PDF Talking about Health: Why Communication Matters (Communication in the Public Interest)

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Who Benefits from Our Health Illiteracy? Summing It Up …. It offers multiple references for each chapter that would be helpful to readers wanting more detailed information. Additionally, it could also assist health care professionals who want to increase their communication skills. Accessible and full of Parrot family anecdotes. Communication in the Public Interest. Undetected location. NO YES. Talking about Health: Why Communication Matters. Selected type: Paperback. Added to Your Shopping Cart.

View on Wiley Online Library. This is a dummy description. Are you ever surprised, puzzled, or even annoyed by the fact that one message about health says one thing and another message says something quite the opposite? Communicating about health is often misunderstood because the vocabulary is both complex and unfamiliar. We say we have a pimple on our face, not a cyst. We say we have a growth on our arm, not a tumor.

She told me, He talked about things that were in my records about which I had no awareness. The orthopedist said these were the diagnosis a couple of times when I had seen my primary care doctor for knee pain in the past. When asked why, doctors say that the difficulty of translating medical and scientific terms is most easily achieved by using language that can be easily understood by lay audiences — metaphors. The first three responses explained that such a cyst is a soft and often painless bump, a closed sac or bladder-like structure that is not normal, and a firm, walnut-sized fluid-filled lump behind the knee.

Our understanding depends upon our willingness and ability to integrate research evidence that may make no intuitive sense. This lack of integration poses a barrier to thoughts and action. In looking back, and with prompting from an orthopedist, my girlfriend who was struggling with knee pain remembered that her primary care doctor told her a long time ago to get some physical therapy for her knee and that her insurance would cover several visits.

Then he says to get therapy to build my calf and thigh muscles. She was seeing both as work-outs involving her knee. Sometimes, science makes different recommendations based on the same behavior having different effects for our health, once more causing the talk about health to be confusing.

Sun exposure provides an apt example. As a child growing up, I walked miles and miles of shorelines along the Great Lakes with my paternal grandmother in the summers, leaning over to look into the waters and collect stones as souvenirs, some of them the treasured Petoskey stones with fossil forms etched into their surfaces. I swam with cousins in cold water and then baked warmth back into my body as we had relays on the beach. No one talked about skin cancer yet because there was no science to support a risk due to overexposure to the sun. There was, however, science relating a lack of sun exposure to vitamin D deficiency and rickets.

Misunderstanding may arise because communication about health reflects the fact that different medical evidence may apply to different people. These may include biological sex, age, or race. As a result, complications arise from the use of some medications or other therapies for them. Media stories have reported about this happening for some medications used to treat depression, for example.

Concern has emerged about whether the use of these medications may actually increase the risk for suicide among teens using them. Cold medicine was never tested on children under the age of two, and use has been found to lead to serious and even life-threatening effects. Sometimes new science conflicts with old science and affects our understanding. Too few efforts are made to tackle this head on. Their mothers may tell them that they smoked and their babies were healthy. The recommendations are even more varied when using the liquid-based cytology screening method, with the ACS recommending every two years, while ACOG recommends annually, and USPSTF states that there is insufficient evidence to make a recommendation.

All three organizations do agree that screening should be started within three years of onset of vaginal intercourse, but not later than the age of Our ability to understand communication about health may also depend upon awareness that often there simply is no science to guide communicating about health. Just untested. It Guides Effort, Emotion, and Excuses The energy put toward health, experiences of positive and negative feelings, and accounts of why we do what we do emerge out of communicating about health.

Communicating about health arouses emotions, some of which are negative. It causes worry and dread. We feel guilty when we eat too much, drink too much, work too hard, or drive too fast. The effort we and others put into health can be traced back to talk about health, but there are gaps in the talk, gaps in our understanding, and so gaps in our behavior.

Our top three complaints? Poor communication with doctors. Poor coordination of care. Medical or medication errors. Poor care coordination, and medical or medication errors have direct links to poor communication. Poor communication thus appears to be all too common. We know this personally because we feel it. We know it professionally because we see it in ourselves and others. We keep on hoping to make our effort pay off.

Little wonder then that too frequently we feel frustrated, mad, sad, and fearful when it comes to our health, when we should feel hopeful, happy, and glad to be alive. Talk about health can benefit us in many ways. It acts as a guide for what to do and how to do it.

It reinforces the match between our life stage and our mental and physical status. It should allow us to focus our attention on all the other things that matter to us, of which there are many as humans. These are aims that can be realized. It takes intention, however, and a harnessing of our efforts in new ways and new directions. That will be the purpose of this book then, to provide insights to redirect our energies and achieve a better understanding out of all the talk about health, together with improved well-being for ourselves and our societies.

