Communication Is the Best Medicine

By THOMAS BARKER | Fellow

This column focuses on a broad range of practical academic issues from teaching and training to professional concerns, research, and technologies of interest to teachers, students, and researchers. Please send comments and suggestions to thomas.barker@ttu.edu.

The academic conversation in the area of health and medicine covers many subjects—pandemics, SARS, breast feeding, brain scans, atherosclerosis, drugs, genetics, breast cancer, and more. But the unifying themes in this discourse, which has intensified over the last 10 or so years, concern the rhetorical nature of medical writing, what is accepted as medical fact, sources of good medical research, how to find methods to do research, and also the forms of medical discourse itself.

Typically, technical communicators who work in universities do research developing a critical view of medical writing, as they explore how patients, doctors, specialists, and scientists communicate. They teach students to understand that encouraging multiple voices can make a difference in health messages. In practice, medical writers and health information consultants find ways to apply a multi-vocal approach to health outcomes. And the voices in medicine and health seem to come from everywhere.

Research in Medical and Health Communication

Why is this so? In her introduction to a special issue of the Journal of Business and Technical Communication on “The Discourses of Medicine,” Ellen Barton shows that research draws from many related disciplines. To build knowledge about medicine and health requires reading in history, sociology, literature, communication studies, and behavioral science. Scan any bibliography of a scholarly article in health and medicine and you’ll find journals like Health Communication, The Journal of Advanced Nursing, Medical Anthropology, and American Sociological Review. This varied conversation mirrors the interdisciplinary nature of technical communication itself. We see this diversity in the STC membership among practitioners who have careers in hospitals, drug companies, and public health agencies. These practitioners enact the written nature of good medicine.

Medicine is a writing-intensive activity. Doctors, researchers, scientists, drug salespersons, and hospital administrators connect through documents. Those connections, the documents themselves, embody the professional ethos, definitions, and, indeed, the realities of medicine. Academics love it when that happens. Put simply, medicine as we know it is just that: what we express in professional documents. To the patient this may seem unsettling: pain is pain. But, when you think about it, diagnoses, treatments, and recoveries depend on doctors’ judgments, interpretations, and best guesses. The best medicine is often not grand, immutable fact, but what a doctor, doctor’s team, lab technicians, and insurance analysts can treat, control, and record.

Research starts with this writing, but goes much further. Research in medicine and health areas among technical communicators examines the tension between the view of medicine as rhetorical and the view of medicine as grand, immutable fact. Researchers like to examine both scientific accounts of a medical event—for instance, a doctor’s discussion of breast cancer with a patient—and then compare that to other “discourses”—such as the popular discourse represented by the “survivor” or “pink ribbon” view of breast cancer. Cynthia Ryan, writing in the July 2005 issue of the Journal of Business and Technical Communication, examines how these two views interact to make a complex picture of an important social reality. My colleague at Texas Tech University, Amy Koerber, writing in the same volume, examines how “popular” discourse on breast feeding compares with the “institutional” discourses, and how these help us understand this complex human activity. Often, as Huiling Ding writes in Technical Communication Quarterly in 2009, the “official” discourse lags far behind what we find in social media and informal information channels like Facebook and Twitter, not to mention rumor and gossip.

As you might expect, these studies reflect a trend in health research toward qualitative methods: interviews, discourse analyses, and case studies. These methods rely on judgment, interpretation, and values, rather than on strict empirical evidence. Qualitative survey research contrasts with this approach—one that underlies the popular evidence-based practice in clinical medicine. Evidence-based practice argues that doctors’ decisions should follow trends in empirical research—that if the pill has not shown clear effectiveness, then you should not take it. On the other hand, technical communication scholars like Mary Lay, writing in Rhetoric of Midwifery, base the validity of a treatment on the community’s acceptance of one practice over another. (Who knows, blood-letting could make a comeback.) In many ways, what we now validate as “best medicine” is often what we’re convinced is best medicine. Research looks at how discourse works all this out.

Thus, the academic conversation in health and medicine holds its ear to patients’ stories, alternative media, history, and web sources of information. While these voices—alternative discourses to mainstream medical information—might seem questionable, they struggle for, and deserve, a hearing. True to a central tenet of technical communication, academics amplify, analyze, and validate users’ voices.

