trust is the underpinning of EVERYTHING patient-related in healthcare. It is at the root of most of the recognized roadblocks of good care: insurance companies are primarily for-profit companies – history has taught patients that the bottom line is more important than their lives; pharmacy benefits managers are supposed to negotiate drug costs – patients don’t often see savings; doctors are confined to fifteen-minute visits – patients feel like their health is being run through a generic assembly line, and receive the message that their lives aren’t worth more than Andy Warhol’s jaded view of the future.*
This is especially true when trying to reach patients in extremis. You know, the ones in desperate need of intervention before they reach the medical point of a chronic condition no return. I’ve been close, and while I am always a tough sell on any new therapy, in that headspace I am nearly impossible to reach.
When I am in a negative spiral, parents and loved ones can’t get through – they hardly know what they’re talking about when it comes to my diseases. Research doesn’t help. There is little to learn after decades and decades. I can guarantee a clinician I don’t already trust won’t. I know what is happening and the more helpless I feel to stop it, the more I back myself into a corner.
Caught between struggle and denial, I wait for the spiral to work itself out. Meanwhile, chronic symptoms and the diseases themselves are causing damage (and getting more expensive for those concerned with “outcomes”).
The only person who can help now is a trusted clinician. I have already built enough trust to follow their suggestions, or at least listen, as my health gets steadily worse. Since the relationship is already in place, both the necessary timing and the decisions on treatment can happen as quickly as possible, and I will be able to get back to my regimen.
I can be open and “confess my medical sins”. I know I won’t be yelled at, guilted, or judged. Because I already know them and they already know me. We both know what works. And what doesn’t.
In most cases, pulling yourself out of an unhealthy spiral isn’t rocket science. It primarily involves getting back to a regimen the patient was already following. So, it really isn’t the message here. I guarantee, the patient already knows what the clinician is going to say. It really is the medium – the deliverer of the message.
Sometimes you just need to hear it from someone else. And if that someone already holds a position of trust, the spiral is going to be a lot shorter than it might have been without it.
*Everyone will have their 15 minutes of fame.