Читать книгу Medical Communication: From Theoretical Model To Practical Exploration - Tao Wang - Страница 10

Medical science communication, also called medical communication for short, is about the spread of medical science. Medical communication is a crosscutting field emerging from the medicine and communication, having a close relationship with traditional science popularization. According to American scholars Stephen W. Littlejohn and Karen A. Foss, science communication can be seen as an interdisciplinary meta-field on the branch of discipline. Undoubtedly, medical communication is a very important part of this meta-domain. At the same time, medical communication focuses on the medical personnel engaged in communication and therefore tends towards medicine in terms of subject affiliation.

According to the most basic “5W” model of communication, medical communication contains the following elements:

First, who to spread?

Medical communication, as a branch of science communication, emphasizes the authority and scientific facts of information source. Therefore, the transmitter of medical communication must be professional medical staff, such as the medical workers in the front line including doctors, nurses and medical technicians, formal medical institutions with medical qualifications, and medical graduates with high medical literacy. Medical undergraduates cannot be considered as separate transmitters because their medical knowledge is not comprehensive. This is also consistent with the fact that science popularization is usually dominated by frontline scientists.

Communicator is the cornerstone of all science communication. Communicator deviation will bring lessons to the communication abound. The “Zhang Wuben” incident is a typical case. Zhang Wuben claimed himself to be the “first person in Chinese medicine diet.” His published book Eating Back to Eat Out of the Disease has aroused widespread concern in the society. Especially in February 2010, after being a guest of Hunan Satellite TV’s “Bai Ke Quan Shuo,” its popularity increased rapidly. Zhang Wuben became the so-called “Traditional Chinese Medicine Master” throughout the country. He proclaimed the “Mung bean cures all diseases” rule, which even caused the price of mung beans to soar in the market. He disseminated his concepts very well. Later, some media reported that Zhang Wuben was suspected of academic fraud. His exaggerated concept of dietetic therapy was also questioned by experts. Everyone despised “Master Zhang” at that time. Hunan TV’s show was also stopped on June 7, 2010. The source of the farce is that Zhang Wuben is not a medical professional as he proclaimed. He was a laid-off worker from a textile factory. He became the so-called “the first batch of senior nutrition experts of the Ministry of Health”, even “the first person of traditional Chinese medicine diet therapy” through marketing. His various health concepts, including the “mung bean cures all diseases”, do not have a basic medical foundation. He has no basic medical knowledge. A “master” with no professional skills spread his concepts everywhere and caused widespread misdirection and bad impact on the public. It can be seen that the influence of subject deviation on the impact of communication can be devastating. When making medical communication, we must ensure the professionalism of the subject. The subject of communication is the basis of the communication.

Some people may question why medical communication must be based on professional medical staff and why the spread of medical or health knowledge by other personnel cannot be included in the scope of medical communication. Medicine is defined as the subject of dealing with various diseases or lesions of the human body by scientific or technical methods. It is an applied discipline of biology, an advanced science in the treatment of human diseases from anatomical and molecular genetic aspects and a system from prevention to treatment of diseases. The areas of medicine include basic medicine, clinical medicine, forensic science, laboratory medicine, preventive medicine, health medicine, rehabilitation medicine, and so forth. Objects of scientific research can be natural or other related fields. Therefore, a certain degree of deviation is allowed. However, the definition of medicine indicates that medicine is a vital area focused on research and dealing with body illness. Any deviation is not allowable during any therapy, otherwise the right to health even to life may be irreparably hurt. As we all know, a medical student has to go through a systematic and long theoretical study, a considerable period of internship and practice, finally to pass the theoretical and practical examination to be accepted as a real doctor. The training of nurses is also similar. They all take a long period. In the long term, through continuous theoretical and practical learning, medical personnel can grasp the necessary medical knowledge and skills, which cannot be replaced by nonprofessional medical personnel’s internet search. Medical communication faces the ordinary public. The right of citizens to live and to be healthy is indispensable. If the communicator does not have the necessary medical knowledge, what he disseminates to people is likely to be wrong or even harmful, which may cause immeasurable danger. This is why we must position the communicator of medical communication to professional medical staff. Only professionally trained medical staff can ensure the reliability and authenticity of the communication content so as to minimize the possibility of incorrect medical knowledge dissemination.