A quarter of a million youth were involved in pilot projects in six states — sit-ups, push-ups, rope climbing. There were charts marking the standard and we all aimed for it. My school had a jump-rope contest among other events. I won blue ribbons three years in a row. I learned that both praise and fun increase effort and commitment to physical exercise. But I was already well aware that boys played sports and girls were cheerleaders. These gendered identities and roles affected the reality that girls were aiming for records in doing sit-ups, while the boys aimed for leading the count for most push-ups.

Across decades of living, being a wife, a mother, a daughter, a sister, and a friend, together with the work that I do relating to how we communicate about health, six questions, sometimes with different answers, emerged at the intersection of these roles in all the talk about health. It was the Fourth of July weekend.

1. Introduction

I had been to the doctor on Friday and it looked like it would be a while before I would go into labor and deliver my first baby. These really seemed more intense. But things stopped, as they often do, and we went home. No sooner were we home than I began to have those pains again. This time, I got into a warm bath and tried to relax. I gave it an hour or so, but things were getting too difficult for me to manage. We lived in a rural area served by a small community hospital.

When he did arrive, he quickly determined that my son was in distress. It was a very surreal experience to see it all overhead in that big round mirror which reflected back the events that were happening to me. As the doctor delivered my son, he asked the nurse to remove his mask. Then my son was placed in an incubator and whisked away, before I even got to hold him, to be kept under close watch for some hours to come. It was very scary. Whenever something with his health seemed a bit odd, we would wonder if it might have something to do with that early event.

Do keep track of the numbers that are important to you for understanding your health status and treatment options. Do you know any numbers about your health? Anything besides perhaps your height and weight? This was based on his blue-gray color, lack of breathing, and absence of reflex. Instead they rely mostly on percentages, population comparisons, proportions, and ratios. This may be accurate and help us understand our health status. Being sedentary may double our risk for some diseases.

Living in an area where there are no parks to walk in and no safe cycle trails to bike on may double our risk for some diseases. Start trying to add it all up and the number may look like we have a 1, percent chance of getting heart disease! There may be different reference ranges for younger as compared to older, for men compared to women, and even for more fit versus less fit adults when a comparison is made.

My triglycerides were in the normal range with a score of 91 and a reference range of 30— My HDL or good cholesterol level was in the normal range with a score of 68 and a reference range of 39— But my bad cholesterol or LDL level was right on the borderline for high, coming in at when the range was 0— I was a bit younger than that at the time, so the doctor talked about what that meant for my risk level by comparison to the standard.

As suggested by the reference range for my cholesterol report, age is often an important part of the standard.

Health history is also important. Doctors and nurses frequently try to get us to pay attention to both in order to understand what the numbers mean. This is called a baseline level of risk. For example, what behaviors might women adopt to reduce risk? Research also focuses on what increases risk.

In women, for example, 1 in 8 is the proportion of women from the entire population who will develop breast cancer in their lifetime. As with the reference ranges aligned with medical test results, many variables might affect our health risk. Among a group of women living in one area compared to another area, or women in one age group compared to another, or women who eat a different diet compared to others, the risk may be higher or lower. This fact may be communicated by a number which gives us the proportion of women affected, but we often lose sight of it.

In one survey of 2, women, for example, almost two thirds incorrectly believed that the lifetime risk for breast cancer applied to their specific age group. Some complex mathematical models take into account many variables linked to a disease and provide a final estimate of risk. Risk for men versus women is often compared. Three times as many men as women develop spinal cord injuries in a year in this fictional example. That sounds like a lot of risk for men, and it is. But perhaps not so much because of the comparisons to women per se, but because of the actual numbers or percentage of people affected, 33 percent of men.

Our overestimation of risk based on presentations of relative risk often occurs because we forget that conversion step in understanding the meaning of the numbers.

Description

Our decisions about what treatment to choose are based on numbers as well. The women were also told that additional treatment could reduce the risk of recurrence in five years by 30 percent. This is arrived at by calculating 30 percent of 30 percent 0. Since 0. This correct answer was given by 47 percent of the women. That means that more than half the women made a decision based on inaccurate understanding.

In fact, 28 percent of the women believed that additional treatment would reduce risk of relapse to zero — a problematic expectation. One reason that numbers are used to communicate about health is the belief that they project an impersonal or neutral voice. But many of us feel anxious about any message that relies on our math skills to be understood, however, and our anxiety may make us not even try to understand. And remember, everyone has a story, even more than one.

Exercising because a friend told you it gave him more energy. Getting a colonoscopy because your colleague told you that the technicians are really kind and do everything they can to make you comfortable during the procedure. They present involved rather than detached views of risk. They describe how an experience felt. Numbers might occasionally indicate how many of us report feeling fear or guilt or some other emotion in response to a diagnosis or lack of compliance with a recommendation.

