Monday, June 6, 2011

Health Narrative | Communication Solutions for Degenerative Conflict in Clinical Contexts

Hi Colleagues,

Waiting Room (above)
So what do you do when faced with a constituent who seems so focused on her care that you suspect, though you're not a psychiatrist or psychologist, that s/he's anxious and neurotic? How do you talk her down from the tree? Conversely, what do you do when faced with a clinician who dismissed, interrupts, or gives the same pat answers you're heard a thousand times? How do you untangle the gridlock?

Gridlock is not only an infrastructure challenge limited to traffic-ridden freeways, biways, and interstates.  Gridlock occurs in conversations, too, such as in that downward spiral conflict in clinical contexts that puts you and your health partners at a stand still.  These questions assume that constituent/clinician relationships are that as partners and co- investigators, inquirers, collaborators, and not separated or demarcated (1) and, following from the first, that collaborative inquiry needs a communication model or format to be successful.


I began this post when I commented to a blog colleagues' post on Sick Girl Speaks, where Tiffany Christenson inquired on defining parameters for partnership-based health as one way to shift what I call mainframe, pharma, and expert models for medicine.  Can blogging and social networking participate in the health reform conversation with credibility? She invited bloggers to participate in her blog focus group by leaving answers to her questions in the comments. I read her blog after a frustrating appointment with a nurse practitioner, who agreed with me in the end that we did not know each other's expectations, one of which I assert should be a basic standards for communicative inquiry for any, yes any, not just for clinicians, but any professional.

Health Communication 

The meeting went something like this:

"Sorry I'm late. I had to admit someone today."

"Oh, I'm sorry to hear that. Poor person...they're having a bad day," I said to myself as she had to leave when her pager went off.


And she looked up at me and launched into her questions focusing on my hand dermatitis, 1 of the 4 concerns I had listed on the form they had given me. Her questions became redundant.

"Have you read the form I filled out that your office gave me?"

"Yes," she replied, too hastily for me, and her tell was that she read the referral what she should have read before my own narrative, at the end of our visit.

Back to my concerns, which I assumed to be the purpose of our visit. I shared them, and she interrupted me halfway through.

"It seems to me you are too focused and anxious about..." as she turned to wash her hands in the sink, back facing me.

Here we go.

"So what I hear you saying is that you think my concerns are invalid because I'm too... neurotic?"

"Well no," she turned and dried her hands on a paper towel. "We're all a bit neurotic..."

I raised my eyebrows. Hm, I did not know I was seeing a shrink.

She spent the rest of the appointment slot (and my money for said slot) as the parking meter ticked away in my expensive, though convenient, parking spot in the parking garage talking about things I could have googled. Cotton gloves. Ointment/cream. Check, check, and things I've heard for umpteen years: Autoimmune, allergies, and the new "it's genetic" fail-safe in mainstream medicine. I told her I didn't buy those assumptions because no tests have been done or done recently to confirm her conclusion.

Anyway, that was a moot point by now. I know when a clinician won't or can't take me seriously, and so I changed my approach: How to communicate diplomatically when someone else is backpeddling (and charging me for it)? Keep my mouth shut, save one all important lesson I have learned in this now 17 year inquiry: Speak up for myself vs. internalize. Hold out my hands, say I'm frustrated instead of fester. Tell what I expect: for my concerns to be taken seriously and/or redirected within the scope of your specialty. You can do that without blaming the constituent or wrongly smacking mental stigma stickers on their forehead when they resist you. Better backpeddling than running over because there's a chance we can come to an understanding.

"I recommend you see someone else whom you can feel free to talk to and not as though you have to have an attitude..."

I let that one slide.

"... I don't think we can have a working relationship."

I agreed that I'd rather see someone else, but I disagreed that we could not have a working relationship.  People can work together when they regard each other as partners.  How do you network partnerships in health approaches?  

