|Analogies for Communicating with the Patient|
Simplifying medical communication Medical information is full of technical words and jargons that often tend to distance patients from providers. At the same time, we need to communicate technical information in. a language that even lay people can easily understand. Even if we are explaining in the local language, we may still be using terminologies and phrases unfamiliar to the patient. Providing information to patients in a manner that the patient understands is not just a hospital mandate but is a legal requirement too.
In eye care, with the large burden of avoidable blindness that can be cured through a simple onetime surgery, providing the right information becomes all the more crucial. The majority of people who could benefit from surgery resides in rural areas and does not avail of services in spite of a high level of awareness of the availability of services. This is mainly attributed to the barriers related to fear, treatment costs, able to manage with current poor vision, difficulty in leaving day to-day responsibilities to come in for an operation, postoperative limitations on daily activities, belief in fate and god's will, and low levels of compliance to treatment. Therefore it is all the more important to communicate in a manner that is appropriate to them. Andre Fuglesang questioned "Why should we expect the illiterate villager to adjust to the way of thinking of the educated man? Why should he alter .his perception of the world to understand us? It is perfectly possible for an educated man to adapt to the concepts used by the illiterate villager but he has to study them". Andre Fuglesang has termed this approach as "appropriate conceptualization" to complement appropriate technology. This article tries to explain the use of analogies in communicating and lists a few examples of analogies used with cataract patients in an eye hospital setting.
Analogy for Communicating Information
Information needs to be provided to the patient and their family members for a variety of reasons. It could be to increase patient awareness to facilitate informed decision-making as well as to motivate the patient to accept a particular treatment procedure which the doctor knows will benefit the patient.
Information can also be provided to moderate patient's expectations. Providing the right information can increase patient compliance regarding treatment procedures, which the patient must follow. For e.g., putting drops in the eye regularly after a cataract surgery or telling the importance of regular follow-up check-ups for Diabetic retinopathy or Glaucoma patients to ensure continued success of the treatment. The challenge is, how do we share all these information with the patients and yet assure ourselves- the providers -that the patients have understood whatever we have told them.
For example, if the patient has to undergo a cataract operation, for which he needs to make a choice between different surgical procedures, the patient needs to thoroughly understand the pros and cons of each procedure. If one were to merely tell them the facts, as they are, it would just be an overload of information, most of which would be new to them. Unfortunately we also do not have the luxury of time and human resource, which can be invested to explain in-depth to each and every individual patient. We need to communicate all this "new" information in a manner, which is easily understandable to the patients and their family members in the limited time available.
This is where analogy will help. The Oxford dictionary defines analogy as "a similar feature, condition, state, etc. shared by two things that are compared. Analogy is using the familiar to explain the new. The familiar being drawn from an understanding of the background of the patient depending on his/her culture, living style, experiences and concerns. This not only, increases the comprehension of the matter quickly but also the retention of the information for a longer time.
Analogies used at Aravind Eye Hospital
At the Aravind Eye Hospital, Madurai, counsellor repeatedly use analogies while trying to explain complex technologies, available' treatment options and even for motivating the patients to get their cataract operations done immediately. A few examples of analogies used during the counselling process for cataract patients at Aravind are:
To explain to the patients what the term cataract means:
The yolk of a raw egg is transparent and you can see through it but once it is cooked the transparent medium becomes opaque and this is an irreversible change. Similarly in your eye the lens which was clear and through which you could see everything has due to different reasons become opaque. This is also an irreversible change. This condition, when your lens becomes cloudy and your sight becoming not clear is known as cataract.
To explain to the patients the need for immediate surgery for a mature cataract:
If cotton price /wheat is not plucked at the right time when it matures, it will burst and it will be of no use. Similarly when your cataract is mature and if it is not removed immediately, the cataract has a chance to burst, which could result in loss of vision.
To explain the difference between ECCE-IOL surgery and Phaco-IOL surgery:
Suppose you are getting a well dug, people are required to manually dig it and its diameter will tend to be much bigger than a bore well. To dig a bore well one needs to bring a machine. The total diameter will be Jar lesser than the manual well. Even though bore well is deeper, it will finish quicker than digging a well, bur more expensive than digging a well. Still people know that a bore well is better than a well and that is why people opt for it. Similarly a Phaco surgery involves the use of a machine for removing the cataract lens from the eye. It will make a very small opening for removing the lens and the whole operation will take less time as opposed to the regular I0L surgery. Since the opening is smaller the healing time or the recovery time will also be shorter.
To explain about quicker recovery time in cataract surgery using Phaco-foldable lensintra-ocular lens (JOL) surgery versus Phaco-single piece intra-ocular lens (JOL)surgery:
Assume there are two persons who want to travel to a certain place. One decides to go by train and the other by plane. Evn though both will ultimately reach the same destination the person who travelled by plane will reach early: Similarly even though both operations produce the same result one has' a faster recovery period, which means that, the person who' undergoes Phaco surgery with foldable lens will be able to return to work faster than the person who undergoes Phaco surgery with single piece IOL.
To explain about the importance of postoperative care after cataract surgery:
Suppose you have grafted a plant. In order for the plant to grow well at the point where the grafting occurred, it is covered with' a piece of cloth. The joint between the two stems is not allowed to be exposed to the elements. We have to take special care like pouring water regularly till the grafted plant grows well. Similarly, as you have had your cataract surgery, you have to take some care in order to ensure your eye is okay. First, the eye has to remain bandaged and protected from sunlight and other elements. Then you have to make sure you put your eye drops regularly. Only with this care your eye will become better.
Analogies thus help to facilitate understanding of unfamiliar concepts by grounding them in the known. It takes the person from the known to the unknown. The same analogy will not work across different groups of people as their circumstances and exposure differ and the analogies need to be created and modified according to each individual requirement. Analogy when used properly and correctly is a powerful tool in aiding communication.
Preethi Pradhan is a Faculty at the Lions Aravind Institute of Community Ophthalmology (LAICO) and V. Annapoorani is the Administrative Trainee-Counselling, Aravind Eye Hospital, Madurai, Tamil Nadu.
HEALTH FOR THE MILLIONS/ August - September 2002.