Irrational Water and its Meaning For Communication

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?

I can't even tell what this water is feeling, inscrutable codger. [via]

I can’t even tell what this water is feeling, inscrutable codger. [via]

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.



Launching Paper Planes

Whether you’re working in the fluoro-lighted sterility of an operating suite, or dropping into your patient by helicopter, the temptation is to spend all your time focussed on the person in front of you. And you should, of course. But any practitioner realises over time that actually you need to look more broadly than just that patient. This is because the patient in front of you presents in a way that is influenced by everything around them.

So if I’m to really take an interest in the health of the patients I look after, I have to take an interest in the big issues of society. I need to pay attention to the public discussion on obesity, because I’m seeing the results in kids turning up with a blood pressure their grandparents would flinch at. Seeing as those from lower socioeconomic groups have worse health outcomes, I have an interest in seeing what policy is going to diminish inequality.

The better educated have better health outcomes, so education policy matters. And between the potential impact Trans Pacific Partnership negotiations on the cost of medicines here and elsewhere, and the scope for corporations (like big tobacco) to sue governments if some parts get through, I even care about murmured conversations going on in Singapore.

I suspect many medicos develop a latter day interest in public health. Particularly if they, like me, remember their undergraduate training as the constant annoyance that results when someone traps a mosquito behind your eardrum, rather than an inspiring adventure flick where the crusading medical team save a whole island.

Which brings me to drowning, and radio shock jock Kyle Sandilands.

This is a gratuitous aerial shot to make up for mentioning Kyle Sandilands

This is a gratuitous aerial shot to make up for mentioning Kyle Sandilands

The Jobs We Hate

When I work on the helicopter, we don’t mind when we get the call to launch. But we could do without the calls to kids who have drowned. Each summer we’ll get around 20 call outs to kids who have been found in a pool, in the bath or in almost any tiny bit of water you didn’t even imagine. And while we have a great rate of the kids recovering, some don’t. And those jobs are horrible. Particularly since drowning should be preventable, but keeps happening.

So when I was offered the chance to chip in on a public awareness campaign on the topic of drowning I leapt at it.

What I learnt was that launching a public awareness campaign is a little like launching one of the paper airplanes my son is obsessively creating. Flight requires a bit in the way of design, and a lot in the way of favourable conditions (as in  the world’s longest such flight here).

It was all a learning experience. Should you ever get the chance to work with people trying to promote some public health, or perhaps promote your research, there’s a bit in this story.

The Idea

The idea for this particular campaign kicked off with an ad agency. That’s right an ad agency. They heard a story about a kid who drowned in a bath and got interested in spreading a message to remind people that the risk isn’t just in the pool or at the beach. What they came up with was a simple idea to demonstrate how little water is needed. And when they looked around to get information to back up their idea, we ended up meeting.

The Work

It turns out there’s more to a slick looking package than clever editing and a couple of famous faces. There’s tips that those who make a profession of getting ideas to people do that any health advocate or researcher could use.

1. Spreading the Word Is About People

You need to connect to people and you need to work with people. First tip for me was to not miss a connection (and I’ll confess it’s a tip I don’t always follow well). Every time I met with someone on this, they had a notebook. The notebook was a little bit about writing down stats or numbers or thoughts. Mostly it ended up with lots of names. Every name spelt right, titles noted and exactly what they did. I could do with paying more attention to every name I hear. Those names aren’t just about the campaign now, they are for all the things you’ll work on in the future too. You’ll never work in this field alone. The more names the better.

2. Clarity

Medicine sometimes seems to employ language that excludes. Research can be a little the same. A campaign designed to convey an idea in less than a minute is like a highly distilled drink. The purest essence of the idea to get the message through. That sort of clarity is what is required every time you communicate what your project is about. It also means you have to actually understand what your project is about.

The flow on point from this is that when you’re asked to contribute to that clarity, you have to deliver what the project needs, not what tickles your fancy. Delivering a message to order is actually pretty good discipline for anything else you need to write (grants, anyone?). So in this case my job was to provide the stats to provide the back story for the campaign.

3. You can only do what you can do

Lots of good ideas flew about, but ultimately there was only so much time and money available to get it done. This applies to every other promotion, be it a public health campaign or something related to your research. If you can’t come up with an idea without it involving a trained orang-utan and a brass band, you’re not going to get there.