Socially Networked Inquiry on Health

Can social networking help health?  Perhaps. Bloggers write their mortal rituals, memories, selves, and arguably others into being by blogging (Chavsta, 2003; Rosko, 2010, December 17). Following are my replies to Tiffany's questions:

1. Do you WANT to be a partner in healthcare (for you or loved ones) or would you prefer to no be directly involved in patient care, plan of care, safety measures etc?
Yes. I expect it because I embody my body and my body is part of me. If you want to treat "me," then I am more than a specimen in a petri dish to hover at a distance, safe from contagian, and write up a chart narrative, script, and send me on my way. It's arrogant and pretentious to size up a constituent without including whatever cognizance they have into the inquiry and decision-making process.
2. If you DO want to partner, what do you need to do so? For example, do you feel like you have enough information to do so? Permission? Guts?

  • Paradigm shift: I expect a new kind of inquiry to involve constituents beyond the Sacred 7 health questions. I don't want to see into what diagnoses I do or not fit in. I am not a container for disease. 
  • Demystify: Simplify. This seems to go against me saying health inquiry is complex. It is, but to see solutions it might take demysifying the process. Solutions are not "out there" separated from us embodied in white coats. 
  • Emphasize Communication: Realize that inquiry means communicating. Develop a flexible inquiry model that honors the basics of ethnographic research: Intro oneself. State purpose of visit. Listen. Let people finish their sentences. Ask open-ended questions. State expectations. Paraphrase. Follow-up. Adapt. Market this inquiry for clinicians and constituents. Make nifty signs or acronymns/mnemonics. 
  • Rhetoric: Change words to convey new meaning, such as health instead of medical, and share instead of care (see UCDavis Healthshare Initiative). 
  • Develop new comm tech for both constituents/clinicians, or broadly, health partners, to input "data" or feedback. Too much legal power in hands of clinicians with narrating health for others. While some may need an advocate, advocacy must always be done as confirmation of a person, rather than speaking for them.  Advocacy, though needed at times, risks assumptions.  
  • Fine-tune sensitivity and parameters for signifying communication violence so constituents need not deal with clinician violence, even if unintended, on top of their physical pain.
  • Design programs/courses for health practitioners that close the gap between theory and praxis (see Conquergood, 2002) in part by requiring ethics (emphasizing dialogic, praxis, ethos, logos, pathos, and poiesis), arts/narrative-based and qualitative methods. Teach people to be mindful to challenge their assumptions and encourage people to challenge each other (deemed not polite). E.g., "It's genetic," Say, "Have you done a genetic test? Is there gene testing for what you're speaking of?" No, but assumptions look at something and simplify (when should remember complexity). Assumptions act as ear plugs.  Correlation does not always equal causality said my grad research text... Many illnesses overlap or mirror each other; never assume that symptomic presentation alone confirms diagnoses.
  • Lastly, conceive health based on its root, holos, or wholeness, totality, and completeness as dependent on, created by, and presented as, Life.

3. What do you see as the greatest challenge to partnership?
Pride and uncertainty. Pride in the expert motif, uncertainty as causing fear, confusion, and straight jacket inquiry methods. I often wonder if what clinicians say to me is more for reducing their uncertainty instead of improving my quality of life.  Also, expectation management, faulty assumptions, and stigmas (individual/group) and -isms (systemic) place obstacles in the way of results. 
4. How might you as a patient/family member become a part of the healthcare team today, regardless of your current clinic/hospital and healthcare team? Can you? Please be specific.
I consult organizations w/social networking, photography, and org/health narrative. I apply my passion/career to making things better and want to continue academic studies with those modalities in mind.
Blogging these ideas with Tiffany helped me conceive the following recommendations and reflections on challenges and implications.


