Medical Communication: From Theoretical Model To Practical Exploration. Tao Wang
to genetically modified foods.
Shall we imagine applying the public participation model to medical communication? For example, a patient was found to have early gastric cancer and needed treatment. Doctors talk with patients and their families, communicating and informing them that there are several treatment options available, the advantages of each treatment, which complications are likely to occur, the current situation of patients, and which treatment is more appropriate. In the process of communicating and discussing with family members, the two sides finally reached an agreement to choose the most suitable treatment for patients. This is the model of public participation in medical communication. Facing the same patient, if the doctor simply tells the patient and his family that they must choose a treatment method without any communication and discussion, then that is the deficit model in medical communication. In this scenario, we can see that the model of public participation in medical communication may be more easily understood and adopted by the public. However, in the public participation model, it is also necessary to take into account the degree of public participation, the basic cultural level of the public and the acceptability of knowledge. Imagine that in the process of communicating with the patient’s family members, if the family members do not participate at all, it is not a real public participation model, but more like the deficit model. Or the public participation models will do harm to the patients when their family members, based on their own one-sided knowledge, ask doctors to choose a treatment that is totally inappropriate or impossible? For example, a patient with advanced cancer, whose general condition was very poor and life was dying, was advised to his family members to take palliative treatment. However, in the public participation model, in the process of communication between doctors and the patients’ families, the family members asked the doctor for the only way of surgical treatment to the patient, regardless of the patient’s current basic situation, then was the final treatment mean in the hands of doctors or family members? Which is the decisive factor in the following? Who is more powerful, can be persuaded by the other, or who is more scientific, more rational, or more based? Is it necessary to adopt the opinions of family members (the public) in the public participation model? These are the problems we need to think about when we apply the public participation model in medical communication.
It should be said that the model of public participation conforms to the requirements of social democratization and promotes the change of scientific communication concept, but it also faces many doubts. For example, the public participation model is more like a political science model of science and public relations than a science communication model. At the same time, this model is also regarded as having the tendency of “antiscience”. These are the questions that the public participation model needs to answer.
2.Medical communication model
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