Medical and Health Communication in the Classroom

This validation, taken into the university classroom, helps students see how communication functions in the medical setting. For example, the following description of a medical and scientific writing course at Carnegie Mellon University emphasizes the connections students need to make in medical careers: “Healthcare Communications is [a] writing-intensive course designed for students interested in how healthcare information is developed by researchers, healthcare providers and writers and communicated to patients and their families, the general public, and other experts.” There seems to be a market for medical writing. According to CenterWatch Monthly (December 2008), the medical market grew from $345 million in 2003 to almost $700 million in 2008.

Most medical and health courses in technical communication programs follow this model. Sometimes medical writing is taught in the same course alongside science writing, public writing, environmental writing, and veterinary writing. Usually these programs offer only one course to help nursing students, health professionals, therapists, and others. Like courses in engineering writing or agricultural writing, these courses strengthen the writing skills of those who help patients and those who translate research findings into practice. These courses sometimes reside in nursing schools, medical schools, and two-year colleges. “But the field is booming,” as my friend and fellow boomer Christine Abbott put it, “what with all the baby boomers now retiring and needing more care, surgeries, and replacement parts.” Let’s imagine we could sit in on one of those courses. What might it sound like?

I recently sat in on a conversation among graduate students in a medical writing class at Texas Tech University. The discussion focused on a book by Annemarie Mol, entitled The Body Multiple: Ontology in Medical Practice. This book explores atheroscleroses by looking at the various conversations among doctors, nurses, researchers, patients, and others interested in blood flow to the legs. Trying to keep up with the discussion among these students made my head spin. This was no class in how to derive, test, and communicate set messages about sore blood vessels. These students used language from discourse analysis, genre theory, narrative literature, critical theory, and sociology. The resulting conversation expanded the notion of health communication beyond narrow, one-way concepts reminiscent of marketing and communication theory. Their discussion brought to life the complexities of medical communication.

Doing Medical and Health Communication

That technical communicators play a significant role in encouraging such a discursive approach to improved medicine is not a new idea. Last summer I conducted a course in independent consulting in medicine and health, in which my students studied the role consultants play in public health. Many STC members who work in public health consulting do research, build health campaigns, and help health agencies shape their public image. Increasingly, however, consultants take on the role of communication facilitators. They use symbolic and analytic skills to encourage communication channels so that health agencies can build alliances with supportive community groups. These skills include conducting interviews and running focus groups, along with strong writing, media, and graphic design skills.

Technical communicators are trained in audience research, which helps them identify and respond to the needs of all persons involved in complex medical interactions, such as we find in medical clinics, telemedical interventions, long-term care/caregiver relationships, and private medical information sources like WebMD. These communication directions suggest that conversation, discussion, and communication could enrich the work of medical professionals. The following example of how narrative functions in medicine at Columbia University’s Program in Narrative Medicine shows how communication and medicine go together to overcome miscommunication.

At Columbia University’s Program in Narrative Medicine, researchers help practitioners put narratives (stories and interpretations of medical events) to work to create good medicine. Their mission statement clarifies the approach: “Through narrative training, the Program in Narrative Medicine helps doctors, nurses, social workers, and therapists to improve the effectiveness of care by developing the capacity for attention, reflection, representation, and affiliation with patients and colleagues” (www.narrativemedicine.org). In this program, courses focus on the training of health professionals in the use of narrative, writing, storytelling, “witnessing,” and interpretation. This kind of discursive medical practice can facilitate patient education, clarify options for patients, and lead to broader, lifestyle interventions rather than costly and often ineffective clinical treatment.

Our health care system could use some of the medicine that technical communicators can provide. Researchers study medical discourse using people-centered methods to develop critical attitudes toward forms of medical discourse. In turn, courses in medical writing and public health communication help medical writers learn new writing skills that can connect caregivers to care recipients. Similarly, medical writers equipped with skills in language, narrative, and dialog, as well as media design and writing, can help health care systems function more effectively though better communication. One researcher who explored the idea of communication in health, Dr. Robbie Foy, writing in the Annals of Internal Medicine (2010), found that interaction among care physicians and patients seemed to improve health outcomes. His review of 23 clinical studies of interactive communication in clinical settings suggests that interactive communication plays a positive role in the delivery of health services. Maybe communication is the best medicine.

Thomas Barker (thomas.barker@ttu.edu) is the director of technical communication and rhetoric at Texas Tech University. A fellow of STC, he is also manager of the Academic SIG and a member of the Environmental Health and Safety SIG. He has published in Technical Communication and Technical Communication Quarterly, and is the author of Writing Software Documentation: A Task-Oriented Approach.

Research in Medical and Health Communication

Medical and Health Communication in the Classroom

Doing Medical and Health Communication

FURTHER READING