I recommend the following changes in our approach to health, which include shifting paradigms, interviewing for formation and regeneration, and challenging norms and assumptions: 
  • health as public domain (vs. mainframe or disparity)
  • health as public commons (vs. expert)
  • health as qualitative and creative inquiry (vs. quantitative)
  • health as confirmation and compassion (vs. reductionism and separatism)
  • health as holos (vs. Cartesian or frames divided from matter and, by extension, from each other)
  • health as multiple frames including tacit, spiritual, somatic, emotional, relational, physical, mental, cultural, and political knowledge (vs. primacy of reason/ration/nature/machine)
  • health as politics of integration and partnerships (vs. hierarchy, front loaded or one-way communication)
  • health as culture of engagement (vs. withdrawal, distance, dependency)
  • health as organizational (vs. institutional)
  • health as local (vs. centralized)
  • health as iterative (vs. waterfall)
  • health as regeneration (vs. treatment)
  • health as formation of people (vs. compliance, or assuming people can't learn what you have to offer)
  • health as creativity, such as storysharing (vs. container)
  • health as correlative processes and experience (vs. separate diagnoses)
  • health as causality (vs. ready-made diagnoses)
  • health as proaction (vs. prevention)
  • health as participation (vs. compliance, one-way communication)
  • health as edification (vs. assuming physical process is bad)
  • health as narrative (vs. legal record)
  • health as inquiry (vs. ready-made diagnoses, assumptions, -isms, stigmas)
  • health research as dialogic, confirming, and auto/ethnographic (vs. numerical measures)
  • health as thrival (vs. survival)
  • health as life (vs. discipline-based medical, biological, etc.)

Mainly these recommendations seek to offset the primacy of current inquiry approaches that rely on a system that supports replicating itself at the price of self-implicature inherent in constituent-complaint.  Overall, in my anecdotal experience such models produce harm, lack justice, and reduce quality of life.  Note that these recommendations correct, improve, or build upon past models and take to heart Block's (2009) advice to build community by envisioning an alternative future.  If we aim higher, perhaps our standards for health inquiry and outcomes will improve.  Perhaps with these new standards we can write a clinician oath that is more precise than the "do no harm."  Perhaps a positive spin "do only good" with precise signifiers for that common good will help.

In my thesis, I speak of compassion as drawing near, confirmation as affirming someone as they present themselves to be, and dialogue as a reach-in to reach-out process (and vice-versa, see also Anderson, Cissna, & Arnett, 1994; Cissna & Sieburg, 2005; Laing, 1960; 1961; 1994; Russell, 2004; Wilmot, 2005).  I study how digital arts helped me when my grandma died.  I find the implications scalable to doing health as expressive arts, holistic leadership, and vocational development.  For future research I want to learn how to apply my concerns for health systems change to each of life's socio- cultural (engage via technology and creativity), political (integrate), legal (text, rhetoric, and legal records), and societal (dialogic and transformative inquiry) spheres.

Resist stigmatizing or prematurely judging constituents. Get to know them.  Observe the systemic challenges each of you face and regard yourselves as partners.  Succeed in your inquiry by asking open-ended and follow-up questions, which protect you from falling headlong over your assumptions and the aforementioned systemic challenges.  Open-ended and follow-up questions include, but not limited to, the following:
I'm sorry, I do not know the answer to that... 
I do know that... 
What do you expect from today's visit?  
What are your concerns? Why?
What do you want to achieve today?
What's the most important thing you want to discuss?
How do you define health?
How do you want to achieve health together?
What results are you expecting?
What are your fears?
What level of treatment do you prefer?
When do you want to feel better by? 
What are you willing to do for your health?
What do you expect of me? 
If not a, then b or c? 
 For the reply:  If I understand you correctly, I hear you say... 

