The question of “How are you feeling?” is both an opportunity for and a potential barrier to achieving a better health outcome. When this question is asked, who is listening, really listening to, and hearing our answer? Helen Osborne wrote, “People must be able to advocate for themselves as they are increasingly seen as active consumers rather than passive recipients of treatment and care”. For those experiencing lower back pain, including those suffering from sciatica or leg pain from a herniated disc, the capacity of a healthcare professional to communicate effectively can drastically alter our own decision-making in taking appropriate actions to protect and promote our own health.
Scott Marrero, Creative Director of Urbander in Orlando, Florida, remarked, “If a friend would ask me how I’m feeling I would say that I wake with pain every day. Some days are worse than others, but what helps me is that I never want to stay still. As soon as I feel like I can move around, even a little bit, I get up.”
When we think of the term literacy or someone being literate, many naturally think of our own reading level or project thoughts about the reading level of others. For the purposes of advancing a patient-centric discussion on lower back pain, we need to first fully understand the definition of health literacy and gain clarity on the role of the patient, focusing on key aspects of listening, speaking, and conceptual knowledge.
A corrections officer from New York shared, “How do I answer when asked how I’m feeling? It is like a bolt of pain that doesn’t subside. It shoots across the lower back through the glute and hip and all the way down the leg into my toes.” When asked how which words he would use to describe this to a healthcare practitioner or a family member, he said, “It is like the worst pain I have ever endured is exactly how I’d answer either.”
A long-time Wall Street executive from New Jersey remarked, “In a word — debilitating. The words I use to describe this is a shooting, burning pain — like having a hot iron thrusted into my legs.”
A retired interior decorator and grandmother of four from Connecticut shared, “This isn’t a headache. This isn’t menstrual cramps. This is nerve pain — it feels like you have been electrocuted.”
Our current accepted definition of health literacy originates from the Healthy People 2010 initiative led by the U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Health literacy was defined within this initiative as “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”.
What is missing and where does this differ from the basic definition of literacy? A general literacy level does not necessarily equate to a health literacy level. Patients with lower back pain may have high fundamental literacy but be affected by situations that lower their health literacy. Patients can also have low fundamental literacy, but high health literacy. It is clear we need practitioners to reconsider their biases and what they may think they know, and focus entirely on the individual needs of each and every patient when they communicate with them. Each patient may require different communication levels or styles from any other patient they have engaged that day, that week, or that entire month.
“Using words like sciatica, nerve impingement, and degenerative disc disease, without a good example is not something that I use daily,” says Mary Rodda, D.C., of Chiropractic Works in New York. “We need to listen and hear the needs of our patients and then relate analogies that are familiar to them — I really like using the analogy of a train or the structural integrity of a house with a failing foundation. Over the course of time, water damage may warp the floor, cracks appear in the foundation, and then you have a sill plate problem, and eventually all the floors above it are off.”
Urbander’s Scott Marrero followed up on his remarks regarding his own pain to offer some “creative” alternative questions for healthcare practitioners to ask instead of the ambiguous “How are you feeling?”:
All human communication, whether face-to-face, written, by telephone, or by other means, has three critical components: sending communication, receiving communication, and feedback. Two-way communication always includes feedback from the receiver to the sender and lets the sender know the message has been received and understood.
“Being a former athlete, and someone who has a high tolerance to pain, unfortunately, I can’t get the relief that I need. I know this is a difficult thing for physicians to manage, however, it is something that needs to be managed more properly,” shared a Wall Street executive from New Jersey. “Specialists who are supposed to have our best interest often don’t. They don’t fully listen to the individual needs of their patients, manage an individual’s pain properly, and to the extent that they should.”
Effective communication leads to understanding, but only if each person is listening on both ends of the conversation. There is no doubt that a patient’s unique ability to obtain, understand, and act upon health information or medical directions are important for their optimal outcome. This unfortunately may be enhanced, or further constrained, by the provider’s abilities to listen and communicate clearly. When asking any open-ended question about the health of their patients, providers need to be prepared to educate and empower their patients with the right message by striving to listen closely to their needs before diagnosing and prescribing.
National Center for Health Statistics. Healthy People 2010 Final Review. Hyattsville, MD. 2012.
Osborne, H. (2004) Health Literacy from A-Z. Sudbury, M.S.: Jones & Bartlett Publishers.
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