In the past, professional medical staff rarely participated in health knowledge popularization or medical communication. The motivation of professional medical staff to disseminate medical knowledge was often based on personal enthusiasm and social responsibility. The lack of relevant incentive mechanism results in the weak sustainability of medical communication. Many medical staff do not pay attention to medical communication and they even think doctors who devote to such jobs are performing unnecessary work. Also, in the assessment of medical personnel at all levels of medical institutions, there is no assessment mechanism for medical communication or medical popularization. Writing ten popular science articles is thought to be less valuable than publishing one journal paper. It is no wonder that Bai Yansong, a member of the national committee of CPPCC and a famous host, appealed that “Medical science popularization work should be included in the business scope of medical workers and medical researchers. Otherwise, it will be difficult to meet the needs of social science.” Fortunately, the community has noticed the problem. Shanxi Health and Family Planning Commission has taken the lead to include popular science articles as review criterion in the 2017 annual health care evaluation of senior professional and technical positions. The status of popular science articles has been upgraded to the same as that of academic papers, which encouraged more and more medical staff to invest in health education and medical science popularization. Benefiting from the incentive mechanism, medical staff have more strength in medical science popularization. The establishment and development of medical communication has made the best footnote for the communicator status of professional medical staff.

Second, spread to whom?

Broadly speaking, the audience of medical communication includes two parts: the medical and the nonmedical. The internal medical communication is the communication between professionals, usually in the path of the academic community such as journals, conferences, seminars, which will not be covered here. Medical communication pays more attention to the dissemination toward the nonmedical people. Thus, the general public constitutes the object of medical communication. The audience is made up of several groups, which according to the difference in health status, include patients, patients’ relatives and friends, susceptible population, and ordinary crowd. Taking diabetes as an example, the audience includes diabetic patients themselves (patients), all relatives and friends of the diabetic patients (relatives and friends of patients), those with diabetes mellitus or body fatness in their families (susceptible population), and people who do not have diabetes or diabetes risk factors (ordinary crowd). Due to the possible genetic effects of diabetes, dietary habits, lifestyle behaviors, and other factors on diabetes, the medical communication to the abovementioned population is indispensable.

Some people may not understand why there are so many objects of medical communication and they may consider it necessary only for patients but not the healthy. However, the reality is more complicated. A person is a unit with social attributes. In the process of resisting disease, it is not enough to rely on the patients to take care of themselves. Help from surrounding groups, including family and friends, becomes more and more necessary. For example, a stroke patient who has a side limb hemiplegia cannot take care of himself even though he has consciousness. Under such circumstances, it is useless to spread the knowledge of how to maintain and care after hemiplegia to the patient himself. These goals cannot be achieved without the help of family members, friends, or nursing staff. Those who care for the patients are the targets of the dissemination of medical knowledge.

There are three levels of prevention: primary, secondary, and tertiary.

Primary prevention, also called cause prevention, is to prevent the onset of illness or injury before disease process begins. Take diabetes as an example. The target of primary prevention is those who are obese, fond of high-calorie diet, lacking exercise, with family history, or other high-risk factors. Primary prevention is the advice about how to eat healthily, how to exercise and control weight to reduce the risk of diabetes.

Secondary prevention, known as “three early” prevention, is the main measure to prevent the progression of the disease and the spread of illness, and to slow down the disease progression. It refers to early diagnosis and prompt treatment of a disease, illness, or injury to prevent more severe problems developing. Also taking diabetes as an example, secondary prevention is for those who may have diabetes. We hope to identify, diagnose, and treat diabetes in the early stages by screening and regular blood glucose measurement.

Tertiary prevention includes interventions that limit disability or enhance rehabilitation from disease, injury, or disability if a patient has elevated diabetes that was not controlled by diet or exercise. Then, the patient may be referred to other specialists to control the blood sugar and avoid complications. Medical communication not only spreads the treatment of diseases but also pays more attention to the prevention of diseases. Thus, everyone should be the target of medical communication since healthy living and behavioral methods are beneficial not only to patients but also to everyone. Long-term persistence may also reduce the incidence of many chronic diseases.

Third, communicate what?

Medical communication has a strict choice of the content. Although medical knowledge is all-encompassing and the latest scientific research results are endless, the content suitable for science communication should be strictly controlled. The purpose of medical communication is to disseminate authoritative, accurate, and scientific medical knowledge to the layman, thereby promoting their healthy behavior and maintaining their health. The medical science knowledge that is still inconclusive, is not suitable as content of medical communication. The content of medical communication should be definitive medical science knowledge, including the contents of current medical books, dictionaries, and medical-related national laws. This is the “gold standard” for medical communication.