Remember that a presented symptom and even a diagnosed process are not to be confused with being a cause.  Notice that these open-ended questions ask What/Why/How/When and go beyond the Sacred 7 or symptom-based inquiry.  Oddly a symptom-based inquiry can only aggravate assumptions and frustrations as at a certain point people are just complaining and listing.  There exists little strategy or forward-thinking in complaining or listing, only simplifications, assumptions, and past/current thinking.  Above all be sure to ask follow-up questions and paraphrase what you hear clinicians and constituents say.  In the very least, for goodness' sake read the constituents' reports via your own office's paperwork and referring clinician's notes.  The inquiry process goes both ways.  See your constituents as a network resource and appreciate it when they show active interest in their health even if it seems to you to be unwarranted.  Never dismiss [shoot] the messenger, for in doing so you revoke your right and nullify your opportunity to live up to your advertised intent and moral obligation to provide quality process and outcomes, which includes experience, for those whom we serve.  Yes, we, for we comprises the very context for our inquiry:  Embodied, interacting, communicating, influencing we.

While clinicians may or may not have goodwill, or intent to help, their methods used and the system that supports them may elicit harm in a world where illness means a kind of exile.  I'm learning to transform problems into opportunities in part by presenting myself and challenging norms I find harmful.  We challenge norms by challenging the assumptions that construct them.  I also seek to inquire and ask questions; be careful, though, for asking questions in clinical settings can get you into trouble with people who may assume that illness is
  • something people contain (dehumanization)
  • something only the poor, lazy, etc. (stereotypes and -isms)
  • something people "have" (devaluation of body)
  • something people need to be educated about (devaluation of tacit and somatic knowledge and unbelief in people's capacity to learn and inquire for themselves)
  • people's fault (blame the constituent)
  • overemphasized (stigmatizing constituents as neurotic, anxious, depressed, each of which a judgement outside of their specialty if not a psychiatrist or psychologist or self-report)
  • assuming goodwill, something that is outside of us and thus unattainable

I've wondered why clinicians' whom I seen exert a knee-jerk response to assign blame, to almost freak out when I ask questions.  I can only know their assumptions by outright asking (1) and observing their behavior (2).  Each of these assumptions I've encountered as road blocks to my health.  Clinicians exasperate me when they act on these assumptions and I can only conclude, so far, that these assumptions keep job security via the assumption that job security means a dependency and compliance model; whereas, job security means reputation not among fellow clinicians who make the referrals and help keep each other in business, but a reputation for quality and compassion among constituents.  A social networking site to that end might elevate the need to market quality signifiers besides specialty, contact information, and photograph.  These assumptions also protect the clinician from contagion, for to draw close means making the time and patience and reneging the economic fallacy that making money requires a factory-style throughput of people.  On the contrary, making money requires quality.  We're not buying gadgets and gizmos.  I want a quality of life and to live life with meaning, purpose, and vision, and to do so I need my body in good working order to carry me through whatever number of days I'm here.

Lastly, these assumptions support fear-based clinical care in an industry that stands ready and rigid to protect itself from lawsuits or litigation.  One such clinician notified me of abnormal test results with a letter sent certified mail and a signature return post card.  I felt I was being served in more ways than one.  Meanwhile the communication process was fraught with confusion and misinformation.  You can imagine the degree of distress I felt. Clinicians and their systems contexts need a check-and-balance that shows itself sooner than litigation, such as an industry-wide best practices for communication processes to transform degenerating to generating conflict, or one that inquires and adapts to learning styles, expectations, concerns, needs, and wants without assigning judgment or blame.  Perhaps digital storysharing, not front-loaded telling, can help in this regard, such as with providing support for clinicians who deal with increasing demands on their memory and time as diagnosis codes, genetic findings, population, and technology increases and changes.

At the same time, clinicians also must be held accountable for negligence, ignoring constituent presentation, slander/libel of constituent that adversely impacts their level of care, inflicting emotional distress, and whatever other disconfirming or dismissive behavior that results in reducing quality or length of life.  Remember, clinicians are not the expert of their constituents; clinicians need constituents' embodied selves as they need their presentation.  A true mark of professionals are those who inquire and communicate with the people whom they serve.

In short, health partnerships mean learning to communicate in ways that confirm and dialogue with people.  This method must be the necessary pit stop before our tires become treadworthy and before problem-solving can occur and we see green and actually make headway in our health journey.

