Patient misconceptions are one of the most popular topics among the providers Dr. Liebel’s met. It seemed a good place to start the series!

In this episode, you’ll learn about:

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An Ob-Gyn shared with me the fact that, a few times each year, she encounters an adult patient who has misconceptions about basic female anatomy. I asked her what she meant by that, and she said that some women believe they menstruate and urinate out of the same opening.

In a totally separate conversation, an Ob-patient educator said the same thing to me: Sure, I'm often saying to patients, our plumbing and our other parts are close together down there.'

So, patients may walk into the encounter with misconceptions about what they're doing there, what you're doing there, or what's going to happen.  They may have misconceptions about treatments, or about human anatomy, or about how the health care system works.  Even about you as a doctor.

In the meantime, you're trying to engage patients, as well as share important information.  Doctors tell me they do not want to let these misconceptions get in the way of a successful encounter, and of a good patient-provider relationship.  Can this be done?

Let’s look into what misconceptions are, where they come from, and how people could “be so stupid.”

Misconceptions can add to everyone's frustration.  They can slow down progress.  They can make it harder to build relationships. They can have personal health consequences, such as on a patient's willingness to follow a recommended treatment,  and public health consequences, such as those surrounding efforts to address global antibiotic resistance.

How can misconceptions be so prevalent as research suggests they are?

We all have ideas about how the world works. About how things go, or ought to go.

We develop these sets of ideas, and ways to express them, over time.  They are based on our own experience in life. But they are also heavily influenced by our communities, by the groups of which we're a part.  And somewhat by society at large. We learn about the world, and how to make sense of it, from our experiences and from the people around us.

What does this have to do with misconceptions?

You may have seen articles in popular media about how everyday' people understand scientific or technical concepts.  Measure us up against the experts, and we almost always score badly.  Then the experts wring their hands and cackle.  Let me give you an example.

Linguist James Gee wrote about how scientists and everyday people understand the same words, and some basic scientific concepts, differently.  As an example, he used a study where scientists analyzed school students' answers to questions about the light from a candle.  The scientist would ask them, “how far will the light travel?” and they’d analyze the answers.

The study, like many others, concludes that everyday people's understandings of common phenomena (in this case, light from a candle) are unacceptable.

Gee writes, 'How, you might ask, can people' be so stupid?'  I would argue that people are not, in fact, so stupid.

On one hand, everyday language works at a level of specificity that is entirely adequate for everyday life.  But it would not measure up to scientific standards for exactitude.  For example, from the candle experiment, Gee compares the everyday use of the word light' with the scientific term illumination.'

Light can mean many things in everyday use, but each of them is clear to us in context.  Only one of them is what scientists mean by illumination.

He goes further and points out how in everyday life, we are acting and talking as everyday people, and not as specialists.  Within the context of everyday life,' our language works.  We know what someone means when they say light.

That is to say, in everyday life, we are not trying to be as correct as specialists, for various reasons. And our language and thinking reflect that.

Consider the language you use in the time you spend outside your professional context, in everyday life, speaking as an everyday person.

Specialized language is, well, for specialists.  And it serves different functions than everyday language; it has to, that's why it was developed.  It is by nature not everyday language; it simply can't be.

To get a feel for what it's like to be a non-native speaker of a specialized language, Consider inter-professional communication.  Maybe some education events, when you might have trouble understanding the professional discourse of colleagues in another specialty.  They have a specialized language made to accomplish specific tasks and reflect specific ideas with exactitude.  So do you.

So let’s bring this back to misconceptions

Now, your ideas about how the human body works are much more informed than everyone else’s.  They are built on millennia of research, supported by your study, and enriched by your years of experience and reinforced by your social groups.

The rest of us non-specialists are also walking around with ideas about how our bodies work.  Those ideas may or may not have scientific merit. But just like yours, they are based on our experiences, our knowledge, and our communities. And they are just as cohesive.

The good news is: a misconception is a window into a person's thinking and potentially more.

Your expert knowledge means you know enough to find the sense or logic in patient misconceptions.  In other words, it’s part of your job to see where they are coming from.

Your task then is to understand your patient’s understanding. Because as non-sensical as it might seem from an expert perspective, whatever your patient thinks, makes sense for them.  And they're using their language to explain it, language which also makes sense to them and has done a perfectly adequate job to this point.

And now you are trying to make sense to them. You’re seeking to understand them on their own terms.  Without this starting point, communication is utterly disconnected.

Let’s put this to work with an example.

The Ob-Gyn I mentioned at the start later expressed to me her concern that adult females were out of touch with their own bodies.  Indeed, there are distressing cultural and social realities that could lead to a woman reaching adulthood and still having her body seem foreign to her.

Let’s consider how or under what conditions this particular misconception could make sense.

Here are some possibilities for such a patient:

This patient wants to be taken seriously on her own terms.  We all do.

As the ObGyn and I spoke, it became clear to me that her concern was also over the larger problem of cultural norms that could keep a woman from knowing her body more accurately.  She was reflecting on her years of accumulated examples of women with misconceptions about their reproductive systems.  We discussed how such norms might connect to political battles over women's health, and socially-constructed ideals of womanhood.

It is important to remember that cultural norms can include silences, taboos, and secrets. These are not limited to women, of course; males also encounter cultural silences, as described in this article on testicular cancer detection.

You attempt to show them that you have their best interests at heart.  You're going to do this with compassion, and all the wisdom you can muster in order to understand how your patient sees their situation, and how this makes sense to them.

As the provider, and the holder of the expert information, it's part of your job to make the connection between what your patient thinks and what you think.  The faster you can see the sense behind what your patient says, the faster you can get on with communication that matters.

Communication that’s going to meet them where they’re at.  Communication that shows respect.

Keep in mind that:

With this in mind, you can begin with the misconception, and build a bridge between your understandings, regardless of how far away you might feel from them in that moment.

In that way, Misconceptions are your secret advantage in patient education

Until you find out what make sense to this person about the topic at hand, there will be disconnects.Building bridges is particularly important when your patient does or says something you find frustrating because of its likely negative impact on their health.

You may teach a quick mini-lesson with a poster,  x-ray, or app.  When you do, at each possible step, connect your expert understanding to your patient's everyday understanding.

Consider sharing with your patients a time you had a misconception about the body, and how you came to know what you know now.   Their misconception is the basis for your education efforts.

We've been talking about embracing misconceptions and improving patient relationships, and how misconceptions are your secret advantage in patient education. 

Remember:

So use their misconceptions as a guide their current thinking.  So you can start where they are, with that they know and assume by allowing yourself to imagine how their misconceptions could make sense.

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