When Patient Vulnerability Stands in the Way of Communication

From the many articles linking relationship problems to electronic communication and social media, it appears that some people share intimate information electronically more readily than they ever would face to face. I won’t comment on the relationship implications. I will suggest that this propensity to share more electronically may help improve patient communication, especially for men (or at least me).

Let me to explain…

Masking Our Vulnerabilities

There has been a fair bit of evidence that male patients wait longer to go to the doctor and when they do so reveal less that might help the physician address their symptoms. Why? This seems counter-intuitive. In attempting to answer this, I looked at my own experience. When I do so, it comes down to priorities (or ego depending on how you look at it). While you’d think my #1 priority would be to get well, it turns out that not looking dumb seems to trump that for many ailments. But even that doesn’t address the issue completely. No, it turns out that not looking dumb isn’t #1 either. If I really look deeply into my own reactions when compromised healthwise, the REAL problem is that I feel weak or vulnerable and I HATE that. Talking about the situation makes it worse. While it’s a sweeping generalization that all men were raised to avoid the appearance of weakness, the truth is that many of us were. Though lamentable and something we can address in our own families for the next generation, we have to deal with the fact that for many men, me included, the real list of priorities looks like this:

1. Don’t look weak.
2. Don’t look dumb.
3. Get well.

Now it’s not so simple as this and I know that. If the ailment were more serious than, say, a cold, I’d guess that #3 becomes #1 in a hurry, of course. But how often does this errant priority list CAUSE an ailment to become worse? I know the other men in my circle of friends and family admit this if pressed (completely unscientifically). So where does electronic communication come in and how can it help? There are a multitude of articles out there on how electronic communication can be helpful in healthcare. The articles make very sound arguments about the business efficiency, and convenience of electronic communication in healthcare. But, none of them address why I might want to communicate electronically based on my (albeit flawed) list of priorities.

The Not-So-Naked Truth

From my perspective, the reasons I prefer to communicate electronically are:

• I expose my vulnerability fewer times. When I come to your office, I have to tell someone at the desk, a nurse and then you.
• I don’t see your reaction. If you read of my ailment and have a disgusted look or just a quick intake of breath, I don’t see your reaction, making it more likely that I will share more.
• I can share at my own pace, making it more likely that I will share more deeply and provide more details.

Admittedly, I have not found any study comparing the rate or level of information-sharing that occurs among patient populations communicating electronically versus face-to-face or by phone. Nonetheless, when I look at my own preferences and priorities, I instinctively feel less vulnerable behind the “mask” of electronic communications.

Have some thoughts? Let me hear your comments.