Tuesday, June 28, 2011

Communicating Inquiry Criteria and Processes as Redemptive and Life Cycle Leadership for Health

Hi Colleagues,

Over the last 6 months I've revisited health inquiry for myself via switching to UW Medicine network clinicians. My primary is a nurse practitioner who has helped me document my ~18 year history and segment it into a pitch for referrals to salient specialists. All the while I've researched possible correlates and underlying causes. I've learned much about myself and continue to be challenged to transform a painful, exasperating, and often disconfirming experience into a redemptive one.

Know the Sun will come Out (above)
Case Study: The Clinicians who Communicated Care

Two recent appointments have assisted me in the latter: One with a cardiologist and his fellow, and the Other with an Otolaryngologist.  I've reflected on what made those appointments different than ones in the past:  (1) I was strategic in my inquiry seeking someone who specialized in my area of concern and whose philosophy matched my learning style; (2) the top notch clinicians I saw were top notch because they articulated a criteria and process for inquiry and explained their reasoning each step of the way; (3) most of the support staff were friendly, responsive, and expeditious.  I wanted to avoid overtesting and going down a trail of false positives or dismissals.  These clinicians taught me how to inquire and communicate my "chief complaint" without coming across as pretentiously "educating the patient." Conscientious comes to mind.  

A Sane Inquiry Model

These clinicians also identified false assumptions in part by demystifying the process.  "We did our best," said one, and another explained how assumed causality a was not actually so due to b and c.  To think of the many years in insanity, or trying the same diagnostics and treatments expecting a different result and symptoms only progressed, not reduced.  On that note, one clinician recommended a diagnostic criteria; namely, prescribe diagnostics that can change outcomes for the better instead of a sweeping test battery that can lead to a diagnostic deviance of false positives. Don't hold your constituent in a bizzarro world of clinical comparisons, of the insanity in repeating the same treatment expecting different outcomes, "this should work," meanwhile your constituent's condition worsens or plateaus, or otherwise over-relying on ready-made and common remedies.  If a treatment doesn't work, adjust, move on, and seek something that will.  Here an iterative approach to inquiry can benefit health/systems. 

Documenting Inquiry & Process

Notably a clinician and clinic philosophy permeates in its attentiveness to document design.  I felt impressed when forms asked what religious or learning style considerations I expected, and even moreso when the form positioned my and the clinicians' notes next to each other in columns.  A tech comm system takes that approach up a notch and allows the clinician and constituent to contribute feedback in an ongoing fashion with dual access (vs. one-way input from both parties).  

An Ethos for Health Inquiry & Process

If you're curious, I learn by reflection, writing, arts production, conversation, process, experience, listening, and research.    Religious preferences? Judaic-Christian prayer and biblically-based encouragement.  Must we comply with each other's religious codes?  Only so far as we draw near to understand the text by which someone orders their life.  Why is such important?  Do either illumine what goes on in my body? Perhaps yes and no, but when speaking of process, the ends do not justify the means.  I prefer Leon Trotsky's "The end may justify the means as long as there is something that justifies the end" (QuotationBook.com).  Remember when speaking of process, it must be due.  Thus, health care communication, to be effective, to garner "opt" or "buy" in, must widen its scope from linear to cyclical process where each participant contributes to the conversation and communicates their process to their team, such as when one clinician explained out loud his reasoning with each line item we discussed.  I'm speaking of health narrative because as humans we narrate; I seek healing of a humanizing and holistically-centered imago dei kind.

Double-Edged Scalpel: Auto/Ethnographic Criteria for Critique

For my part I've learned I need to take courage each step of the way in being willing to open myself up (say "ahhhh") to what has been dark, scary, and painful parts of me and to make every effort to speak clinician's language, prioritize my chief "complaint(s)," to challenge clinicians or staff on the spot for inaccurate assumptions or even rude behavior, to make amends when my actions necessitated it, and to, above all, believe it possible to redeem a painful narrative that has constituted half of my life.  What criteria and process I apply to others I must also critique within myself.  For example, a coordinator told me at one point to "take your care elsewhere" if I needed to reschedule last minute again.  So I canceled my appointment and mailed a certified letter to the clinician, office manager, and said coordinator as people deserve to know the terms by which they're evaluated.  Seems extreme, I know, but my world is words and by them I want to reify a better experience for myself and hold offices to better practices.  Some time later he called and apologized for being rude and asked me if I wanted to still make an appointment. Yes, I said. 

Redemptive Inquiry: Transforming Adversity & Reconciliatory Conflict

Someone asked me why I'd go back after being treated rudely. The glimmer of light is not hope itself, but the hope for redemption.  When I say I redeem something, I mean I pull from adversity's trough for a beneficial outcome via a formative process.  Redemption doesn't mean vindication, though vindication may play a part in a redemptive process.  I'm a professional, that's why.  What professionalism I apply to my work, I want to see in other spheres, including my challenges, whether they be health-related or otherwise.  Such is a team effort nothing short of a miracle.  I scheduled an appointment with the head of that particular center; I met with him today for my appointment and appreciated his articulate reasoning. After my appointment I asked to see the coordinator and thanked him for calling back to work with me. He shook my hand with both of his, held my hand, and smiled. He came across warmly. He called me his "problem child." I told him I hoped I did not get him into trouble. I did not have hard feelings.

"Thank you. That makes a difference,"
he repeated.

