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Health Care Providers Seek Better Communication With Patients, Families

By Rudi Williams
American Forces Press Service

ALEXANDRIA, Va., Sept. 9, 2002 – More than 200 federal and civilian health care providers kicked off a three-day conference here today aimed at helping them become better risks communicators for patients and their families.

"This conference is all about trying to ... improve the care and delivery of health information to those who need it most," said conference co- chairman Dr. (Lt. Col.) Charles Engel Jr. He's the director of the Deployment Health Clinical Center at Walter Reed Army Medical Center in Washington and an associate psychiatry professor at the Uniformed Services University Health Sciences in Bethesda, Md.

With the theme, "Risk Communication and Terrorism: New Clinical Approaches," the conclave has also attracted social workers, public health officials, bio-terrorism experts and concerned citizens.

Those on the frontline of ensuring the nation's public health and safety are discussing such topics as anthrax, West Nile virus and other emerging health threats; the new and changing role of health care providers in communities' responses to terrorism and crisis; technologies and techniques to help spread information; and building patient-provider trust.

DoD, the Deployment Health Clinical Center and the Department of Energy are sponsoring the forum. Other participating agencies include the Department of Health and Human Services, the National Aeronautics and Space Administration and the Department of Veterans Affairs.

Individuals at the conference include Ellen P. Embrey, deputy assistant secretary of defense for force health protection and readiness; Beverly A. Cook, assistant secretary of energy for environment, safety and health; and Jerome Hauer, acting assistant secretary of health and human services for public health emergency preparedness.

Engel said "risk communication" means relaying complicated health information to and between clinicians, patients and sometimes their families.

"This information is often hard to understand," he said. Each person has his own ideas about how much risk he's willing to take, he said, so improving communications between provider and patient, and perhaps family members, too, empowers the patient. An informed patient is a better, smarter patient, he said.

He said the anthrax attack in the postal system last October is a probable example of poor communications. Even though anthrax vaccinations were made available to concerned postal workers, only a few took up the offer.

Engel attributed some of that situation to the workers' unrelieved anxieties about the vaccine's effectiveness and side effects. "So risk communication is about finding effective avenues to get information to people who are making decisions about whether or not to accept (the risk)," he said.

"In health care, we're talking about the risks associated with diagnostic tests, medications, various diseases, (and of) not treating the diseases or not preventing diseases," he noted. "Another one in our (military) setting is communicating risks that service members face when they deploy into hazardous environments."

"We initiated this emphasis on risk communications for clinicians even before Sept. 11 because we knew this was a concern," Engel noted. "Since Sept. 11, the level of urgency has gotten much, much greater. Deployment has been completely redefined. In many ways it's a cumbersome word because deployment can be in our own backyard.

"We may be facing serious environmental risks associated with biological or chemical weapons. As a consequence of an attack, we know that there will be hundreds, possibly thousands, possibly hundreds of thousands of people who would be concerned about the health effects if such an attack (occurred)."

The clinical center grew out of health concerns of Gulf War veterans -- the so-called Gulf War syndrome and the need to provide sound clinical care for folks who had health concerns after serving their country."

Engel said health care providers discovered that they didn't always do a good job of explaining to the veterans how they could help themselves, how they could help them, the nature of their problems and the exposures they experienced, the degree of health risks associated with those exposures and other information of concern to the veterans.

Lessons learned after the Gulf War and after Sept. 11 terrorist attacks and anthrax attacks on the postal system - "people become ill," Engel noted. It's sometimes hard to link illnesses to the attacks, he said, but sick people often do anyway.

"That link may or may not be a scientifically valid link, but they make it so," he added.

"What we've learned is that we are vulnerable," the doctor noted. "This is the time that we should be pulling together lessons learned and developing communications strategies for dealing with our patients. Poor communications can be as a great a source of morbidity as the threat itself."

The military didn't start the risk communications program, he emphasized. "This was a recommendation that came to DoD from a variety of different blue ribbon panels on the heels of the Gulf War," Engel said. "We needed to develop programs to improve risk communications. This is part of doing that. Many agencies have their own experiences with risk communication. We have our own in DoD."

Health care providers have to get better at listening to their patients describe their experiences and their concerns, and then addressing those concerns, Engel said, "even when we're not able to identify a specific disease we can link in a cause-and-effect way."

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