Content that does not meet the criteria of “conclusive medical science popularization” includes the following:

The research content that is still in the academic debate and not coming into a conclusive stage should be avoided. For example, is genetically modified food safe? Transgene is the transfer of one or several exogenous genes into a specific organism by genetic techniques. Foods produced by using genetically modified organisms as raw materials are genetically modified foods. The safety of genetically modified foods has been controversial since its birth in the United States in the 1980s. Because there are many ingredients in genetically modified foods, which have never been found in traditional foods, countries have developed more stringent safety inspection standards than for general food. Since there is currently no authoritative official conclusion on the safety of genetically modified foods, for the field of medical communication, it is clearly not suitable for promotion and dissemination. We believe that citizens should have the right to know about cutting-edge scientific issues; however, the academic debate is likely to cause public confusion and anxiety and it cannot provide good guidance for healthy behavior, which is far from the purpose of medical communication. Considering that citizens in China are generally at a low level of science literacy, the content of academic contention should be avoided in medical communication.

Recent literature publications and reports, including those published in authoritative medical journals, should be avoided. Just like cutting-edge research in other fields of science, cutting-edge research in medicine is exploratory, which means many of the contents published in the literature have not undergone the check of time and practice. The Han Chunyu incident is a vivid example. In May 2016, Chinese researcher Han Chunyu published the genome editing results of the NgAgo system in the world’s top academic journal, Nature Biotechnology, and received much attention at home and abroad. Some media even called it the Nobel Prize–winning experiment. However, about 20 Chinese and foreign scholars later questioned that the experiment could not be repeated, which led to the retraction of the paper from the journal. From this point of view, the latest papers published in authoritative academic journals may not stand the test of time. At the same time, the most cutting-edge scientific research has a big gap in the lives of citizens. Therefore, we do not advocate the direct dissemination of medical science popularization content in the academic literature to citizens without the test of time. In September 2018, an Egyptian astrologist together with American scientists completed the study “A homing system targets therapeutic T cells to brain cancer” and published it in the top international journal, Nature. The paper claimed that cell therapy has been successfully applied and the technology effectively treats brain tumors. This technology is realized by an immune cell engineered by a so-called “homing system” which passes through the blood–brain barrier and enters the brain tumor entity. The immune cell performs targeted killing of brain tumor cells. In January 2019, an expert from the University of Oxford in the United Kingdom published a positive review of the abovementioned article in another top journal, The New England Journal of Medicine, and introduced the technology to the peers enthusiastically. However, this article in Nature has been questioned by many medical experts at home and abroad. The editorial office of Nature launched a survey and retracted the article on February 20, 2019. On the same day, the editorial office of The New England Journal of Medicine retracted the review of the positive significance of the technology. Even papers published in top international journals may be questioned. There is considerable risk in disseminating content that has not been tested by time. This confirms that medical content that has not been precipitated over time is not suitable for direct dissemination to citizens.

We advocate time as the standard for testing truth. Take in vitro fertilization (IVF) technology as an example. This technique was first created in 1978 by British professor Robert Edwards. It was not until 2010 that he won the Nobel Prize in Physiology and Medicine for the creation of this technology. A rigorous scientific attitude should be adopted in the field of medical communication similar to that of the Nobel Prize. In the 1980s, when IVF technology was founded at the beginning due to the unpredictability of technology, medical communication is not suitable for the dissemination and popularization of this technology. Today, 40 years later, time has proven that IVF technology is a very mature technology. It brings millions of families with children and vitality that might have been missing. IVF technology is well suited to the content and topic of communication in the field of medical communication. Although advocating time as the standard for testing truth, we must modify the content to keep pace with the times. This is the timeliness of information. Medicine is constantly improving and developing. If the content is still in the book 30 years ago, it is correct but ridiculous. IVF technology at present has much progress compared to 40 years ago, so we should spread the technology based on the current situation. When we do medical communication, the content and technology disseminated should be improved and changed along with the progress in proportion.