The Cabana Boys had absolutely nothing to work with in terms of resources on this one, and they still managed to get enough people to donate their time to come up with this.

4. There’s always stuff you can’t control

You build a campaign. It’s good. Celebrities are involved. You’ve got a Facebook page. You manage to get in papers. You get a plug on morning breakfast TV. You really hope it lights up, goes viral.

Then one of your celebrities refers to a local journo as a ‘fat slag’, just in the week of your launch. Good luck, positive coverage.

It’s not in the video, but even the bit on The Today Show was shoehorned straight after the release of an entirely different report related to pool safety. Somewhat diluted the message.

If you had a big budget, you could get around that. If you don’t, you can just plug on. This campaign still got somewhere, but I suspect they’d hoped for a bit more.

So what are you left with? Well, hopefully some sort of difference. And there’s always the next one. The next paper plane to launch in the hope of a gentler breeze.

Can video make a PhD star?

Like many parents, I have a complicated relationship with kids’ television. There are times when I enjoy the pure joy in a song composed entirely of nonsensical whimsy. Then there are times when I would like to find an appropriate furnace to burn Thomas and all his shunting friends.

Like some parents, occasionally when I watch a kids’ performer pretending to be a bed-hopping monkey, I think to myself  “I could do that. And my monkey would have more mischievous glee too.”

The PhD – Delivering Reality Checks for Free

 Of all the unlikely vehicles to allow me to test my front of camera skills, I have this PhD project. When I embarked on it almost accidentally (pretty clumsy, right), I assumed it would mostly be me and a computer and lots and lots of data. One day it might be. What I didn’t expect was that 2 years in the surrounding bits would be such a major part of the process.

As I’ve said before here, it has become massively apparent that if you have an idea you believe in communicating is part of the job. Who else is going to talk up your thing if you won’t?

Coupled to this is the fact that I’m doing this within a charity organisation. Unsurprisingly, they also want to tell people about stuff they do. Of course, there’s not really any way I can think of getting funded that wouldn’t involve communicating what the work involves.

And so it is, that I ended up in front of a camera.

The Brief

To explain a bit about the research, we’ve created a short video pitched at the layperson. If you care to view it up front, you can look here (the link is at the bottom of the page).

The target we set was to try and answer a few questions in these 3 or so minutes:

  • Who we are and what we do.
  • Why do we give a damn about trauma and particularly traumatic brain injury?
  • What’s the problem we’re trying to address and what the hell is the monitor with the fancy name all about?
  • What are we actually doing about it?

We did this armed with a script from me, a volunteer called Cam on the camera, a bunch of black drapes in an office and 3 props. Now it’s out there for anyone to judge if we were successful.

What did I learn?

1.     Imagery is everything

One of the hardest elements to get across was the idea of how the monitoring might reveal stuff that’s going on in the brain. That’s where the balloon (and some textas plus a rather saintly wife) came in. This concept was developed in the preparation for the Bright Sparks PhD Pitch Night from earlier in the year and I still like it, although I’m always looking for a better one. A good image can demonstrate a concept way quicker than many, many words.

The search for a way of demonstrating this idea also led to a really clear focus on exactly what it is we’re doing and made me understand the complex stuff better. There are all sorts of benefits in communication.

2.     A Camera is a Strange and Unrelenting Prison

I can talk plenty in a small group. I can talk in a big room. I am seriously unnerved by a flashing red light (and no there’s no hidden associations with red lights and a long suppressed past).

Practice felt easy. In the dark room, with the light on I rediscovered the self-consciousness of a big-haired teenager. It’s truly strange how the unblinking glint of a camera lens makes it feel like you yourself are blinking way too much. It felt as if my eyelids were convinced they had a chance to live out their dream of stepping up to the big leagues and delivered a performance akin to wipers trying to clear dead bugs off a windscreen.

My hands, usually friends of mine, became massively oversized. They felt so big and everywhere I wondered if I’d forgotten the point earlier in the day where I washed my hands in a particularly angry hornets’ nest. My hand acting clearly followed the teaching of this serious actor.

So enough daydreaming. I can happily acknowledge now that there are reasons pros are pros. Which just means it’s time for practice.

