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Frontline health workers are regularly identified by the public as the most highly trusted sources of health information. As such, we have a corresponding responsibility to provide health information that is both accurate and tailored to the needs of our patients and consumers. Many government agencies and health-related civil society organisations (heart foundations, cancer organisations, etc.) enjoy the same level of trust and have the same responsibilities.
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Disappointingly, research has demonstrated that we consistently fail to communicate effectively to our patients, consumers and communities. This applies in all settings—face-to-face in the clinic, online through different digital platforms and in the wider community through different media and networks. We use words that are medically correct but alienating for most people; we use language that is complex and often beyond the literacy and language skills of our consumers; and especially in clinical locations, we fail to mitigate the stressful environment in which people are receiving complex health advice. By contrast, opportunities to help individuals to become more engaged and autonomous in health decision-making are frequently missed as we place emphasis on “compliance” and encourage passivity in the methods and content of our communication.
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No one intends it to be this way and the reasons why we come up short are often complex, especially in a pressured, time poor, dynamic clinical environment. Fortunately, we now have a more sophisticated understanding of effective communication methods, underpinned by research and practical experience. This body of knowledge has helped identify a range of evidence-based strategies for improving written and verbal health communication that are practical to implement even in busy clinical environments. This chapter provides an overview of principles and practical tools for effective communication with an emphasis on their application in clinical settings.
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2.2 Universal precautions
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In Chapter 1, we identified that a majority of the population in most countries have difficulty in understanding even basic health information, and that this difficulty is exacerbated in a clinical environment. Past research has indicated that most information exchanged during a medical consultation is either forgotten immediately or recalled incorrectly. For these reasons, it is generally recommended that frontline practitioners use health literacy universal precautions. This simply means that we should assume that all patients, consumers and caregivers may have difficulty in comprehending health information; and that we should communicate in ways that most people can understand. This approach, pioneered and advocated by the US Agency for Healthcare Research and Quality, assumes that all patients are at risk for miscommunication and misunderstanding, regardless of education, socioeconomic status or literacy skills. A universal precautions approach is based on research that has identified limited health literacy is common and that patients may go to great lengths to conceal their lack of understanding, that frontline health professionals are insufficiently skilled at detecting when patients do not understand and that formal assessment of a patient’s health literacy ...