Editor’s Note: We’re excited to welcome Geri Lynn Baumblatt as a regular contributor to Healthcare IT Today. Geri has a unique perspective and a variety of experiences in healthcare that will make for some great content. We’re excited to have her and her passion for healthcare as part of the Healthcare IT Today team.
Health is social. And healthcare occurs in a web of social dynamics.
We create technology and resources to improve healthcare conversations and relationships, but they can also have unexpected effects and stymie those dynamics: like the way the electronic record can steal eye contact and focus during appointments. Other times, they have unexpected positive effects. For example, I was surprised when family caregivers of heart failure patients explained they appreciated daily automated phone calls asking to report their family member’s weight. The automated calls meant they didn’t have to be the annoying caregiver telling the patient to get on the scale each day.
Any technology or intervention has some kind of effect. How deeply do we delve into these dynamics? I recently found myself sorting through the dynamics and emotions of a series of care conversations.
My mom has been recovering pretty well after breaking her hip. She’s in her late 80’s. And she’s physically, mentally, and socially active. I often forget her age because she doesn’t seem old, let alone “elderly.”
But all was not quite right with her recovery. Her foot now turns in a little. And she has new back pain. She’s not a complainer. So in our dynamic as mom/daughter and care partner — if she proactively tells me about back pain, it’s nontrivial. To give you a sense of it, over the past couple of years when she broke a few ribs or got pneumonia, she didn’t tell me because she “didn’t want to bother me.”
But now, a woman who religiously swims a half-mile each day was having a hard time walking down the hall, or walking from the parking lot into the gym to swim. And the pain was getting worse, not better.
Luckily, she already had an appointment on the calendar with the doctor overseeing her rehab. She’s known him a long time. He also cared for my dad years ago. I was relieved. She’d see him in a few days and get help. But when I spoke with her after the appointment, she was disappointed. Her doctor felt she was recovering well for her age. And he wasn’t concerned about the back pain.
It’s easy to say she should have pushed back. Asked again.
But in the moment, it’s awkward. After all, conversations are dynamic — with seconds to formulate a reply. And the doctor’s unexpected response to her pain caught her off guard.
Pushing back or reiterating a concern also bumps up against ‘impression management,’ meaning we want others (especially people we rely on for our care) to have a good impression of us.
My mom also wants to maintain this good relationship. No one likes being “that annoying person” — even though the pain is impacting her quality of life.
Interestingly, she said she didn’t want the doctor to feel he wasn’t successful in helping her with her recovery. So a bizarre loop developed: her concerns about his feelings prevents her from giving him important feedback to help him truly do his job to help her recover. Is it rationale? Socially, yes – medically, no.
So, she’s disappointed. When I bring up her putting his feelings above her recovery, she admits he’s there to help her — and her social concerns shouldn’t be such a big deal compared to her pain and long-term health. But there you have it.
My mom had an appointment scheduled with her primary care doctor the very next week. So we decided she’d call me during the appointment and we’d tell him about her back pain. Her primary care doctor and I know each other, and I’ve dialed-in during a couple of appointments over the years. But if I’m honest, I worried that even old-school technology like a phone call might infringe on their friendly dynamic. Do I add pressure or make him feel like I’m putting him on the spot — especially since I’m both a family member and a patient/caregiver advocate?
She dialed me in when the appointment started. He discussed her recent labs and asked: anything else? I waited for my mom to bring up her back pain but she said, “No, I don’t think so.”
I’m still not clear why she felt it wasn’t okay to bring up her back pain. Perhaps she felt it wasn’t his responsibility or infringed on the rehab doctor’s domain, or just she didn’t want to trouble him with it. But I only had the concern about her pain, so I jumped in to explain. He was immediately concerned and grateful I’d told him. We made a plan to have her meet with a physical therapist right away. I have to add here that my mom has had great success with her physical therapy and frequently expresses her gratitude that I intervened. She knows it could easily have become a long-term problem.
A couple of days after the call, my mom told me her primary care doctor was thrilled I’d joined the conversation and made him aware of the issue. I was surprised how good that made me feel — not just that we got my mom into PT, but that I was explicitly welcomed and appreciated in the consult. That feedback will make a real difference in my comfort level to join future calls.
An interesting last interaction: my mom ran into her rehab doctor at the hospital a week later and worried he’d figure out that she was there for PT he hadn’t ordered. Again, she didn’t want to make him feel bad or feel like she’d done an end run around him. So he continues to be in the dark.
These interactions may seem like pleasantries, but important treatment almost didn’t happen for fear of awkward conversations or offending professionals who went into medicine to care for us.
I’m sure there are many more nuances not captured here. As designers, when we play out the way we think these interactions will go, are we being realistic about the complexity of the social dynamics, the emotions of all involved, and how any technology or service interventions may impact them.
Sometimes technology is transformational, like being able to see a specialist through a virtual visit while living in a remote town. Sometimes the technology is so simple, it’s something we take for granted, like dialing into a loved one’s appointment. The impact can be profound. How do we ensure they have a positive impact for clinicians, patients, and care partners?