My daughter was about to be transported to the emergency room of a nearby hospital with the likely diagnosis of blood clots in her lungs strangling the very life out of her. My father, who served as a B bomber crew chief in the military during the Vietnam era, made many flights crouched in tight quarters for long periods of time and, as a result, experienced blood clots in his legs. One of my younger sisters experienced blood clots in her legs from the use of birth control pills.

Neither had experienced clots breaking off and traveling to their lungs, an often fatal event. We usually tell stories to describe events that disrupt our life routines. These official stories come from organizations such as the Centers for Disease Control and Prevention CDC in the US, for example, keeping us informed about how common conditions such as flu and uncommon conditions such as anthrax exposure are affecting individuals and communities.

Because we so often rely on stories to guide our understanding, many organizations have begun to provide access to firsthand accounts which have been prescreened for their accuracy related to medical details. The American Cancer Society, for example, includes stories of cancer survivors on their internet site. Cancer patients receiving radiation therapy for breast or prostate cancer, for example, adapt better physically, socially, and vocationally when they share their experiences of pain, fear, recurrence, financial concerns, treatment side effects, and even death.

In one study of breast cancer patients, women revealed the implicit effects of secondhand experience stories, as 49 percent said that they did not disclose their worries about the diagnosis because they had concerns about money, about missing opportunities with family, and about being disfigured. These expecFigure 2. I think that I knew something was wrong, long before I admitted it to myself. It was this past February that I started to think that something might be wrong. I ran in a Peachtree qualifier. Women have to finish under 55 minutes in order to start a bit ahead of the pack on Peachtree Saturday.

I ran the race in sheer pain and crossed the finish line 42 seconds away from qualifying. I was upset with myself for getting out of shape, but committed myself to trying again. Over the next couple of weeks, despite my effort, I became more and more exhausted and strained with every workout. I blamed my fitness; I blamed my allergies; I blamed my hectic schedule. I thought of a million different causes for my declining fitness.

Finally, things took a rapid downhill turn. I began having pains in my chest and pain from breathing the moment I rose from my bed in the morning. I coach a high school rowing team, and one of my rowers came down with pneumonia. I assumed that I had the same. My husband finally made me go to the doctor, and they ran a battery of tests.

My fitness was good I had been an athlete in college , and my lungs were clear. Still, the doctor had a suspicion that I had a blood clot in my lung, and I needed to get to the hospital right away. We drove to the hospital, but I was so frustrated because I felt like this would not be anything serious.

We were wasting time; I had so much work to do at home. We had a wonderful nurse who sat with us and made us feel pretty comfortable in the emergency room. They wheeled me off to have a CAT scan of my lungs. I returned from that and relaxed for another 20 minutes or so, until the doctors came in. I could tell right away that something was wrong. They told me that I had extensive clotting in both my right and left lungs, including a blockage off of the pulmonary artery. The condition is called pulmonary emboli and one clot to the lungs is frequently fatal.

My lungs were just filled. I knew that I was sick right away. I was immediately hooked up to monitors, IVs, and oxygen, and I began to cry. I was a very lucky woman. Because I had such a great lung capacity from being a collegiate athlete, I could handle the clotting and still maintain plenty of oxygen to my system. The hospital was hard to sleep in, and I wanted to go home so badly. They let me go home after a couple of days, but I had to give myself shots in my stomach of blood thinners every day for 10 days.

The first two weeks were VERY rough. My parents came down from Pennsylvania, and friends and family came to help. I was just so tired. The doctors said that the clots had been massing for weeks to months. It was almost two months later before I was given the OK to exercise again. I was horribly out of shape, and a little scared of being able to tell whether being short of breath was just due to the exercise or my lack of lung capacity.

I have a wonderful friend named Jenny who became my personal trainer. It was painful at first, but I have come such a long way at this point. Needless to say, during all of that, I missed the registration for the Peachtree Road Race. However, I feel that completing the Peachtree would make me feel that I had overcome the physical barrier that has been holding me back. Since I have been working out, I have had a stress-test performed on my heart, and I am completely clear for all physical activity. I would love to have the chance to run the Peachtree Road Race with Q I really appreciate your consideration of me for the race number.

These included Gattaca, Jurassic Park, and Multiplicity. Jurassic Park focuses on the cloning of dinosaurs to populate a theme park. Culturally common stories, which may be told by someone who has no direct or only secondhand experience, are repeated to make an issue or practice salient in a cultural group. Culturally common stories also affect how we view the role of medicine, technology, and science for health, contributing to our beliefs about personal control over health. African Americans in the US tell about the experience of the Tuskegee Syphilis Study which began in with recruitment of African American men to study the course of the disease across the next 40 years.

There was no standard treatment for syphilis when the study began. This did not occur, however, before 28 men had died from syphilis and others had died from complications related to the disease. Telling about this event reminds that trust was violated by medical researchers. Communicating about poor health may reduce our motivation to try in domains of our health and well-being where we actually do have some control.

