Friday, October 19, 2012

Exposing Yourself One Signature at a Time

Gunderson Lutheran Hospital is responsible for the authorial and publishing duties of “Notice of Privacy Practices,” their informed consent pamphlet. In it is a section titled: “For Healthcare Operations,” which is the focus of this critique. The section contains a list of all the reasons the hospital may use your information in regards to healthcare operations. All of it is beneficial to patients and services, but if you were to read the sentence: “We may use or disclose, as needed, your health information for certain administrative, financial, legal, quality assessment and improvement, accreditation, credentialing services and training activities,” it may feel otherwise. It feels daunting and ludicrous that a hospital would need your information for all of that. The rest of the paragraph fleshes out what this first sentence means, but the fingerprints of the Official Style have dirtied the paragraph with its reading ease level of 12.8 (this is not like golf, where lower means better, oh, and it is out of 100), its 29.8 words per sentence, and its average reading grade level of 19.6, meaning that if you are not in the midst of obtaining your doctorate, you may want to read slowly and with Google search open, just in case.  
In this specific case, the use of Official Style seems counterintuitive to what Gunderson is trying to do. The hospital wants to use patient information to improve upon programs, treatment, and their health care experience as a whole, which is evident in the passage:

“For example, we may use health information to review our treatment and services, and to evaluate the competence, qualifications and performance of our staff in caring for you. We may use health information to conduct training programs in which students, trainees or practitioners in areas of healthcare learn to practice or improve their skills.”

The information seems promising, the patient may even go, “Oh, well isn’t that nice?” But, that quotation comes very early on, being the second and third sentence of the paragraph. From here on out, though, it is a list, a list of obscure processes, using words that gloss over and do little to illuminate said processes. Two examples are, “formulary development” and “business management.” The Official Style threatens to derail the train of progress, by forcing the patient to read about every place their information may go. The patient has the right to know, but the Style is so sterile that the “it will help you in the long run” message, evident in the above passage, cannot shine through. The entire thing reads like a list of the people who have seen you naked (no matter the length of that particular list), making you feel exposed, and well…naked. Now if you absolutely have to be exposed, would you not want it to be for a purpose? What if that list also included the outcome of each instance of nakedness, instead of only just the names? “We may also disclose information to doctors, nurses, technicians, students, and other Gundersen Lutheran hospital or clinic personnel for review and learning purposes.” Why not elaborate on these learning purposes?
According to the American Medical Association, the point of informed consent is to create a communication between patient and physician, which is most likely also a goal of Gunderson Lutheran. In this case, the hospital has to communicate to the patient the various places and desks it might find its way to. “For example,” shows up twice in the only two clarifications in the entire paragraph. The use of these two words makes it seem that Gunderson Lutheran is withholding pertinent information, only allowing a glimpse of what they can do to be seen by patients. The inability to disclose all of the things your medical information will be used for hinders communication between the hospital and the patient. Also, the phrase, “we may use,” appears in the paragraph a total of four times. Robert Lanham might say that this phrase may be the perfect metronome, the dangling pocket watch, to hypnotize the reader and put them to sleep. The drowsiness affect goes against the intended outcome of the informed consent. The repetition mentioned above, and the passage’s list-like format, make for a very boring read. Oh, and don’t forget that it is a long, single paragraph. Is there any better way to make a patient zone out, or better yet, just skip it entirely? So not only can the lack of specifics (only two clarifications, remember?) make the list seem daunting, but also it is such an eye sore to even look at (and God forbid, to read) that it might not even do its job, you know, of communicating.
By law, the hospital has to spell out everything for the patient, so the governing bodies seem to have forced the hand of Gunderson Lutheran into using the Official Style. The operators of the hospital want to continue to have a job, and thus, must comply. Gunderson Lutheran wants to use your information to improve on what they do, be it through research on your condition or reason for visit or using it as training material for new staff. Informed consents are very much a legal document, which means that the Official Style is all but required. But, this necessity to use the Style severs the communication between hospital and patient that is stressed by the American Medical Association. The message of the consent form, “we want to improve,” is buried underneath the Style.
The Style shuns the audience, focused, in this case, on covering legal bases. The Style should not be allowed anywhere near consent forms, forms that are supposed to promote communication. Most people are not going for their doctorate, but most people want to know what their information is being used for and why. If legal forms like this one were written with the reader, not just the judge in mind, lawyers and healthcare systems everywhere would be pleasantly surprised at the level of compliance from the intended audience, those signing their life away. Why not, at the end of each section, tell the patient who they can go to with questions, questions that may be specific to their particular experience. If these ideas are kept in mind, communication would be repaired, and the beneficence (a component of ethics!) that is trying to be conveyed via the consent form would be not only present, but visible.  

This pamphlet can be acquired by either asking for one in person at Gunderson Lutheran, or having them mail a copy to your residence. 

--Chad Nickerson

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