Challenges & Implications

Even with these ideas multiple challenges remain. For starters, how do we scale fluid and multi-modal social networking into a seemingly rigid mainframe system of doing health?  Certainly social networks and blogs can help constituents deal with their experiences and grow as a person; what about physical results?  What therapeutic and transformative options exist for clinicians to better succeed in their health delivery and outcomes?  What resource limitations and socio- cultural and political norms or hegemony stand in their way?

Even though I feel more clear and confident in writing this post, I know well the implications.  This blog implicates me as it does the clinician today, though not in fair proportion.  She's being paid to put up with me; I'm not being paid to put up with her.  Even so, writing her descriptions of me in this post may well perpetuate her impression of me in readers' minds.  
However, I'll take her insults and run with them.  I reflected in the car do I over-focus on my health?

"Wouldn't you?" I asked her, "if you were sick for 17 years and went to people for help and all they did was dismiss you?"

She had no response, but I did.  Yes, my response is understandable, though I hardly find her assessment of me accurate.  Yet the question lingered... Do I trust people to help? Clearly, given my experience, no.  What about God? Do I trust him to care or respond, or do I feel I have to do this health inquiry on my own?  Cultural norms for silence and stigma-stickers don't help.  We are not containers for disease, we do not own nor consume disease, and in a world of One-sided questions, Front-loaded solutions, and Nary a negotiation, we certainly aren't each other's saviors.

I felt for her, I really did, but I'm learning that humanizing health [care] means pushing back.  Resistance, not for arrogance, but for freedom, can make a difference.  The trick is learning how to resist with redemption in mind. More on that in a moment.  So the challenge in transforming medicine to health is discerning between resistance and résistance; one opposes change, one seeks it.  

I say healing means being transformed, reformed actually, from fragments to a whole. A reductionistic culture impedes such healing and even causes its opposite.  What does a holos civilization look like anyway?  A holos civilization no longer in Cartesian fashion splices, divides, and conquers matter and frames of knowing (Heley, 2011).  A holos civilization is loyal to the whole and integrates others' ideas while applying one's own and all with a shared sympathy for the human experience (Parker Follett, 1918).  Forget a holos civilization; we're still trying to perfect an imperfect narrative.  Health narrative standards and best practices need to be laid out.  After all, in a culture where writing is power, I invest time, money, and a legal narrative about myself over which I have little say or feedback and negatively impact my health.

I let her believe that it was the system; she brought up on her own that the system is imperfect.  I wanted her to know that her individual response can influence the system; her ability and willingness to listen vs. interrupt, to empathize vs. stigmatize, and to contribute vs. retreat into her specialty all impact my impression of my experience and her professionalism.

"I wanted to show you my feet," I said, "I'm trying to ask you questions and share my concerns thinking you may have some insight, and you keep interrupting me."  So she asked me to show her my feet.  I did, especially my left, with blood vessels breaking all around the sides, heel, and top and my large toe nail embarrassingly fungal after the cuticle, now healed, had been infected and bleeding for months.

"That's normal," she replied.

"For a thirty-year-old?" I asked, bewildered, but not surprised, by her paltry-as-my-white-foot definition of normal. "I've seen feet like this on an 80-year-old!"

I wanted to know if she knew of a link between the discoloration in my feet (skin) and whatever my be causing my feet to turn purple when I sit or stand for a period of time.

"Do you have Raynaud's?" she asked, or a syndrome that makes your fingers and toes turn purple due possibly to stress or cold.

I sighed inside. "It's been suggested to me, but I've no confirmed diagnostics done."

She says she only deals with one thing, and if I ask questions she thinks I'm neurotic ("We're all a little bit neurotic," she justified), yet all the while she diagnoses me outside of her discipline without any inquiry besides what she sees.  The whole process seemed madness.  If I wanted people to superficially diagnose me, I could have asked anyone to look at me and give their opinion for free.