This may reduce the negative labels and stereotypes linked to the condition and behaviors such as overeating and not exercising. It may also increase the likelihood that resources will be allocated to discover ways to manage these conditions. In turn, college administrators make more rigorous requirements, with the cycle being potentially unending. Normalizing a diagnosis can also lead doctors and others to dismiss significant events affecting our well-being. The word for that is idiopathic — that is, the cause is unknown. Most elderly patients are seen by internists and family practitioners rather than geriatric specialists.

Pain experiences of elderly patients are often a sign that something is wrong, just as they are with younger patients. An endless list might be generated of the ways that addiction and addictive behavior have been normalized in this fashion. This, too, harms the impact of a serious diagnosis linked to addiction.

That contributes to misdiagnoses, missed diagnoses, and lots of frustration in between. At a broad level, we have vision, dental, and medical care just for starters to give a sense of the terrain. An optic neurologist is more specialized than either, focusing on just the optic nerve in the eye. Such specialization is both to our benefit and our detriment. When Choosing Alternative Treatments Record the use of alternative or complementary approaches.

What home remedies do you use for your health? Do you supplement your diet with purchases of vitamins? Alternative medicine is defined by the National Institutes of Health as something used instead of conventional medicine, while complementary medicine is something used together with conventional medicine. We choose them because they are accessible, affordable, recommended by friends or family, and they work. I learned to treat bee stings with an onion because I rode on the wagon with my grandfather, dad, and uncles to cut hay, and got in the path of an angry swarm reacting to having their home destroyed as the tractor and plough cut the hay.

I remembered that experience when my own daughter was stung by a swarm of bees as we were uncovering patio furniture and stirred up a nest. Put some coke syrup in his water. Melt a peppermint and add it to his water. Massage his stomach. Ask any one of us and given a few minutes, we can all come up with lessons learned about taking care of our health that had nothing to do with doctors or schooling.

The use of holistic medicine includes herbal remedies, vitamins, and sensory approaches such as aromatherapy or art therapy. When I began to have some stiffness in my hips, they all recommended this product to me. I went online and found one study designed to determine the effects of glucosamine use on knee pain.

The sample in this study included participants with moderate to severe pain who were 40 years old or older. They were overweight, mostly women, and white. There was significant improvement in pain if they received 1, milligrams of glucosamine and 1, milligrams of chondroitin sulfate daily for 24 weeks when compared to a control group given a placebo. In the group experiencing moderate to severe pain, age, weight, gender, and race are all reflected in the results.

Among the 1, patients overall, the use of glucosamine or chondroitin sulfate alone or in combination did not reduce pain effectively. Garlic, for example, has been found to interact with anticoagulants and contraceptives, and ginger with calcium channel blockers, affecting their treatment efficacy. In some situations, we will want to know this to prevent harming our health.

In other cases, it may not matter to us, as the alternative therapy may be the only option we have. If we face a lifethreatening diagnosis, we would probably prefer to be the exception to a prognosis of death in the near term. The number of persons who survive spinal cord injury SCI has increased due to better resuscitation rates, and more available and improved long-term care.

More than a quarter of a million people live with SCI in the United States alone, with an estimated two and a half million worldwide. More males than females are living with SCIs, and in the US, about half of these incidents occur to people between the ages of 14 and In doing so, however, they may remove opportunities for the patient and family to cope with the news. Being normal, on the other hand, may instill a false sense of security, reduce efforts to stay normal, and fail to lead to discussion of resources available to prevent the possible future result of not being normal.

It also frames decisions about how much mortgage we want to afford, how many personal and societal resources we believe should be devoted to health promotion efforts compared to medical research, and how worried, fearful, anxious, or angry we get about all of these issues. All of which also contribute to our health. We should know our cholesterol levels, together with weight, height, blood pressure, and pulse rate, and even blood glucose levels. Each of these numbers about our health status predicts whether we are more or less likely to experience such major chronic illnesses as heart disease, diabetes, or even cancer.

Our doctors track them and we should, too. Knowing that different standards describe different people may seem to support the futility of trying to have an active role in the process. In reality, just the opposite is true. Only we have the complete picture of our health, both past and present.

Only we can really prevent a misinterpretation of the numbers. And really, only we can keep track of all the numbers. Awareness that stories affect us gives us some insights about what information we have implicitly learned. We often form our views about whether we have control over our health and whether therapies are likely to work or not based on stories.

In all these ways, we can take stock of why we feel the way we do when someone starts talking about health habits, medical exams, sex, birth, illness, recovery, and even death. In the meantime, and along the way, there are some things we should know about ourselves and why even when we know better, we sometimes risk our health.