Developing Health as the Public Commons via Democratic Inquiry

His response reminded me of the power of appreciative inquiry.  On the way home I saw a political billboard that said "Thank you" to so-and-so; the sarcastic punchline was too small a font to make the sign successful.  The sign succeeded in promoting the candidate vs. defacing him.  At mail call I received a thank you card from my cardio clinic.  "That's a first," said I, just as I considered mailing them one.  Will embedding appreciation in health communicate trust, value, and subsequently, results?  Such virtues constitute the workings of partnership, where each person contributes to the whole.  Parker Follett (1918) wrote that democracy involves integrating people into the whole via generating a collective will and contributing via gifts- and idea-based approach.  I recommend designing health inquiry and process as though we're developing a democratic public commons, and we are in every sense of the word.  Remember that whole draws from holos, or health.

The Power of Thank You (above)
Health Systems: The Human Caterpillar

So there it is: Perhaps health inquiry, with its misunderstandings and disconfirmation, looks as the caterpillar line of traffic that lurches forward only 2 car lengths at a time, stop and go, stop and go, go, go, stop, go, stop...  Eventually you arrive at your destination. What you need, what I need, is grace for the moment to desist from complaint and name-calling, to resist reducing people as being incompetent or incoherent, and instead do your best to navigate life on a road that without any hope of finish or human kindness can take its toll.  I left hearing his thank you and seeing his warm eyes and feeling his hands hold mine.  We made amends. Over something seemingly small, yes, but if it's possible to succeed in realizing our goal, e.g., to provide me with professional care, then perhaps lessons learned here scale to the larger challenges that health systems face.

Narrative Awareness, Mindfulness, & Prowess

One challenge that health systems face includes how and for what purpose to narrate a criteria and process for inquiry strategized towards desired outcomes, but with enough restraint to challenge assumptions, enough compassion to talk through the contagion, and with enough savviness to document the inquiry as proposal and process.  Narrate, strategy, restraint, compassion, and savviness.  These comprise the workings of trying to manage the ebb and flow of inquiry that takes place when organizing the masses of people who need or want an inquiry and process for health.  After all, health inquiry takes place in the relational and performative contexts of conversation and written texts, which we design within and based on socio- cultural, political, and institutional systems, each of which inform, frame, and perpetuate our assumptions, beliefs, and goals about health.  So let us design communication systems and conceive inquiry processes that respond with (1) awareness to these micro/macro realities and (2) mindfulness to our ethos and desired outcomes.

Strengthen your feeble arms and legs
Make level paths for your feet
so that the lame and disabled
can Walk and be Healed...

Lifecycle Leadership for Health

On that note, I recommend regarding health inquiry and communication in terms of lifecycle; see the process through, go back if needed, move forward to the next item, develop health iteratively and not in a waterfall or mainframe, but via confirmation, dialogue, and strategic process.  For instance, seek diagnostics that can change outcomes beneficially, e.g., by improving quality of life or reducing the frequency, scope, severity, and duration or even occurance of a given symptom.  Here is where deterministic testing can be useful; we do not determine what we will find, but purpose what understanding we seek, which includes a plan in how we will respond to what we find.  

Sharing Health for our Future

Of course a redemptive and life cycle approach to communicating health must include making right where neglect or other wrongs occurred, but correction comes as setting a broken bone and not as leaving the bone broken.  In this sense health inquiry is neither treatment nor cure, but an inquiry process that requires clinician and constituent or their advocates to take the time to participate in a conversation in a world that can't help but risk, by its textual design, but reduce interaction to efficiency or a legal record.  We need not take a defensive posture when the "eye is on the prize" (Phil. 3:14).  Perhaps we can learn something from UCDavis' Global HealthShare Initiative when communicating health inquiry as not only participation and contribution, but as sharing.

Treating health as a professional constituent (above)
Credibility: Redeem by Example

For my part, I want a redemption that benefits myself and those proposing to help me; beyond that, I want to transform a difficult history as just that, a history that offers a vantage point on which I contribute to narrative health care and developing communication systems with a research ethos for participation, contribution, and compassion (i.e., drawing near), iterative health development, and effective outcomes.  In other words, let me co-write a new chapter in my life where God "redeems the years that the locusts have eaten" (Joel 2:25). I hope my work encourages others, whether clinician, constituent, support staff or network, to persevere through their health inquiry one strategic and rewarding step at a time (Isaiah 35:3), which I hope illumines a bit of the God-print in us (Job 4:4) even though we inquire in an imperfect and mortal system. If systems reflect the people who build them, then a new paradigm for health communication as health reform may improve outcomes and shine a little more light. So I draw on adversity as a well and invite the people who may or may not at one time left me thirsty to help me pull up the bucket.  Don't let me fool you; sometimes growth comes by design and not effort.  I can scale my experience only so far as God's grace and a supportive climate allow.  A bucket of water may be heavy, but we need water to live.  Health systems may be complicated, but we can by wisdom apply life-giving inquiry.

From Constituent to Contributor: Professionalizing Experience

For my future doctorate studies and current consulting work, I want to contribute to developing narrative healthcare and research ethos and then find ways to apply what I learn to design communication systems and approaches that yield effective and ethical outcomes.  At this juncture I need a network, access, and exposure.  It's one thing to merrily skip along with ideas, but another to implement them.  That's where network, access, and exposure come in for this "professional" constituent.  Learn more about narrative health care and health communication, two areas in which I want to contribute via writing, broadly conceived, social media, and leadership.  

What communication systems and/or inquiry processes do you believe will benefit or reform health/care?

Thank you for reading, and for those of you who continue to pray and support me in my health inquiry,


Parker Follett, M. (1918). The new state. Danvers, MA: General Books.