Explaining cardiac interventions: Using analogies to improve communication

Explaining cardiac interventions: Using analogies to improve communication

Dr KK Aggarwal

The doctor-patient relationship is the foundation of practice of medicine. And, communication is the key factor that decides the interaction between the doctor and his/her patient and influences outcomes.

Doctors are bound, both ethically and legally, to provide adequate information to the patient so that the patient can participate in the decision making process and are in a position to take an ‘informed’ decision.

Any information given to the patient should be in a language, using words or using terms he/she can understand.

But do patients really comprehend the information that is given to them during the process of informed consent? The science of medicine is abound with complex concepts. Medical terminology uses technical words and jargon that are unfamiliar to the patient and difficult to understand. This may hinder the effectiveness of communication.

One way to improve communication and enhance understanding of medical information is by using analogies. The dictionary meaning of an analogy is a ‘resemblance between two situations, people or objects that are otherwise unlike, especially when used as a basis for explanation’.

Analogies are situations that are familiar to the patient and so easily understood. The information is also better retained. Hence, using analogies to explain complex medical terms or concepts can improve doctor-patient communication.

This is how I explain cardiac interventions to my patients. I take the example of traffic management, a situation familiar to all.

For any traffic management, following are the options:

• Placing traffic signals can be equated to dos and don’ts of lifestyle management.
• Posting a traffic inspector on the crossing. This can be equated with a clinical cardiologist.
• Diverting the traffic from main road to side roads. This can be equated to opening collaterals by drugs and/or exercise.
• Hiring an architect to make maps. This can be equated to an angiographer (cardiologist) doing angiography.
• Looking for the possibility of widening the roads. This can be equated to balloon angioplasty.
• To prevent encroachment of widened roads to place railings around the widened roads can be equated to placement of metallic stent.
• To prevent mishandling of railing, safety grills are put. This can be equated to drug-eluting stents.
• When the roads cannot be widened, flyovers are made, which can be equated to bypass surgery.
• Flyovers can be made by stopping the traffic. This can be equated to open heart bypass surgery.
• Flyovers can be made without disturbing the traffic, this can be equated to heart bypass surgery.
(Disclaimer: The views expressed in this write up are entirely my own)

Is quantum communication the future?

Is quantum communication the future? Dr KK Aggarwal For the first time, entangled particles of light have been successfully transmitted through sea water, which is known to absorb light, in a feat that can be called as ‘quantum communication’ or ‘quantum teleportation’. Researchers from the Shanghai Jiao Tong University in China tested entanglement of photons in water in a proof-of-concept experiment. Saltwater from the Yellow Sea was put in a container. And, they were able to transmit entangled photons through the seawater in the 3.3 meter long container without disturbing their quantum link. In the study published in the journal The Optical Society, the researchers said, “Our results confirm the feasibility of a seawater quantum channel, representing the first step towards underwater quantum communication.” This experiment was based on the concept of “quantum entanglement”, a concept that was once considered impossible by Einstein, who termed this phenomenon as "spooky action at a distance". Matter, we know, can be sequentially converted into atoms and then to subatomic particles (protons, electrons and neutrons), photons, quantum and wave. A photon (or quantum) has properties not only of a wave but also of a particle simultaneously (wave particle duality). When two photons interact or become “entangled” and then separate, they are connected at a speed much faster than the speed of light and affect each other, even when separated by huge distances. In this entangled state, the two photons (or quantum bits – qubits) share an existence or characteristics (quantum information measured as quantum bits ‘qubits’) and are interdependent. When one is altered in any way, the other too is altered even at a distance. Transmission of quantum information from one location to another is called quantum communication or quantum teleportation. All communication today is local i.e. antenna, wires, cables, optical fibers are required for transmission of information. Wireless communication includes applications such as two-way radios, cellular telephones, personal digital assistants and wireless networking (Wikipedia). Quantum communication or teleportation, on the other hand, is indicative of non local connectivity. This proof of quantum communication has raised possibility of ‘quantum’ internet in the future and also that transmitting ‘quantum’ information or messages underwater without fear of their being intercepted may soon be a reality. Disclaimer: The views expressed in this write up are entirely my own.

Principles of communication

Principles of communication Communication is the foundation of an effective doctor-patient relationship. It works both ways i.e. it has advantages for both the patient as well as the doctor. Good communication is the key to building trust, patient compliance to the prescribed treatment, patient satisfaction including better clinical outcomes. A good communicator is also a great motivator. Poor communication has been attributed as a major contributor to litigations against doctors. Hence, good communication skills are therefore very important for the doctor. There are certain principles of communication that should be followed for effective outcomes. • Know your target audience. Your audience is made up of diverse group of people, with different cultural backgrounds and health literacy levels. Assess their level of awareness of your audience and tailor your message accordingly. If the level of awareness is low, talk to them at their level and gradually build up the level of your message. Do this even if this is the case with even one member of the audience so that all get the benefit of your message and nobody feels left out. Remember, “One size fits all” messages don’t work always. • Decide your agenda. You must know what message you want to give. The health information should be field tested and should not create any panic or fear in the society. Communication should be concise and focused. • Use multiple channels of communication. Decide how you want to deliver the message. There are several channels of communication. Print – newspapers, posters, press releases etc. Audiovideo – radio/TV interviews, press conferences etc. or internet – email, social media, SMS. • Message should be evidence-based. Your message should be fact-based or evidence-based and not based on opinions or myths. Higher the level of evidence, lesser the chances of your message being contradicted or refuted. While giving a health statement, quote a credible source of information such as meta-analysis, randomized-controlled studies and reviews published in credible journals. • Strike while the iron is still hot. Timing is of great importance in effective communication for desired outcomes. • Follow the cycle of Teach, Reason, Summarize and Revise. Pre and post evaluation of the audience is important. Always revise at the end to find out what is understood. • Word of mouth communication. Involve “community leaders” or “celebrities” people who count in the community, who are considered reliable by the people, who people look up to as role models.