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My father retired from the military after 20 years and retired again after completing another 20 years as a civil servant. He and my mother wanted time to explore places not yet visited. The two were doing just that, hiking across Alaska as pictured in Figure 3. When they got back home, the pair resumed a more usual pace on the familiar trails around the area where they live, and he again experienced the symptoms. It had to be significant for him to mention it and then to make an appointment to see a doctor.

The left anterior descending artery, LAD, and right coronary artery, RCA, divide into further branches to supply the front, back, and sides of the heart muscle. We all face competing choices linked to living our lives and balancing risks. Nor is it specifically about how our environments may contribute Figure 3. Instead, it considers how and why we act on some content while ignoring other messages that may have more direct meaning for our well-being. We can go a long way in predicting how communicating about health affects us by taking a look at a few personal characteristics.

Why Communication Matters

These include how we define reward versus punishment; our need for novelty and aversion to being bored; whether we have a tendency to procrastinate and if so, when? And finally, how central religious faith is to our sense of self and what that means for how we think about our own health. Our Response to Reward Cues Connect what excites you or gives you pleasure to your efforts to be healthy. Avoid letting your efforts to be excited or experience pleasure cause you health harms. Does the thought of winning a contest excite you? Do you like to act on the spur of the moment?

Maybe you find yourself doing things for no other reason than the fact that they might be fun. It was a holiday party and the skiing season had begun. Is there something wrong with that? These are all examples of intrinsic rewards. A feeling of peace, perhaps of satisfaction in a marriage or a job, and a sense of accomplishment — these are things we may work for, but that others cannot see.

Positive communication can also be rewarding. For example, adolescent diabetics manage blood glucose levels more effectively when parents praise them for doing so. Communication about health often assumes that good health is a reward, in fact, the reward. But the message has to compete with why and when food is rewarding to us. So the reward of not getting diabetes has to go up against and win over other reward cues, some of which are quite tangible and concrete. This includes heart rate, blood pressure, sweating, and breathing. A little faster heart rate, a little rise in blood pressure, perhaps some sweaty palms, and faster breathing.

Triggering these events linked to our arousal and brain activity also relates to the release of dopamine. This is a hormone and neurotransmitter that relates to our motivation, pleasure, and the transfer of information in our brains. When information is transferred in our brains, it affects emotion and cognition. The limbic system in our brains relates to our emotions and the formation of long-term memories.

The cortical system relates to memory, attention, and language. Both are affected by the release of dopamine. Thus, our response to rewards, by triggering the release of dopamine, produces pleasure and motivation, and also aids the memory of these experiences. The process even affects our abilities to use language and pay attention. So our response to reward cues has significant implications for how we respond to communication about health and what communication we will be drawn to in the first place. Some rewards are concrete or tangible such as having or attaining a desired object.

This might include money or a new outfit. Some efforts to get smokers to quit smoking have used messages like those in Table 3. Communicating about health also appeals to tangible rewards when weight loss is linked to purchasing a bikini or installation of safety features in our home leads to a better home insurance rate.

Table 3. If you need an added incentive to quit, think about how much of your pay packet is going up in smoke every week. What could you do for yourself and your family with that extra money? More than you think. Source: Smoking — the financial cost. Better Health Channel. Fact sheet. Retrieved from www. Some of us seek the experience of feeling enthused linked to activating our arousal system for its own sake. Some of us love the excitement of making nerves tingle and hearts race.

Use of an illicit drug or even a prescribed medication may also stimulate the feelings. Nicotine has been found to set off the mesolimbic dopamine system in rats. Nicotine has been found to enhance human performance on tasks of selective attention, improving the ability to inhibit distracting events or facilitate selective attention. This includes air traffic controllers. Smoking itself may not be at all rewarding. Yet it may provide a way to achieve what is rewarding, good job performance.

Some individual characteristics are linked to a higher likelihood of seeking reward experiences. Being an extrovert is one. In one study of 2, Australians, ranging in age from 18 to 79 years, extroverts were highly motivated to pursue pleasure and feel excited — both rewarding to them. Do you worry about making mistakes? Do you worry that someone might be mad at you? Or, do you have few fears compared to your friends? As a result, our responses to punishment cues may contribute to behaviors that put our health at risk, or it may guide us to behave in health-protective ways.

Like rewards, punishment can have a wide range of meanings for us, ranging from objects to experiences. We may be motivated by punishments linked to losing a desired object, losing a job, getting a traffic ticket or having to pay higher car insurance, and sometimes, becoming physically sick. Or, we may be motivated by effort to avoid a sense of failure at life or love, or deep dissatisfaction with our job. Punishment, however we define it, relates to our feelings of anxiety, fear, and worry.

