What happened in Dallas recently is something the U.S. health system had spent the past six months preparing. Consequently, the Centers for Disease Control and Prevention developed a checklist for evaluating possible Ebola patients and distributed it to health care providers across the country.
Many clinics have prepared for patients with Ebola-like symptoms, but even the best preparation requires clear communication between caregivers and patients, and among diagnosis and treatment teams.
Although the CDC can be commended for its efforts to contain Ebola here and abroad, the effort could be improved if changes to the health and risk communication were made.
Checklists for evaluating possible Ebola patients and clinical precautions would benefit from being changed to an “active choice” format.
Like most checklists, the current form for Ebola directs caregivers to check a box when a condition is present ( Does patient have fever, subjective or > 101.5°F?) and make no response when it is not. However, equating a negative judgment (no fever) with inaction (not checking a box) discounts the mental effort the judge uses to reach it.
A more optimal checklist format would require people to make an active choice between two options rather than just “opting in” for one. This two-option format balances the consideration people give to positive and negative assessments. In this case, having caregivers actively choose between “yes” and “no” for each Ebola-consistent symptom could enhance the calibration of their judgments.
The language used to describe the health care worker’s role in diagnosis should also be changed from passive to active. Items describing diagnosis in the CDC checklist focus on the patient’s actions, not the caregiver: Does patient have fever? Has patient traveled to an Ebola-affected area in the 21 days before illness onset?
In contrast, those about post diagnosis procedures emphasize the caregiver’s actions: Isolate patient in a single room, Notify hospital infection control program, etc.
In practice, caregivers must be as active during diagnosis as in subsequent procedures. Language that describes diagnosis in “caregiver-active” terms (Check patient for fever symptoms, Inquire about patient’s travel to Ebola-affected areas, etc.) reinforces the caregiver’s role in this process as an effortful investigator, not a passive observer.
Patients should also understand that multiple caregivers asking them the same questions is necessary. For example, an intake nurse might ask whether the patient has traveled outside the U.S. in the past 21 days, and the physician might ask the question again. Yes, this is redundant, but it isn’t patronizing or accidental.
Repetition is important for careful communication. Asking the same question multiple times gives patients time to confirm responses and serves a check-and-balance function between caregivers. If one caregiver forgets to ask the question, the next one will have a chance to catch it. Redundancy should be viewed as a reassuring medical practice.
Crisis situations are times of uncertainty for everyone involved. Crises are unpredictable, so people’s knowledge of the situation will vary widely. Caregivers will respond to diverse patient questions about the spread and containment of the disease. Furthermore, patients and caregivers might not know the latest information because crises evolve rapidly.
Social media can play a key role in spreading both accurate and inaccurate information. To ensure accuracy, people should check their information sources carefully and verify with expert health organizations such as the CDC and World Health Organization. Having patients and caregivers working together to manage uncertainty is vital.
We must make sure that patients and communities stay informed and that hospitals have the best assessment communication practices. Along with epidemiology, quarantine, diagnosis and treatment, effective communication is the heart of effective disease containment.
Matthew S. McGlone and Keri K. Stephens are associate professors of communication studies at The University of Texas at Austin. Both are affiliates of the Center for Health Communication in the Moody School of Communication at The University of Texas at Austin.
A version of this op-ed appeared in the Dallas Morning News and the Huffington Post.
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New op-ed on TP: We need to change patient questionnaires to contain Ebola and other diseases.http://t.co/HlJ56svk2u
— Texas Perspectives (@TexPerspectives) October 23, 2014