The reason why medical communication is so strict about the content of communication is that the rights to live and to be healthy are both the highest rights of everyone. When we were doing medical communication, citizens may accept the communication with a very trusting attitude. There are quite a large number of people who may change their way of life and behavior according to the content of the dissemination, or even change their medical treatment behavior. If the content we spread is not reliable or has not been widely certified, it is likely to be harmful to the health of people or could even threaten their lives, which is likely to hurt citizens’ right to be alive and healthy. This is an error that is not allowed for an emerging discipline. Medicine itself is a very rigorous science. Unlike traditional medicine, modern medicine is evidence-based. It requires a large-scale experimental demonstration to prove its effectiveness before it can be gradually promoted. We need to pay attention to this when we plan medical communication. There is a precedent for a treatment that was once considered effective later to be proved ineffective and harmful. We cannot carry out extensive publicity and promotion while the treatment is still in the experimental exploration stage. This is a disrespect for the people and a disrespect for their right to live and to be healthy.

Fourth, through which channel?

The channels of medical communication encompass all the ways to transmit. From the face-to-face communication between medical staff, patients, and their families, to the medical communication activities in the community, and to the use of mass media and new media platforms, medical communication uses various communication channels according to the characteristics of different audiences.

In addition to the traditional medical science popularization pathway advocated by the government, today’s medical communication makes full use of the advantages of network communication and actively explores the “Internet + science” model. Since 2010, medical health official accounts on Weibo and WeChat have increased rapidly. Take Sina Weibo as an example. Many personal microblogs that are certified as medical professionals, such as “Emergency Department Superwoman Yu” and “Xiehe Zhang Rongya” have millions of fans, and their published medical information covers a wide range of concerns.

However, Social Media platform has also become a problematic area of medical false information and rumors. A variety of false information under the banner of health has brought harm to the health and property of the people. The wide spread of healthcare information and the dissemination of health knowledge are far from each other. This so-called healthy communication is the rise of packaging for health information content marketing. Many Social Media health care platforms are not supported by professional medical personnel and the quality of communication content cannot be guaranteed, which is contrary to the concept of medical communication. Medical communication through the media platform should be rigorous and deliver accurate medical knowledge, rather than sensational and having profitable effects that are required in the general sense of the media platform. From the position of the communicator of medical communication, the lack of professional medical personnel to support Social Media communication cannot be regarded as a true medical communication, but a pseudo-propagation. Moreover, if there is no regulatory platform, the dissemination of some false medical content is extremely harmful to the public. The Wei Zexi incident illustrated this problem. Wei Zexi (1994–2016) was a 21-year-old Chinese college student who died of cancer after receiving questionable treatment from a hospital that advertised via the search engine. Wei Zexi was diagnosed with synovial sarcoma, a rare form of cancer. When his family were told that there was little hope of treatment in regular tumor hospitals, his family members found a hospital through the online search engine. The hospital claimed to have very advanced bio-immunotherapy that can cure the disease, but it was more expensive. As a result, the family used this unofficially approved bio-immunotherapy and repeatedly sought treatment at the hospital four times. Finally, after running out of all the savings, Wei Zexi died. The general public cannot always identify correct medical information. If the network platform for medical communication cannot be strictly supervised, and there is no support for medical personnel behind the scenes, it may bring a devastating blow to those who cannot identify correct information. Therefore, regardless of the way of communication, the communicator of communication and the content of communication are very important in medical communication. Only by identifying the subject of the communication and the content of the communication can the preparation and reliability of the communication be ensured.

It is worth noticing that communication skill is a very important part in the way of communication. Experienced and skilled doctors are not necessarily good medical communicators. The usual case is that when the experts are having an impassioned speech on the stage, the audience sleep with no attention left. This may be related to communication skills and modes of communication. As mentioned earlier, the dissemination of the fake doctor Zhang Wuben proved to be pseudo-science and pseudo-medicine, but his communication skills can be used for reference. He caught the attention of the people and adopted the appropriate methods and techniques to make his ideas quickly promoted. While as the communicator of medical communication, it is easy for the professional medical staff to forget that the audience of communication are not peers with medical knowledge, but citizens who have no medical foundation. Medical staff often use very professional terminologies when speaking to the public. These contents may benefit their peers, but they may be too difficult for citizens. Therefore, we should use words that are easier to understand and use appropriate metaphors to achieve better results. For example, when we spread cardiovascular and cerebrovascular knowledge to people, we may tell them the illness they need to prevent is “cerebral apoplexy,” which could not be understood by public. When it is switched to the word “stroke,” it will be easy to understand. For another example, the World Health Organization and our Chinese residents’ dietary guidelines require no more than 6 g of salt per day. If we only tell the public that the salt intake cannot exceed 6 g, it is difficult for them to implement. Because when cooking, the public generally do not take the scale to weigh the amount of salt. If the communicator changes the way, telling the public which foods or condiments contain invisible salt, and how to reduce the intake of salt, the effect of such communication will signally increase. Sometimes, it is necessary to have a certain touch on the subject of medical communication. For two books that have the same content, the one named 80 Days to Become Nursing Master is obviously more acceptable to the general public than the other one named Family Nursing Knowledge, since the latter one looks too professional for layman to understand. This can be inferred that proper communication skills have a positive effect on medical communication. Medical communication cares not only about how much reading is available, or how many people pay attention, but also the scientific and normative of medical communication. In order to communicate medical knowledge to a wider population in a common and easy-to-understand way, certain skills are needed.