I can't believe I'm paying her money for this... recurred throughout our appointment.  The purpose of our visit was to focus on my health.  That's why people pay clinicians.  I wanted to pay her for health inquiry and not to listen to her interrupt, speak stigmas, and backpeddle.  I glanced at the clock and heard my parking meter tick away.  She fixated on one question I asked when I wanted her to see my inquiry approach.  I repeated myself to redirect her, but to no avail, "Given your expertise, I want to know what links or insights you have with the four concerns I listed on the form that you gave me."  The conversation felt as an exercise in insanity.  Insanity is asking people to do mutually exclusive things and pretend there's nothing wrong with such a process.

I find medical inquiry an exercise in insanity when it places such a label on constituents for operating within its parameters. Certainly I'm focused.  I failed to understand why she considered my focus a problem; the nature of our visit sanctioned health inquiry and symptomatic complaints to be confined within those parameters.  So I redirect, I try something new, I ask my inquiry, do my research, say what I want. I'm active. Yet I'm penalized for being active. So I find "educating patients" as a pretentious philosophy for practitioners.  That philosophy runs against my belief that constituents carry tacit and somatic knowledge and that health inquiry requires integrating people as partners.  I'm also aware of the socio- political, legal, and cultural ramifications of labeling people causing me to seek insight from empowerment studies and integrative politics (e.g., Freire, 1970; 1994; Parker Follett, 1918) because as it stands now, they write my name in stone and they don't even send me flowers.  
The performance continues each time we interact with a living text (Chvasta, 2003).  In wisdom let us write our names in light, breathe a breath of fresh air, and live.  

Wrap Up: Defrocking the Robe

At visit's end I shared my interest to study the arts, communication, and leadership as applied to health, noting that I do not always live up to my standards even though I try.  The clinician said she didn't think she was a complete failure (not my words) and that if I wanted someone for her speciality that she was "biased... but the best."  Someone is only the best when they communicate their work as embedded in a larger social vision and are able to critique their own roles and texts.  How arrogant and pretentious she presented herself by interrupting, pre-judging, and criticizing me.  

Be that as it may, I will continue to be reponsible, to respond, in the interest of our health.  "But to critique a system, I have to go through it," I said quoting Ai Weiwei, "Fortunately and unfortunately...," I mumbled, and then trailed off with my hands folded neatly on my lap covered with a blue thin clinical gown (more of an apron).  Behar (1996) challenges researchers to "forsake the mantel of omniscience" (p. 12).  She spoke of a research method that involves reflecting and writing on one's own experience as related to larger social issues (such as I'm doing here).  The cost? Ambivelence from those who want to keep their robe, and admiration from those who want to decloak.

I seek to connect with people in meaningful and effective ways via consulting for communication, social media marketing, and creative content.  I apply my consulting work to themes of health, community, and social change.  My inquiry approach involves stating wants, asking open-ended and follow-up questions, or otherwise interviewing for transformation and empathetic understanding.  I also aspire to deliver quality results. I give my best away even for free.  I can't imagine how someone can feel successful (1) and with a free conscience (2) to charge me hundreds of dollars for a less than fast food experience.

On the dialectic ("other hand"), my narrative here frames the experience a certain way, too, and the framing is by its nature political when done in a public sphere (Phelan, 1993).  Which narrative will persuade a court in a defamation or malpractice case?  Which narrative will convince clinicians to take my presentation seriously?  Which narrative will order insurance companies to pay for treatment?  My blog narrative or the clinician's chart narrative?  Why not build a better communication system between clinician and constituent instead of judge-complaint?  I rest my case... for now.  So what do you do when your action seems to be actively waiting for a standstill to end?

But you who revere my name
the Sun of Righteousness will rise
with healing in his wings.

