Article from the Boston Globe’s On Call Magazine, February 2002

By Helen Osborne, M.Ed., OTR/L
President of Health Literacy Consulting

You often need to tell people about risk. For instance, you may need to convince them they should change the battery in their smoke detectors or wear their seatbelts. You might have to explain side effects of medication or talk about treatment precautions. When you do, you not only need to raise awareness about the probability an event will occur but also highlight what the consequences would be, even when the audience doesn’t want to know.

Communication, according to James Hyde, MA, SM, is as much about listening as it is about speaking or writing. Hyde is an associate professor in the Department of Family Medicine and Community Health at the Tufts University School of Medicine. One of the things he does is teach health professionals how to effectively communicate information about risk. To be effective, he says, health professionals need to appreciate that patients and families may perceive risk in ways that differ from their own point of view.

When health professionals speak about health risks, they usually speak as experts. They are likely to be objective and unemotional and to base their recommendations on a careful review of epidemiological data and research findings. Health professionals often think of risk from a population perspective, telling patients and families, for example, that their chances of contracting a particular disease are “2 out of 100.” Because they are well-versed in the subject they are talking about, health professionals are also apt to use technical words and jargon.

Patients and families, on the other hand, are usually non-experts. They may be unfamiliar with the topic being discussed and have difficulty making sense of statistics and research findings. As non-experts, they may relate risk information to stories they watch on TV, read in the newspaper, or hear from their family and friends. They are likely to be less interested in what happens to the population at large, and much more anxious or fearful about the health and financial implications in their own situation.

Understanding the Patient’s Point of View

To communicate risk information effectively, Hyde recommends that health professionals remember what it feels like to be in situations in which they are non-experts. For instance, not long ago, a computer virus wiped out my computer’s operating system. I remember that when I first heard about this virus, I didn’t think the “risk” related to me. I assumed my chances of getting the virus were remote, and I felt confident that the precautions I was taking were sufficient. But I got the virus anyway.

Regardless of whether the topic is computers or health and safety, when you communicate about risk, you need to take into account certain factors that can affect how non-experts understand and perceive that risk. When you consider the following, you can more readily understand the audience’s point of view.

Vulnerability. People tend to be more fearful when they feel that situations are out of their control. For example, a person may feel there is a greater risk to his or her health and safety when flying in an airplane than when smoking cigarettes. Hyde explains that while the statistics do not support this, people often perceive a risk to be greatest when they feel vulnerable.

Popular culture. Movies, television, and newspaper and magazine articles all impact a person’s sense of risk. After a tabloid headline about a flesh-eating disease, for example, a person may feel at great risk for contracting it. In actuality, however, the person is far more likely to get the flu, which poses a greater risk to his or her health.

Personal experience. Once a person is affected by a risk or knows someone who has been, their perceptions are forever shaped by the experience. After my bout with the computer virus, even though I don’t want or like to, I am spending the time and money needed to protect myself to keep this from happening again.

Putting the Information Into the Proper Frame

Appreciating how people perceive risk is a good beginning, but you also need to do more. You need to speak and write about risk in ways the audience can understand. Hyde offers some strategies you can use to better communicate with patients and families about health and safety risks.

• Use clear and simple language. In order for people to respond to risk information, they first need to understand it. Appreciate that patients and families may not be familiar or comfortable with the technical words you might be using. “You are not talking down to someone,” says Hyde, “when you use words that they can understand.”
• Remember that communication is about listening. Listen when patients tell you their concerns and fears. Give them your full attention and do not write in the medical record or shuffle papers while they are talking. Do not interrupt them while they are speaking, and confirm that you do understand them by repeating back what you hear them say.
• Avoid using too many numbers. While you, as an expert, may be comfortable talking about population-based figures — what can happen to thousands or millions of people — these numbers may ratchet up fear needlessly. They can also downplay how serious a risk is. Too many statistics or too huge a number can be confusing and can give people a false sense of safety or risk.
• Give people time. People often need time to digest and reflect on risk information. Invite patients and families to take the time they need to think about the information you present. As appropriate, follow-up your initial discussion with another appointment or phone conversation to address the questions and concerns they still have.
• Have additional resources for people who want to learn more. Oftentimes, a person will want to learn more about a particular risk or hazard. Providing resources such as brochures, journal articles, and Web sites will help people develop a deeper understanding of what you are saying.
• Be empathetic. Remember how you respond in situations when you are a non-expert. Communicate with patients and families in ways you like to be spoken to when you are anxious, emotional, and unfamiliar with the subject matter. “Do not trivialize people’s concerns,” says Hyde. “Understand why they are worried and meet them there.”

How To Find Out More

James Hyde, MA, SM, is an associate professor in the Department of Family Medicine and Community Health at the Tufts University School of Medicine. You can reach him by e-mail at: James.hyde@tufts.edu.

Resources on the Web

• National Library of Medicine. Current Bibliographies in Medicine 2000-2007. Health Risk Communication. Prepared by Marcia Zorn, M.A., M.L.S. and Scott Ratzan, M.D., M.P.A., M.A. http://www.nlm.nih.gov/pubs/cbm/health_risk_communication.html
• Agency for Toxic Substances and Disease Registry-U.S. Centers for Disease Control, Atlanta, Georgia. A Primer on Health Risk Communication. http://www.atsdr.cdc.gov/HEC/primer.html