3.     There’s Room to Improve

When I see it, I think it’s a start. There are things that I wish were more slick and professional looking. Actually, that’s mostly just my face I’m talking about. I am very impressed at the efforts of the CareFlight team in building on top of a little idea, supported only by 2 balloons and 3 takes.

It turns out a PhD delivers way more than just an experience in research, or the fascinating pain of literature reviews and revision. It takes you in unexpected directions. Although next time I watch Play School I’ll have to acknowledge the harsh reality that maybe I won’t be disputing the rider with Big Ted, Humpty and friends any time soon.

If you made it this far before checking it, here’s the direct link. I submit it to the court of public (well, not that public really) opinion. And if you’ve got the time, let me know what you think. How did we go? Is there a better option than the brain balloon or am I going to be popping those things for the next few years? Should there be more gags? Is it even easy to include jokes about brain injury in this sort of thing? I’m all virtual ears. After all, my future in research may well depend just as much on my communication as my stats.

No textas were harmed in the decoration of this balloon.

No textas were harmed in the decoration of this balloon.

The Science Break-Up

We are approaching the end of another week. Yet another week where those who are actually quite keen on science could be forgiven for getting a little disillusioned at the unmitigated rubbish being mounted on walls as posters to support unscientific propagandists on a bunch of different subjects. Just this week there’s been rallies against wind turbines, partly on the basis that they are responsible for every medical symptom listed in Harrison’s Internal Medicine, anti-vaxxers likening doctors to terrorists, politicians suggesting a public review process on the evidence for fluoride in water and folks promoting pseudoscientific sexcereal (and no, I’m not putting many links in because there’s a balance to covering stuff and providing too much oxygen to these particular organisms). On top of the now constant hum of people still disputing the consensus on anthropogenic climate change, it’s enough to make a person go a little bit Hulk (although I’d probably only be able to unleash my muscled up rage on a crisp bit of celery, given the state of weakness I start at).

It’s easy to get frustrated with those who pretty much choose to selectively disregard everything science has to contribute on a topic to support a flawed paradigm. Particularly as sometimes that paradigm can impose real risks to others. There’s part of me that just wants to say:

“Look, if you’re planning to break up with science over vaccination/climate change/wind turbines, then it’s only fair to make a clean break. So science would like its stuff back. You know, all that stuff it has given you. Please hand back your mobile phone. Actually, you should really just hand back all means of telecommunication. It would be a little awkward for you to keep using that stuff. You can keep interacting with gravity though. I’ll have to get back to you about fire. The whole thing could be a bit awkward of course. Now that you’ve made the break, science expects you’ll take up with all sorts. Like homeopathy. Anyway, science already knows it’s not them, it’s you.”

I want to just point out all the good stuff out there debunking some myths, like this on vaccination. Or maybe some of these explanations around climate science (that one from @drkarl). Or I could point to the words of that well known tree-hugging unicorn apologist, the head of the World Bank (that one via @bencubby), who has not only said everyone should get on with addressing it, but suggested that disputing the evidence was to deny science itself. The evidence I could point to on all these fronts would be everywhere. To point it all out though would be unhelpful (although my moral superiority would get a good feed).

While some of the people stoking these fears and spreading misinformation aren’t covered by the next statement, the majority of people questioning the science are probably just good people with worries and fears. Most people at some point will look for information on a topic, and if they’ve landed on the side of those denying the science, then isn’t it possible that the real issue is that the window to communicate the science effectively has been missed? Maybe the problem is that the “crazy zealots” are actually being pretty effective at communication.

Maybe there wasn’t enough out there. Maybe people don’t like how those doing the science bit are engaging. What is undeniable is that those promoting the other side of the equation are sometimes effective. As covered most eloquently by Will J Grant here, the “Stop these Things” campaign demonstrates that these campaigns are not to be underestimated. So if the goal is to win hearts then minds, maybe those communicating on the science front need to double their efforts. It’s all too easy to see things from your side if you’re out there banging the drum, but maybe it’s more important to consider what other influences are striving to reach the person you’re trying to persuade (this idea has been much more elegantly explained and visualised by Heather Bray here).

So if I’m going to be someone who supports science and the evidence that’s out there, it’s important to reconsider what I could do better. Maybe in this break-up it’s more about me, than them.