And you will go free,
leaping with joy
like calves let out to pasture...
~ Malachi 4:2


Isn't that a redeemed culture, one that values freedom, reverence, and healing?  Redeeming experience means experiencing and expecting life where you once expected life's opposite. Redemption carries the promise of reparition for the sake of restoration (Joel 2:25a).  Perhaps those are the makings of an empowerment narrative I hear shouting silently from the blogosphere, one that asks health culture to change by putting aside the pretense of knowledge and caring and learn that inquiring also means listen.

On that note, I recognize that my post here carries its own assumptions or at least impressions inherent in framing my clinical experience as conflict.  I do not want to polarize or demonize.  To reform the situated-in-the-system, or the interpersonal conversations that take place in clinical contexts, we must envision health organizations as relying on all frames of knowing, and not just one over the other (such as science/reason over somatic/tacit).  Moving forward, 
I want to learn if, how, and why social networking and blogs sort out assumptions, habits, processes, stigmas, pride, uncertainty, unmet expectations, and systemic limitations to provide a new public commons for assembling to express health.  I want exposure and to collaborate with clinicians and constituents to ethnographically and impressionistic autoethnographically research perception and experience in clinical settings (1) and social media (2).  From these bodies of work I want to understand and share insightful recommendations and implications to transform the public agenda and clinical practices via writing (broadly conceived) or narrative healthcare and leadership.

My appointment today, though exasperating, was not a total loss.  We parted on amicable terms and I knew I had given her things to consider.  Mostly we stayed in the tension that comes when you feel an urge to fight or flight to protect your interests or enhance your way of life.  We tried, it seemed, to resist that fear-generated impulse long enough to shift the conversation, albeit in a tiny increment, to consider how we can better communicate expectations for health. 
By listening to her, paraphrasing, and stating my frustration in a balanced way (both/and) without casting blame ("I don't mean to disrespect you"), the visit turned around somewhat. At visit's end we shook hands.

"I hope your day gets better," I said. Did I smirk? Maybe not as I truly desired her day to get better.  Still I laughed later when I relayed this quote to my husband.

"You too," she said emphatically. "I know it's frustrating to not get answers." I added that it's frustrating to pay so much money to hear the same answers. She promised to keep the cost down as much as possible because she knew I wasn't happy with our visit. I really wanted to specify the primary reason for my frustration, to tell her how she can improve her inquiry next time, for the primary reason leads to the secondary.  I need not worry about cost as a waste if I know I'm investing in expeditious and quality processes and outcomes.  Certainly cost is a concern regardless, but today cost me money and then some.  We talked about imperfect systems, and I let the conversation stay there.  I did not want to complain any more.

I learned at Gonzaga to transform problems into opportunities, which, if you haven't yet noticed, requires courage.  I told her my research interests, and felt inadequate yet empowered at the same time sitting with my bum on the exam table in my paltry thin apron. In some ways I felt that should be paid for our appointment; as much as I want to be professional and consult, when I pay a clinician to inquire on and improve my health, that's the outcome I expect.  Even so, I felt as if we had a little more time we could have turned our jalopy even more to turn off of our pot-hole strewn road and actually gain speed once on asphalt. Alas, the turn veered too sharp this time, but I press through my frustration to stating what I want instead.

I want to change
how and why we communicate health
to be more effective, humane, and just.

Can we really turn this jalopified road-hog around? Ultimately progress needs people to rewrite causality with a systems' perspective, to rewrite jurisprudence as a synthesis of subjective and objective, to educate people to create life via choices and a collective generation of wills and so empower society, and to above all respect each moment, person, and decision as embedded in ever-changing and on-going life (Parker Follett, 1918).  A fortiori Life changes and living things grow.  Our conception of healthcare must shift from disease to life.

This my friends is a starting point for learning to demystify conflict as an opportunity for dialogic engagement.  The tension is part of that.  The only challenge waiting for redemption: my health and finances are at stake.  On the latter, perhaps health institutions should run as a business instead of a social norm.  Businesses understand the power and purpose of engaging constituents and maybe still appreciate the literal buy-in from clients.  Medical institutions may take buy-in for granted in a world where illness is plentiful and people practice medicine on the mainframe instead of the public commons.