Some of us are more motivated than others to avoid feeling anxious, fearful, or worried. In the same way that we at times act in order to reap the feelings of excitement or pleasure, we act to avoid the feelings linked to punishment. Some of us experience these as gnawing or skin-crawling anxiety. The way it feels to be fearful, for example, may be viewed as punishment. Anything that might be linked in our minds to the possible experience of fear may be avoided in order to avoid feeling fearful.

If speaking in front of a group of people brings that feeling, public speaking becomes an experience to be avoided. If exposure to messages such as the one depicted in Figure 3. Our effort to promote our health may be compromised by our effort to avoid these messages. Thus, one of the realities we must face is that how we respond to punishment cues is linked to how we approach, avoid, and ultimately respond to communication about health risks. The human system linked to punishment cues is involved in the release of serotonin, which helps to regulate our aggression, mood, anger, and even sleep and appetite.

If communicating about health triggers a punishment cue, and we begin to worry and fret about the matter, it may make us more aggressive or angry, cause us to be restless when trying to sleep, or to have a loss of appetite as a result of serotonin deficiencies. On the other hand, communicating about health in ways that reveal possible health threats while showing us that we can handle them may limit the worry and fear we experience. If serotonin is then produced in normal functioning ways, such communication may enhance our well-being, not only through its ability to focus on a health threat and our effective response in handling it, but through its ability to aid our sleep, mood, and appetite.

Source: News-Medical.

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Net February 27, Graphic warnings on cigarette packs DO help smokers quit. Reproduced with permission. We respond to both reward and punishment cues. In turn, the serotonin and dopamine linked to these two systems of response have been found to interact in ways that may regulate our effort in working toward our goals. Dopamine activity regulates our ability to perform memory tasks, while serotonin may put the brakes on the activity of dopamine.

Dopamine in turn affects their memory tasks. Short-term memory acuity is vital for professionals who must remember where all those planes are in their piece of the sky at any given moment. Air traffic controllers are infamous not only for their high levels of smoking on the job, but for their erratic sleep patterns. In part, this may arise based on the inability of serotonin to perform its task of putting the brakes on the activity of dopamine. How might this work to affect health for all of us? One of my sisters, pictured in Figure 3.

Being an air traffic controller requires working a shift that covers the usual nighttime sleeping hours at least once weekly. And doing that once a week. Communicating with anyone whose life revolves around such a changing schedule about their eating habits, the need to exercise, or other lifestyle choices including smoking may often be met with a bad mood. Perhaps if more attention was given to the innate responses going on rather than the levels of our overt response linked to mood or aggression, more serious efforts to revise these activities would emerge.

Punishment cues do sometimes motivate us to behave in a healthy fashion, but perhaps not always in the ways we imagine. Our desire to avoid a punishment and our anticipation of one linked to an action may guide us to approach some paths and avoid others. The Australian cigarette package, Figure 3. Thus, to avoid the punishing cues of fear and anxiety aroused by seeing these images, rather than by the health harms linked to smoking, one has to avoid buying cigarettes.

This assumes that the images on the cigarette package actually are punishing, which in some cases may not be true. Again, this occurs at a low level of awareness, until we decide to become aware of how much our lives revolve around trying to avoid what makes us fearful. Sensitivity to punishment has been found to contribute to the urge to drink as a strategy to reduce negative states, such as fear, while sensitivity to reward contributes to the urge to drink to achieve positive affect associated with drinking alcohol.

For the rest of us, both approach and avoidance tendencies may be equally motivating. Do you seek new experiences just for the sake of having them? Sensation-seekers strive after novelty and often act on the spur of the moment. The efforts to move us from not thinking about our behaviors as having health effects to actually contemplating this reality are more successful when content is novel.

Some of us are highly motivated to seek novel experiences, some of us not so much. Some of us experience this reality in one domain of our lives but not others. Novelty seekers can put their health at risk in efforts to achieve the experiences or sensations linked to their searches for things that are new. Some of us are thrilled by the experience of being fearful.

An entire industry of horror movies has evolved around this reality. Some of us find it exhilarating to compete in athletic competitions, as suggested by Figure 4, a photograph of Jordan Smith, my son-in law, that expresses his intensity and elation during an international competition. But as my son-in-law reveals in Table 3. High sensation seekers have been found to pay more attention to novel stimuli, including messages or cues embedded within the message content.

In one longitudinal study of how a group of boys developed, those boys who as infants more easily broke visual attention when exposed to the same stimulation repeatedly were followed across time. These boys were found to have higher levels of novelty seeking at the age of 15 years and also to carry one particular version of a dopamine receptor. Sensation seekers more often recall a message that has an unexpected ending.

Among 25, teenagers, recall of 28 Legacy Foundation smoking prevention ads was examined for associations between various message style elements and recall. Figure 3. In order to play high school sports you have to have a physical. At 15, I went in to have mine and my normal doctor was not there. She listened to my heart, and asked if there was any family history. One case, I think. Either way something sounded odd. It was enough for her and my parents to warrant a trip to a cardiologist. Since I lost a sister some years back to unrelated problems, they are cautious.

