A simple tool for increasing the probability of better communication between patients and clinicians: A “mini-bio”.
(”The Encounter of 2″, Victor Brauner)
There’s been a lot of things to reflect upon and to discuss over this week at the Salzburg Global Seminar. Ideas accumulate in my notebook at an overwhelming rate. But now I want to stop and focus on one single idea, a very simple one that, in my view, carries a lot of potential.
On our 5th seminar day, we move away from presentations to actually work on developing plans and prototypes based on topics collectively identified by the participants. Among these topics, I choose to be part of a team working on the interaction between patients and doctors. There were many other exciting themes to be part of but, for me, this issue lies at the heart of creating a shared culture of health. This micro-interaction contains the potential for macro-transformation.
Our discussion was based on the idea that there is a need for a fundamental transformation in the way clinicians and patients interact, which is actually the idea upon which the whole seminar is based. In the case of our group, we understood interaction in the most fundamental way, the physical co-presence of two persons, on a given space and for a brief amount of time. Initially, we worked on the basis of a list of questions that some of the members of the group had already developed, questions from the doctor to the patient and from the patient to the doctor. Questions that could enable the development of authentic conversations and richer communication between patients and clinicians
In the context of this conversation, I came up with the very simple idea of a “mini-biography”. Basically, before the actual clinical encounter happens, both patients and doctors will have access to a brief (200 to 500 words) mini-biography of each other. This means that every clinician (and, why not, every member of staff) of a health facility will be required to write a mini-bio and make it available for the patients and for the rest of the staff. This should contain information that goes beyond what’s already known about the doctor, beyond what can be read in the diplomas hung in the Doctor’s office. The mini-bio should contain information about hobbies, passions and lifestyle information, such as favourite football club, family, pets, etc. He’s free to choose what to say, but with this orientation.
On the other hand, the patient itself should provide his own mini-bio. The way his bio will be collected is flexible, it could be required as soon as he’s registered in primary care or another level of health care, or maybe in the waiting area, while he waits to be called.
Finally, the media used to make this information available for both the doctor and the patient is flexible. It can be a virtual platform where clinicians and patients communicate, it could be displayed in the waiting room’ digital screens, it could be a printed booklet in the waiting area with the whole collection of pictures and mini-bios of the clinicians working in that specific facility. And in the case of the doctor, he could access this mini-bio directly in the patient’s health record or in its initial registration form.
Being aware of this information before the clinical encounter unfolds could have the power to create a better context where communication is not based purely on diagnosis/treatment but on broader commonalities. It could provide excuses to take a step forward in what to ask, or what to say, from both sides. It could multiply the probability of a different kind of conversation, one that could go beyond the identification of a medical problem and the definition of a treatment.
In the conversations at the Salzburg, this idea took many other forms and directions, and it’s already being discussed, re-thought and re-crafted to fit into each participant needs and contexts. But I would like to use this text to develop my personal reflexions about it. This is because I think the simplicity of the idea should be protected, for the sake of its potential impact across national borders and levels of medical care. But in order to do that, I would like to situate this proposal in the context of a broader discussion, where the “mini-bio” constitutes just but one possibility or “tool”.
Sociology has tried, with mixed success, to define a realm of analysis that goes beyond the individual. To grasp the in-betweenness. This realm could be called relations, interactions, networks, structure, culture, communication, etc. While there’s an enormous intellectual and academic production around this (and it’s not going to stop), I bring this point here because I think that, again, if we want to come up with ways to improve the interaction between doctors and patients, we need to try to think in terms that go beyond the individual doctor, and the individual patient.
What I’ve seen and heard in many discussions and presentations is that there is already an interest in exploring this issue, but that there is also a tendency to frame the “solution” in terms that fall either on the side of the clinician or on the side of the patient. This is exemplified by an almost infinite reliance on the medical curriculum, the idea that what is needed is to create even more contents and spend even more hours training doctors, in order to create an ability to communicate empathetically. And while there’s still a lot to do in this area, I think focusing only on this is problematic.
At the same time, another tendency is to place the responsibility of asking the right kind of questions in the hands of patients themselves. While I think there’s plenty of potential here (much more than in the prior option), I still think we need to come back to the “in-betweenness”: how do we make sense of the interaction itself, as an “emergent” level, a reality in its own right.
And while I’m tempted to engage in very unproductive discussion on social ontology and the nature of reality, what I’d rather do is to propose the simple mini-bio as a tool that affects the level of the interaction. On the one hand, the tool doesn’t require a new “sensitivity” by the doctor, or a new “attitude” by the patient. It doesn’t need more training (on the side of the doctor), it doesn’t depend on a high level of empowerment (on the side of the patient). Its only function is to create a better set of conditions for communication to happen. It simply makes both parties aware that the person they have in front of each other is, on the one hand, not only a doctor, holding the power to heal, and, on the other hand, not only a patient, in need of health.
Let’s move a little bit closer to the patient side of the situation. Of course, there are already ways in which eloquent patients can start a conversation that transcends each other pre-defined roles (“patient” and “doctor”). But clearly there is a larger group of patients that don’t necessarily have the tools to face uncertainty in a proactive way, and that will remain tightly fixed to their pre-defined, “sick” role. In my view, having access to a mini-bio of the doctor could make a difference to this larger group, and could make things even easier for the first group.
Of course, there’s going to be patients that won’t really care about the doctor’s bio, but their own bios could make a difference if looked from the doctor perspective. If we follow Wiener and Schwartz invitation to “listen to what matters”, what the mini bio could provide is what I call clues and cues. Informational clues about the patient’s life and context, and “conversational” cues that could make it easier for the doctor to explore contextual aspects of the patients’ life, in an un-invasive way, dialogical way, and for the sake of diagnosis and a treatment plan that consider the patients’ life.
I’m sure this idea may sound completely un-innovate. Actually, it looks like the exact opposite of the kind of disruptive, revolutionary innovation we’re all waiting and/or working for. Let me finish this text with three reflexions about this.
First, probably the most important feature of the Salzburg Global Seminar is that it brings people who face completely different realities and challenges in their own health care systems. People coming from places that in most cases have nothing to do with each other, particularly in terms of a technological baseline from which transformative innovations could be developed. Therefore, it makes sense to try and think about common denominators and small transformations that are scalable, that make sense to a wide array of stakeholders and that have the potential of transforming, gradually, how things are done in many different places. This is for me where the idea of the “mini-bio” makes sense.
Second, it might be the case that we, as researchers, lead patients, policy-makers, academics and clinicians, are so used to the idea of the “mini-bio” that, actually, it doesn’t excite us in the way other kinds of innovations do. We have had plenty of space to shape our own public identities, in websites, twitter accounts, CVs, technological solutions, authored papers and books, etc. Describing ourselves in written form is part of what we do all the time. But we need to consider a broader context, where large groups are permanently locked in a state of anonymity. People that never had a chance to spell out, for a wider audience, who they are. People that never had a chance to add something of their own creation to the hundreds of documents, text-fields and platform carrying their identities from one database to the other. In this context, the idea of a shared mini-bio available before the clinical encounter holds plenty of potential.
Finally, I believe that in order to produce the future that we want we need to carefully consider the way we think about the future. The future might not lie in “revolutionising”, but in finding the right tools that, placed in the right context, can induce the right process (and this three “rights” can be defined in three different moments in time). The future might not be the result of a comprehensive solution, but of carefully crafted tools, tools with an orientation towards certain desired results, tools based on values, but tools that can be redesigned and combined in contextually-relevant ways. A small data, “modular” future.