Me... Waiting (above)
What about you? 
How and what communication techniques, perspectives, or technologies do you think will help people to partner in the interest of health?
Speaking of résistance,
what do you think is the Pièce de résistance, or exemplar/ideal for health systems?
Do social networks/blogs contribute to "doing" health?" How and Why?


Recommended Resources

To learn more about health communication, see Breaking the Cycle and We are the Change.  To learn more about health stigmas, go to But You Don't Look Sick, a website produced by speaker, blogger, patient advocate, and self-proclaimed Spoonie Christine Miserandino, who describes The Spoon Theory to help readers understand what it is like to live with chronic illness.  See CureTogether for an example of socially networked health. Watch UCDavis Nutritional Gemonics' medical interview YouTube broadcasts Parts I and II to learn about 3 interview methods.  Consider the power of sharing via the Global HealthShare Initiative.  

Discover my research, consulting work, and career desires.  Learn more about offsetting communication violence, such as can occur in clinical contexts, with dialogue and confirmation.  Visit The Living Memorial to participate with a project on digital storytelling and social networking for health in loss.  Access a list of links salient to health systems change and my thesis reference list for texts relevant to performance narrative, research ethics, and social networking for health.  Read my health narratives on Storify.  Follow my Text and Pixels twitter feed for a list of links pertinent to health reform.  Learn more about narrative healthcare and ethical leadership.


Anderson, K.N. Cissna, & R.C. Arnett (Eds.), The reach of dialogue: Confirmation, voice and community (pp. 229-244).  Hampton, NJ: Hampton.

Behar, R. (1996). The vulnerable observer: Anthropology that breaks your heart. Boston: Beacon.

Block, P. (2009).  Community: The structure of belonging.  San Francisco: Berrett Koehler.

Chvasta, M. (2003). The mediated life; ‘And I loved her’.  Unpublished essay.  Retrieved October 26, 2010, from

Cissna, K.N., & Sieburg, E. (2005).  Patterns of interactional confirmation and disconfirmation.  In J. Stewart (Ed.), Bridges not walls: A book about interpersonal communication (9th ed.).  New York: McGraw-Hill. 

Conquergood, D.M. (2002). Performance studies: Interventions and radical research. TDR, 46(2), 145-156.

DeGraaf, D., Tilley, C., & Neal, L. (2004).   Servant-leadership characteristics in organizational life.  In Spears, L. & Lawrence, M. (Eds.), Servant-leadership: Succeeding through trust, forgiveness, and bravery.

Freire, P. (1970). Pedagogy of the oppressed.  New York:  Continuum.

Freire, P. (1994).  There is no true word that is not at the same time a praxis.  In R. Anderson, K.N. Cissna, & R.C. Arnett (Eds.), The reach of dialogue: Confirmation, voice and community (pp. 300-305).  Hampton, NJ: Hampton.

Heley, M. (2011). The civilization of holos. Retrieved June 10, 2011, from

Laing, R. D. (1960).  The divided self.  London: Tavistock.

Laing, R. D. (1961).  Self and others.  London: Tavistock.

Laing, R. D. (1994).  Confirmation and disconfirmation.  In R. Anderson, K.N. Cissna, & R.C. Arnett (Eds.), The reach of dialogue: Confirmation, voice and community (pp. 73-78).  Hampton, NJ: Hampton. 

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

Phelan, P. (1993). Unmarked: The politics of performance. New York: Routledge.

Rosko, D.M. (2010, December 17).  Master’s thesis: Performing impressionistic autoethnographic narrative in Text and Pixels to explore fear of death in end-of-life care-giving contexts.  Retrieved April 12, 2011, from

Wilmot, W.W. (2005).  Communication spirals, paradoxes, and conundrums. In J. Stewart (Ed.), Bridges not walls: A book about interpersonal communication (9th ed.).  New York: McGraw-Hill.