At present, the new media form has moved toward the Omnimedia and Media Convergence. The various media forms such as radios, TVs, phototapes and videotapes, films, publications, newspapers, magazines, and websites are highly integrated. Due to the high development of the media, we have entered an era of “everyone communicates, everything is media”. The channels of communication are extremely prosperous and complicated. These channels are what medical communication needs to study. Meanwhile, we should keep in mind that good-quality content is primarily important.

Fifth, what effect does the communication have?

First of all, medical communication is based on scientificity and propagation as two major evaluation indicators.

The aim of medical communication is to popularize medical knowledge to the public. The effect of communication is determined not just by the number of the audience. What is really important includes whether through the communication health indicators are improved, healthy living behaviors are formed, information gaps between doctors and patients are closed, and whether as much as possible the ultimate goal of rational allocation of medical resources is achieved. The first-aid reality-show documentary “Emergency Room Story” filmed by Dragon TV, is the first program to use the fixed camera shooting method, shooting the story of the hospital emergency room in every respect, combining the plot and humanities, with expert interpretation. After the program was broadcasted, many viewers commented “touching” and “understand the doctors.” The patient complaint rate in the emergency department of the hospital dropped significantly. This is due to the documentary filming method, which allows the audience to jump out of their medical experience, reexamine the doctor–patient relationship from an objective perspective, realizing mutual trust between people and promoting positive energy. The scientificity is reflected in not only the content but also the topic. The selection of topics is based on time, region, target population or specific public health events, and so on. Take the target population as an example. It is inappropriate to popularize the prevention and treatment of hypertension, hyperlipidemia, and hyperglycemia among primary and middle school students because the students are not at high risk for these diseases. Considering that students are in the stage of growth and their studies are heavy, “How to prevent myopia,” “How to get nutrition,” “How to prevent obesity,” and “How to get through adolescence” are suitable topics of medical communication. As for region, it is very ridiculous to popularize how to save yourself and save others when the tsunami comes in Sichuan Province. Sichuan is a basin with high incidence of earthquakes, while the ocean is much far from there. There have been many earthquakes in history, such as the 2008 Sichuan earthquake, which is still remembered by people. In Sichuan Province, how to save yourself and save others when the earthquake comes is a good topic and the audience is very broad. Take time as an example. The incidence of various diseases varies from time to time. Summer is the season of high incidence of infectious diseases of digestive tract, whereas winter is the season of cardiovascular and cerebrovascular diseases. Medical communication should be timely. If you popularize “heatstroke prevention” in the winter and “prevent frostbite” in the summer, the audience will be rare. When the order is interchanged, it will have a good effect. Taking time as an example, from last winter to this spring, the flu broke out all over the country. At one time, the respiratory, infectious, and pediatric departments of major hospitals were overcrowded. At this time, many medical staff and the media began to give lectures on how to prevent the flu and how to treat the flu. These lectures have received widespread attention. Meanwhile they have played positive roles in the ultimate control of the flu pandemic.

In addition to the scientificity and propagation, effectiveness is the most important evaluation indicator. The effectiveness includes the improvement of the public’s health science literacy level, the improvement of relevant health indicators, and the reduction of the incidence of specific diseases through medical communication. The focus of medical communication is not on the number of audiences in a short period of time, but on the fact that after continuous dissemination and popularization, people can really change their behavior and way of life, gradually develop in a healthier direction, and finally achieve the goal of reducing the incidence of disease, mortality, and disability rate, and achieving the goal of promoting the health of the people. The effect of medical communication is similar to the etiological prevention.