Читать книгу Medical Communication: From Theoretical Model To Practical Exploration - Tao Wang - Страница 21

As mentioned in the first chapter, although there is a certain subordination between medical communication and scientific communication, due to the natural public participation attribute of medical communication, the scientific communication model introduced in the first section cannot fully and effectively guide the practice of medical communication. First of all, because health issues are closely related to everyone, the public does not completely or absolutely lack medical knowledge. Everyone has some health experience and common sense more or less. Secondly, the emergence of disease and the maintenance of health have a strong context of personal life, which needs to consider individual life experience, social environment, and cultural impact. For example, the health demands of residents in Hengduan Mountain Area of Yunnan may differ greatly from those of residents in Shanghai. Thirdly, considering the influence of traditional Chinese medical culture, the “layman knowledge” (such as health preserving knowledge of traditional Chinese Medicine) of modern medical knowledge is widely spread. Therefore, the public has local medical knowledge in varying degrees, which is also a problem to be considered when conducting medical communication. Finally, the ultimate goal of medical communication is to improve the health level of the whole society. Therefore, the public should take part in the decision-making of medical science. Therefore, none of the above four models can cover all aspects of medical communication practice. Based on a comprehensive review of the current practice of medical communication in China, we propose the multi-expertise contextual engagement model.

First of all, we need to fully consider the multiple medical health knowledge system of Chinese residents. In the past thousands of years of Chinese civilization, traditional Chinese medicine, Tibetan medicine, and other local traditional medical system knowledge have been deeply rooted in people’s minds through oral communication, community communication, book communication, and other ways. While these traditional medical systems have solved some problems, there are also many disputes. Let’s give some typical examples. As everyone knows, after giving birth to a child, the mother has to rest for a month. Confinement can be traced back to the book of rites of the Western Han Dynasty, known as “within the month”, which is a necessary ritual behavior after childbirth. Confinement is the process of helping the parturient to recuperate and adapt to the role of the new mother as soon as possible, and it is also the key period of helping the parturient to pass through the physiological and psychological transition of life smoothly. So what should the parturient do during her confinement? There are many classic practices handed down from the older generation, and there is no scientific basis for the correctness of these practices. For example, the older generation said that during the confinement period, you must “cover up”, not catch cold, not be exposed to the wind, not be able to take a bath, not to wash your hair, of course, not to turn on the air conditioner, even in the hot summer. In the past few years, a tragedy happened in a certain place, that is, the mother listened to the idea that she must “cover up” during the period of confinement. During the ultra-high temperature in July, the mother also wrapped up very tightly, dressed in thick clothes, covered with thick quilts, and did not open air conditioning, windows, without showers, which eventually led to heat stroke of the mother, finally being announced no cure after being sent to the hospital. For another example, many people think that traditional Chinese medicine is safer than western medicine and has no side effects. It’s not clear why people had this idea and where this idea came from. It may have been passed down from generation to generation. As a result, many people like to eat traditional Chinese medicine after getting sick, and for health preservation. We don’t mean to belittle traditional Chinese medicine here, but all drugs have certain side effects and are not absolutely safe. The “kidney disease of Chinese herbal medicine” which caused great furor in the past few years is a typical example. “Kidney disease of Chinese herbal medicine” in that year was caused by aristolochic acid contained in some Chinese herbal ingredients. There are a lot of traditional Chinese medicines containing aristolochic acid, including more than a dozen kinds, such as Guanmutong, Guangfangji, Qingmuxiang, Zhushalian, Tianxianteng, Asarum, Fangji, Huaitong, and Dujuan. So the Hong Kong Department of health has banned the sale of traditional Chinese medicine containing aristolochic acid in 2004. In 2005, the national pharmacopoeia of China banned three kinds of Chinese medicine with high content of aristolochic acid, i.e. Guanmutong, Guangfangji, and Qingmuxiang. In the list of carcinogens published by the World Health Organization in 2017, aristolochic acid and plants containing it are included in a class of carcinogens. It can be seen that traditional Chinese medicine is not absolutely safe, and it needs to be used under the guidance and supervision of doctors. In these cases, we can see that the public has a lot of medical knowledge from the traditional system, from the ancestral ideas of grandparents, fathers, and mothers, and there is no solid scientific and medical basis, which is very questionable in practical application. In recent years, there is another phenomenon worthy of attention. With the development of network and information technology, people may search for medical knowledge through the Internet. For example, a middle-aged man recently suffered from poor appetite, weight loss, and general weakness. He didn’t have time to go