The cardiologist put me through a battery of tests, the likes of which were worse than some of my practices. After all the data had been collected they sat down and explained to me what they saw in my test results. Nobody could say what it meant for the future, or maybe they did not want to speculate knowing so little since it had only just been spotted.

Of course, more study was recommended. They sent me to a medical university to see a specialist. As it turns out I ended up seeing a visiting doctor from another country — he had to have a translator. I think translators are supposed to speak both languages, but you could have fooled me.

After we got past the fact that I was not going into the NBA the next year, they somehow came to two possibilities though no more testing or questioning had been done. Either I go on medication that would slow me down mentally and physically but ensure that I would not be frightened to sudden death or hopefully just not collapse one day. Or I could do nothing. Somehow I had the impression that since it was very minor and had not developed into the syndrome that it was going to be OK.

It was found while chasing a mitrovalve prolapse. There are a lot of other similar unknowns in life. I have to take this one with a lot of faith. It was found out of the blue, and it could have easily never been spotted. My heart has been listened to countless times since then, and no one has ever heard or suggested anything out of the ordinary. I try to live my life. Keep tabs on it, but not focus on it. The likelihood of procrastinating in relation to any action that we put off doing has been found to be predicted by two things.

And second, we lack the skills to behave in ways that we know we should. In either case, or for whatever reasons we are putting it off, procrastination leads to more acute health problems. Reminders reduce forgetfulness for patients, with use of automated phone calls about appointments long found to increase appointment attendance. Their expansion to include reminders about pre-appointment procedures to be performed has enhanced the value of the practice. After six months, the women who were telephoned by a friend were significantly more likely to have had a mammogram since the start of the intervention period than women who were not contacted.

The strategy was equally effective for black and white women, with even better results among women with low-tomoderate income. Dosage relating to a prescription for pills was inaccurately reported by 28 percent of the participants who reported that the dose was one tablet each day for seven days instead of one tablet by mouth twice daily for seven days. One third of the participants who were able to state that the instruction said take two tablets by mouth twice daily could not demonstrate the correct total number of pills to take each day. Sometimes we procrastinate because we never really understood what it was that we were supposed to do in the first place.

Hundreds of patients in medical research across the past two decades have been unable to identify the health problem diagnosed by their doctors and what they were supposed to do. Commercial fishermen, truck drivers, farmers and ranchers all have high rates of fatalities associated with their occupations. In such cases, efforts to adapt to risk rather than avoid risk may increase their ability to work and still be safe.

Pesticide protection in extreme Southern US climates, where heat and humidity make the use of impermeable rubber suits unbearable, contributes to heat stroke due to dehydration. The filtration system in the mask designed to be worn by miners often becomes clogged, leading miners to ignore their use in order to be able to breathe and then contributing to a range of health harms.

Our spiritual identities and religious faith, or lack thereof, are key in our everyday lives and living. Morals and ethics, personal responsibility — our sense of these fundamental notions emerges in faith discussions and forms our own sense of our spiritual being. This can connect to our health in many ways. It guides our decisions about whether to participate in medical research92 and our views about what research should be conducted in the first place.

This contributes to personalizing a relationship with God and forming expectations that God will foretell future health events through prophesies and dreams. Others may tell stories about how God led a family to find a particular doctor who was possibly the only human who could contribute to a positive health outcome. In both cases, religious faith and spiritual identities are guiding health attitudes and practices.

In tandem with these realities, our views about the role of science and religion in health and health care emerge. All of these guide how we communicate about health and how we respond to communication about health. An increasing number of churches offer programs that range from fitness and nutrition to depression and marital counseling, as well as substance abuse prevention, with these religious institutions forming an identity around these services. Religious faith and spirituality are used to frame the role of religion and spirituality in science, and the role of science in religion and spirituality.

The choices function as a harbinger for health literacy, the skills associated with the ability to use health information to promote well-being. This is true for the public but also for our medical professionals, and the influence is bi-directional. Not only are far-reaching decisions made that relate to education and science, but, as illustrated by a growing number of medical schools in the US that offer courses in religion and spirituality,99 effects will be felt relating to education and religion. There is a tendency, sometimes seemingly unintended but other times apparently quite strategic, to pit science against religion and spirituality in discourse associated with frontiers of discovery around disease and medicine.

Such reductionism has been challenged in the past. The science of religion often asserts that subscribers should view the two as complementary rather than mutually exclusive. So much talk about health seems to be aimed at taking the fun out of life. It can be so worrisome, so fearful, so anxiety provoking. Or following the advice can be so downright dull and boring, time-consuming and difficult, or conflict with our religious faith and values. What is rewarding versus punishing often links back to our views of spirituality and religion. We may feel happy, hopeful, or cheerful when we do act in ways that align with faith-based beliefs.

