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Enrique Sueiro, Ph.D. in Biomedical Communication, University of Navarra, Spain

Communicating cure to patients and companies

Mon, 10 May 2010 08:12:37 +0000 Published in Navarra Newspaper

In mathematics 2+2=4, but human communication is not an exact science. If you were the relative or the doctor who had to inform a terminally ill patient of his condition, what would you tell him, should you tell him the whole truth with the utmost scientific rigor?

On the communication of bad news, I have just read El buen adiós: cómo mirar serenamente hacia el final de la vida. Silvia Laforet and Jesús Poveda relate the experiences of a physician experienced in palliative care. To begin with, they remind us that medical science fights against disease, not against death. Goodbye is irremediable, but the farewell can be pleasant or, at least, bearable.

At that final moment, knowing and feeling accompanied greatly attenuates the suffering. The mere presence is already palliative, although the perception of time varies according to the position with respect to the bed. That is why it is so important to synchronize our watch with the patient's, because all his time is only a little of mine.

Starting from the novel premise that communication begins with listening, it is easy to conclude that "communication can be painful, incommunication... much more so". To hear, we need our eardrums; to listen, we need our heart. This fine sensitivity allows us to grasp the abysmal difference between what we know, what we transmit, what the patient hears and what he truly understands.

In what can be described as preventive communication, the patient may not despair if he/she knows what to expect. For example, not knowing what the tests and analyses consist of generates avoidable anxiety. In addition, all the time invested in communicating with the patient and offering explanations beforehand is saved in justifications afterwards.

After the progressive information on diagnosis, prognosis and evolution, when the time comes for decisive communication, The Good Good Goodbye states something also obvious: the information must be adapted to the patient and not the other way around. The good goodbye states something also obvious: the information must be adapted to the patient and not the other way around, but what should be told: "the bearable truth", i.e. the information that the patient can understand and bear.

In fact, the scientific journal Archives of Surgery has just published a research that evaluates the effectiveness of submit to those undergoing cardiac surgery an audiotape recording of the conversation at enquiry. These patients, who are often nervous," must understand, evaluate and retain complex information about their own care. Such communication improves" the patient's " knowledge and perceptions" of their health status and reduces levels of anxiety and depression.

Corporate pathologies

This complex reality of patients is millimetrically adaptable to organizations because, in a way, companies are like people: they think, feel, have illusions, grow, get sick and, if they are not cured, die. This is illustrated by one of the greatest contemporary management experts, Javier Fernández Aguado, in Pathologies in organizations. He estimates that the three most widespread in the institutional environment today are myopia, stress and osteoporosis.

Some lines of thought and action that I have developed can be useful for treatment: the PePa Principle (people first, then roles), the 80/20 of listening/talking for an effective management of perceptions, the 11 words core topic (say what you do and do what you say), the CCC formula (communication + coherence=confidence), the possible transition from KO to OK in crisis situations and the oxygenating reference letter of rectifying (always make new mistakes).

Anecdotal and eloquent that one of the most renowned universities officially publishes in its guidebooks that the sculpture of its founder that presides over its campus is the "statue of the three lies". It refers to the legend at the foot, which reads: "John Harvard, Founder, 1638". Neither the figure corresponds to John Harvard, but to a student that served as model; nor the personage founded the university, but was its first benefactor; nor the date coincides with the origin, 1636. So, three lies in four words. Not bad for an entity whose motto is, rightly, Veritas (Truth).

statement The institution itself is no more than an amusing anecdote. Moreover, it deserves praise for its transparency. The same reality, if concealed, and worse if denied, can easily provoke internal distrust and undermine public reputation for life. Leonardo Castellani must have thought something like this. In How to Survive the 21st Century Intellectually, he states that "there is no worse scandal than wanting to suppress the truth for fear of scandal". Good communication works as a therapy, sometimes as a shock therapy, both in patients and in organizations.