The other day I had a long debate with someone as to whether the Italian word carabinieri referred to a particular type of police found all over the place, or specifically the cars they drive. At my disposal I had many facts. I had reference books. I had the unassailable logic of a battalion of these individuals blocking our progress through a park as they celebrated their bicentenary. The most traction I got was “well they must have been named after the cars”. I eventually let it pass for two reasons: it’s an illustrative example of the futility of facts in the face of a strongly held belief; and my debating colleague was in primary school.
The Consciousness of Water
The discussion led me back to some of the interactions I’ve experienced as a doctor. The type of conversations you approach with steady logic while your brain is yelping and pawing at the inside of your cranium as precious facts make no indent on an irrational belief. Like the earnest individual explaining to me that the greatest risk their child had faced in their life was combining anaesthetic agents with the powerful homeopathic remedies their child had been taking. It is fair to say I find the interaction of water with anaesthetic agents the least of my concerns.
Another aquatic example hit the media recently, when Gwyneth Paltrow revealed a developing interest in the consciousness of dihydrogen monoxide. Expressing the idea that negative emotion expressed around water might be able to influence its chemical structure, Gwyneth gave a sobering glimpse into what must be a daily struggle. Imagine attending to the multilingual moods of water (I assume it’s multilingual as the original experiments in the area were done by a Japanese scientist). Imagine the effort involved in undertaking conscious uncoupling with the water in your shower as you affirm it’s value to you before it heads down the drain. How do you even drink tea?
The thing is were I strapped to a chair being forced to engage with a ‘water whisperer’, there’s plenty to tell me that their strongly held beliefs won’t respond to logic alone. So if you’re a medico confronted with similar beliefs, what can you do?
Lessons from Other Fact Happy Groups
In lots of cases in medicine, a disagreement in broad terms may not get in the way on agreeing on common management goals. The broader communication between doctors and patients is obviously a key part of this. The trickier question is what to do when the facts believed by those on the other side of that relationship can’t be reconciled with a medical perspective that is safe for a patient.
The tendency of any health care worker may well be to reach for a range of trusty facts. This follows the notion that any rational person presented with new appropriately sensible facts will change their beliefs to logically incorporate those new facts. Lots of us believe this but look back to when you first realised that people aren’t entirely rational. You should be cringing at the fashion people were wearing in your glorious crystalline memory.
It turns out that facts are just one part of the equation. There’s stuff out there showing that people are only like to let facts sway them if they were inclined to be swayed anyway. Those that enthusiastically endorse your precious facts were probably believers anyway. For those really dancing somewhere down at the conscious water end of the spectrum, your facts will just as likely be discarded like a lonely chip wrapper in the school playground.
There are lots of examples of where further presentation of facts doesn’t seem to sway the most ardent crew. Climate change, vaccination, GM food and homeopathy are all good examples and the failure of facts alone in these settings is well covered here, here and here. Health care types probably also need to account for strength of the belief held and how easily the person in front of you can incorporate your attempted phase shift into their sense of who they are.
This latter point is well covered in this piece. It also mentions that the strength of that initial belief and the degree it matters to the person’s sense of self aren’t just important as to whether they’ll shift their stance. Even if they alter their position the original apparently false position will continue to colour their thinking. So you have a lifetime of experiences and preconceptions to deal with.
So, if we accept that our shiny facts are in fact the equivalent of limp celery, what can be done when the discussion is down a frustrating alley?
What do pro communicators do?
Not all examples of approaches applied in other settings can be easily applied to the one-on-one patient doctor relationship (or equally when it’s a doctor discussing things with a family unit). One example from those trying to correct misconceptions in the climate science area involved addressing both the rigorous evidence side and by altering people’s associations with what is happening to the climate, explaining the scale of heating in terms of bombs in Hiroshima. This sounds promising, but the people listening might well still be those who were inclined to be swayed. Opening up a chat on the medical wards by mentioning atomic bombs may be counterproductive too.
Other suggestions include framing the facts in a manner sensitive to the pre-existing beliefs of those you’re chatting with. Nyhan and colleagues (mentioned in that link from above) are exploring the idea of working on people’s sense of themselves by testing if they are more broad-minded after recalling a time they felt good themselves (they were in the situation tested). Asking patients to write about their best ever day before you chat might be a little time consuming though.
In wrestling with this topic, it seems the most pertinent point is that lobbed facts will only alienate. Don’t really on them alone, but place them in the context of what the patient wants. I suspect this message has already been conveyed by the doctors I’ve always admired. Every interaction with a patient starts with respect and listening, and after that common ground is easier to find.
And if that gets me nowhere, maybe I’ll have to turn to Gwyneth to make sense of it.