— Charles Webster MD ⎌ (@wareFLO) September 27, 2016
WHAT TO SAY WHEN THE WRONG THING WAS SAID
Today’s #HCLDR (Healthcare Leadership) tweetchat topic, What to Say When the Wrong Thing Was Said, hosted by @researchmatters, reminds me of a paper I wrote and presented over two decades ago (in Hong Kong!): Communication Ethics and Human-Computer Cognitive Systems. I discuss communication ethics and its relevance to designing intimate human-technology interfaces. My paper is mostly about humans using and communicating with intelligent tools, from intelligent prostheses to smart robots. In this post I retrieve some of those ideas and apply them to ethical human-to-human communication.
“Communication ethics, traditionally, involves the nature of the speaker (such as their character, good or bad), the quality of their arguments (for example, logical versus emotional appeals), and the manner in which presentation contributes to long term goals (of the individual, the community, society, religious deities, etc.) (Anderson, 1991 [in Conversations on Communication Ethics]). These dimensions interact in complex ways”
“Consider Habermas’s (1984) ideal speech…. Communication acts within and among cognitive systems should be comprehensible (a criteria violated by intimidating technical jargon), true (violated by sincerely offered misinformation), justified (for example, not lacking proper authority or fearing repercussion), and sincere (speakers must believe their own statements). These principles can conflict, as when an utterance about a technical subject is simplified to the point of containing a degree of untruth in order to be made comprehensible to a lay person. Thus, they exist in a kind of equilibrium with each other, with circumstances attenuating the degree to which each principle is satisfied.”
“Four principles—observed during ethically convicted decision making—have been influential during the last decade in theorizing about medical ethics (Beauchamp & Childress, 1994): beneficence (provide benefits while weighing the risks), non-maleficence (avoid unnecessary harm), self-autonomy (respect the client’s wishes), and justice (such as fairly distribution benefits and burdens, respect individual rights, and adherence to morally acceptable laws). People from different cultures and religions will usually agree that these principles are to be generally respected, although different people (from different cultures or ethical traditions) will often attach different relative importance to them.”
In another series of posts (five parts! 10,000 words!) I wrote about the concept Pragmatic Interoperability. Key to pragmatic interoperability is understanding goals and actions in context, and then communicating in a cooperative fashion. Healthcare professionals are ethically required to cooperate with patients. Implicature part of the linguistic science of cooperative communication.
“We’ll start with implicature’s core principle and its four maxims.
The principle is:
The maxims are:
- Be truthful/don’t say what you lack evidence for
- Don’t say more or less than what is required
- Be relevant
- Avoid obscurity & ambiguity, be brief and orderly”
I think most, or all, of the above ideas are relevant to figuring out that to say next, when the wrong thing was said. I will be looking for examples during the Healthcare Leadership tweetchat.
Healthcare Leadership Tweetchat Topics
T1 Beyond classical adverse events like wrong-site surgery or incorrect medication dose, adverse communication events can also occur in healthcare. What types of troubling or harmful communication issues have you experienced that affected your care?
T2 Perceptions vary. Patients may perceive something as a problem, whereas the healthcare team just sees business as usual. How can patients help clinicians understand that perceived problems are as important as actual problems?
T3 What steps can help (quickly) establish rapport between health care practitioners and patients so that if communication goes off-track, each is better equipped to address the problem or perceived problem?
T4 If nurses or other care team members observe poor communication between a physician and patient, what is their obligation–how should they attempt to address the situation?