to the hospital for examination, and there were no doctors or friends to consult. Online search is the easiest. So, he went online and searched through search engines. Once he found out that gastric cancer had these symptoms, he took it for granted that he had gastric cancer. But there are many other diseases that may have these symptoms. As for the cause of the disease, it can only be determined through regular medical tests. It doesn’t confirm to be gastric cancer. For another example, diabetes is a group of metabolic diseases characterized by hyperglycemia. Seven large-scale epidemiological surveys on diabetes conducted in China showed that the prevalence of diabetes was gradually increasing. In the latest, the 7th epidemiological survey conducted in 2013, the prevalence of type 2 diabetes in the population over 18 years old in China reached 10.4%, among which men were higher than women. That means one in 10 adults was diabetic. Therefore, it is necessary to popularize the medical knowledge about diabetes. And the medical knowledge about diabetes on the Internet is also overwhelming and accessible. One patient with diabetes took oral hypoglycemic drugs but the effect was not good. The doctor required him to inject a certain amount of insulin every day. The patients’ blood sugar was well controlled since insulin was used instead. But this patient always felt that it was a little trouble to use insulin every day. So, one day, this patient found some kind of health care product to reduce blood sugar by checking on the Internet. The health care product was boasted how effective its hypoglycemic effect was, and the patient himself felt that it was troublesome to use insulin, so he stopped using insulin without permission and changed it into the health care product recommended on the Internet, which eventually caused blood sugar surge and coma and the patient was sent to the hospital for emergency treatment. Fortunately, the rescue was successful and a life was recovered. These cases are all based on the harm of medical knowledge obtained from Internet search. It is the bounden duty of medical communicators to correct the wrong views of health through the dissemination of scientific medical knowledge. However, there was no denying that many of these “local knowledge” and “layman knowledge” still played a positive role. Therefore, the so-called “grandma doctor” (that is, the elder’s health care knowledge), “Internet doctor” (that is, the medical health knowledge based on the Internet) and other phenomena were very common. Because most of the people do not have the attribute of medical knowledge, the medical staff who carry out medical communication first need to ensure that the content of the communication must be accurate. At the same time, we need to consider how to spread the modern medical science knowledge while fully taking into account the existing multiple knowledge structure of the object of communication. We should try to avoid the conflict between multiple knowledge and realize the truly effective medical communication.

Secondly, we need to give full consideration to the context of our residents’ health issues. China is the third largest country in the world, with a vast area and different cultural customs and living habits. The health problem is deeply rooted in the local culture, so it is necessary for medical communicators to take full pre-research, to understand the local folk culture and health demands, and spread medical knowledge according to different people and different places. For example, cardiovascular disease is a common disease of middle-aged and old people, with the characteristics of high incidence, high disability rate, high mortality, low control rate, low standard rate, so called three high and two low. According to China cardiovascular disease report 2017, the mortality rate of cardiovascular disease in China ranked first in 2017, higher than that of tumor and other diseases. The proportion of deaths has reached about 45%. That is to say, in China, two out of every five deaths are from cardiovascular diseases. And the number of cardiovascular patients is as high as 290 million. The morbidity and mortality of cardiovascular diseases are still on the rise. It should be said that cardiovascular disease is a kind of disease that needs to be paid much attention, and also a kind of disease that needs to carry out medical dissemination and medical science popularization. The main risk factors of cardiovascular disease include overweight, obesity, lack of exercise, high salt, high oil diet, etc. It is very necessary and popular to carry out the prevention and control of cardiovascular diseases in the target population, such as in major cities. It is a kind of medical communication which is very suitable for the needs of the public. Once upon a time, there were medical science popularization workers who went deep into the mountainous areas of Yunnan Province to popularize the prevention and treatment of cardiovascular diseases for rural residents. Due to the lack of investigation on the diet, life, and behavior of local residents in advance, when they had arrived the area, it was found that the diet structure of local residents was low in crude food and oil. In addition, they often need to climb mountains at ordinary times, thus the amount of daily exercise and the number of days of exercise per week were sufficient, and cardiovascular problems were not common. Therefore, they failed to take proper medicine and effectively communicate. For another example, Keshan disease is a kind of local cardiomyopathy. It was first discovered in Keshan city of Heilongjiang Province in 1935. The main cause is the lack of selenium in the diet. It was reported that at least 700 million people in China live in selenium deficient areas. The spread of prevention and control knowledge of Keshan disease will not only be popular, but also benefit the