Our religious faith also affects our views about personal autonomy in decisions about health and shapes how we allocate our personal time and other resources for health and health care. We respond to talk about health with our overall identities and many times resist things which seem to be at odds with how we see ourselves. We can go our whole lives without putting our finger on the pulse of why we do what we do.

In turn, a new way of approaching those same situations in the future might be imagined. We may feel happy, hopeful, or cheerful when we do act in ways that protect our health. As a result, we may put more effort into being healthy. In , my future daughter-in-law served in Bosnia as a member of the Army National Guard. She was a journalist writing for the weekly newspaper, Talon, funded by the US Army.

Beth joined the Guard after high school to help support her college education. After the usual rigors of boot camp and while still juggling her college coursework, her unit was called to serve. Just like the Flintstones, for those of you who remember the cartoon show. They called it Camp Bedrock because it was on the top of a hill in a strip-mined coal mine. Mining continued around the area even as she served her tour of duty. She and my son carried on a long-distance relationship during that time, which included her sharing copies of the Talon with me.

Through reading the stories there, I learned about all the dimensions of the US involvement and specifically what soldiers at Camp Bedrock were doing beyond the images in the evening news: organizing donations of books to the Bosnian library; teaching Tae-Kwon-Do to locals; helping injured children from the local community with the aid of Army emergency medical staff; seeking deadly mines to destroy them before they injured residents.

Over the months of her duty. Beth sent some pictures like the one in Figure 4. We saw her sleeping quarters. She and another woman shared a tent with three men. They used plywood dividers between them and the guys in their unit, with a blanket draped over a bungee cord for a door.

So she probably went there less often than she might have if they were closer and less often than is healthy. One night, she woke up in horrible pain, doubled over, and barely made it to the bathrooms. She was unarmed, which she worried about because they were supposed to carry their weapon everywhere, but in too much pain to take the time to retrieve it before going.

She felt some better after the bathroom but once back in her tent, sat on her cot suffering until sick call, which happened every morning. Her camp had a doctor and some nurses in a medical trailer. The doctors saw soldiers in the order the nurses placed them based on triage conducted in a big tent. If the camp doctor could take care of a soldier, he did. Otherwise, he gave permission for the soldier to go to a military hospital run by a reserve medical unit, not the National Guard. It was on a Swedish base and reached by a long bus ride. He gave her some meds for the infection and said that if she kept having pain, she needed to come back.

They would send her to Germany for more tests. She never went back. The infection cleared up, but she spent the rest of deployment worried about the mass. Once Beth was back in the US, other military doctors also felt the mass. Another ultrasound was performed, and that technician had no trouble seeing that all of her organs were pulled to one side. They suspected endometriosis as the diagnosis. She was scheduled for surgery within two weeks and they found she had Stage 4 endometriosis. Endometriosis is a condition in which the endometrial tissue lining the inside of the uterus grows outside the uterus and attaches to other organs, including ovaries and fallopian tubes.

Stage 4 means that it was extensive. After surgery to remove the overgrown tissue, the surgeon told her that he thought what the other doctors felt was actually her colon. Since the endometriosis was so bad and had pulled all her organs to the left, when her colon was full it felt like a mass. We may have heard a news report about research that shows a promising new drug to prevent the pain associated with a chronic condition such as arthritis, or a report about the discovery of a gene linked to heart disease.

Doctors may not tell us about these options being unavailable unless we ask about them. Otherwise, it would be an odd conversation going something like this. So just continue to exercise, watch your weight, and take the medication that seems to be helping lower your cholesterol levels. Some say that participating would be too much burden on particular patients, requiring them to travel great distances or find child care.

And sometimes doctors say the intensive and often intrusive protocol associated with an experimental therapy is too much for some patients. Doctors also worry that proposing a clinical trial will harm their relationship with patients. And they observe that just talking about trials with patients is an indirect way of telling them that their condition has no known effective treatment. I had a doctor tell me that very thing, for example, regarding the development of arthritis in my hip area at about the age of If no one says as much, however, we may feel dissatisfied with what seems like dismissal of our complaint.

There have also been reductions in staffing in many health care organizations, which reduces support for doctors in their care of patients. Doctors recommend some hospitals for care rather than others because hospitals develop contracts with individual doctors and groups to provide exclusive coverage for various services. This shift is intended to produce cost-savings and higher-quality patient care as it standardizes specialized procedures or services.

Introduction

Among all the issues that may be in our chart, they select the ones we make most relevant by our statements of why we have an appointment that day. So, not surprisingly, doctors benefit from cues to assist in prompting them to discuss some things with us as patients. Chart reminders, for example, have been found to increase the likelihood that doctors will talk about prevention guidelines.