local residents. But if we go to non-selenium deficient areas or even selenium rich areas, such as Enshi in Hubei Province, Rugao in Jiangsu Province and other areas to carry out the prevention and control science popularization of Keshan disease, it is just for the purpose of science popularization, which is not suitable. In addition, when conducting medical communication, we also need to consider the needs of different genders and different age groups. Taking gender as an example, people of different genders have different physiological structures. For example, prostate is a unique organ for men, while uterus and ovary are unique organs for women. If we carry out science popularization of “ovarian cancer” in men and “prostate cancer” in women, even if it is not a joke, the benefit it can bring is little. At the same time, people of different genders and body structures have different concerns and health demands. For example, lectures on “breast disease” and “uterine disease” and lectures on prevention of “prostatic hyperplasia” are given to adult women and men, respectively, which is a good topic to be selected, meeting the context and needs of health issues of different gender groups. People of different genders have different disease spectrum. Taking the incidence of cancer in men and women as an example, the top ten tumors in men in China are lung cancer, stomach cancer, liver cancer, esophageal cancer, colorectal cancer, bladder cancer, prostate cancer, lymphoma, brain nervous system tumor, and pancreatic cancer, while the top ten tumors in women are breast cancer, lung cancer, colorectal cancer, stomach cancer, thyroid cancer, cervical cancer, liver cancer, esophageal cancer, uterine cancer, and ovarian cancer. It can be seen that the incidence of cancer is not the same in different sex groups in China. In order to achieve better results, we need to consider the gender differences in the dissemination of cancer medical knowledge. Taking age as an example, people’s health concerns and demands are not the same throughout their life. For example, perimenopause is the performance of women’s ovarian function decline and their reproductive function tends to terminate. Women in this stage, due to the decrease of estrogen secretion, will have a series of symptoms with autonomic nervous system dysfunction and neuropsychological symptoms, which are called perimenopausal syndrome, also known as menopausal syndrome. At the same time, osteoporosis is very easy to occur. Therefore, women at this stage will pay more attention to menopausal syndrome, postmenopausal osteoporosis, and other topics. But for young women, because they are far away from menopause, they are less likely to pay attention to such topics, and may pay more attention to the medical knowledge of childbearing, reproductive health, and parenting. So, we should pay attention to choosing different topics in different age groups to meet their health needs in medical communication. Taking life habits as an example, while cooking, Ningbo people tend to add much salt in general, and their salt intake may exceed the standard. At the same time, Ningbo people like to eat a lot of salted food, which has a high content of nitrosamines. And long-term consumption of it may cause cancer. However, Suzhou people’s cooking is generally sweet and their sugar intake is high. So when we popularize healthy diet for these two people with different living habits, we should consider their different eating habits and popularize them with goals. Generally speaking, for the context of residents’ health issues, we need to consider various factors such as region, age, gender, living habits, folk culture, and try to fit their different health demands, so as to maximize and optimize the effect of medical communication.

Finally, medical health issues are closely related to everyone, so medical communicators should also let the public participate in the discussion and dialogue of medical affairs, and actively establish a democratic mechanism in the field of medical decision-making. At the same time, the public should play an important role in the decision-making of medical communication. For example, during the Spring Festival of 2018, an article entitled “Beijing middle age under the flu” was widely circulated on social media. The author is an ordinary middle-class citizen living in Beijing. In this article, the author described the whole process of 29 days of medical treatment from the pneumonia caused by influenza to the death of his father-in-law. This article written by an ordinary person, including tens of thousands of words, should be said that was too long for online articles, and usually few people would read it all. However, in a few days, this long article had been read by hundreds of thousands or even millions of people and had aroused wide discussion, because his identity and narration fit the common sense and concerns of most ordinary people. In the eyes of professionals, this article may have various misconceptions in medicine. But after careful analysis, first of all, he raised a topic that people were most concerned about in the season of influenza epidemic in China in the last winter and this spring. It is about the medical and health problems that the public paid most attention to at that time. Secondly, he described a seemingly simple medical problem that eventually led to death from the perspective of ordinary people, which is more in line with the thinking of ordinary people in that condition. Many people will have a feeling of empathy after reading this article. This article not only aroused wide public resonance, but also inspired medical communicators to create a series of popular science articles to popularize influenza prevention measures, and targeted questions and answers, and achieved good popular science results, which played a positive role in the final control of influenza to a certain extent.