The Talking Cure: A Conversation with Elissa Foster

​​​Professor Elissa Foster is passionate about improving communication in health care settings. She is the director of the college’s graduate programs in health communication and is active as a researcher and in working with health care professionals to improve the quality of their communication with patients, families and other practitioners. Here she shares her thoughts about problems, progress and careers in health communication.

How do you define health communication?

I take the broadest definition of health communication. It’s a discipline that harnesses all the insights that can be gained from communication, research and theory—from interpersonal communication all the way to culture and media—and applies them to solving problems in the health care context.

I’m talking about context pretty broadly, too. My personal area of expertise is in the clinical area, so clinical communication, which includes both the communication between clinical providers and their patients, and communication among professionals within the health care delivery context. To a certain extent, we are also looking at health care systems and how they work.

You have to understand how the organization and organizational systems affect clinical communication. There are legal constraints and systems constraints, and even just the practical aspects of charting and the like. So to have an understanding of the provider-patient communication, you also need to understand the context in which their communication happens.

What would you say constitute some of the challenges to providers in communicating with patients and families?

I think one of their main concerns is time, that there are significant time pressures on providers now and concerns about productivity and the number of patients that need to be seen.

It’s really not unlike other changes to communication in our culture. That doesn’t necessarily mean that you can’t establish effective relational communication. It just means it needs to be accomplished in a different way, and you need different communication tools and habits. I’ve seen many, many clinicians who have learned how to do all of it well.

I would also say continuity. It is very difficult now within practices for your patient to see you every time they come in, particularly for acute visits. But the answer there is that if you have a team that works together and communicates effectively, the patient can still have a sense of continuity and what we might call a patient-centered medical home.

That’s a shift for patients who want to rely on one person. What do you know about patients, their communication needs and how they communicate?

I think we’ve put a lot of pressure on the practitioners to change the way that they practice in order to try to preserve this relationship, but patients don’t always have the understanding of the clinical environment that would help them to partner better with their providers. Doing all this research on WebMD before they come in is not always helpful to the doctor.

I think most patients are waiting for the physician to take charge, and if the physician gets it wrong, the patient feels like they didn’t get to tell their story or get all their concerns out. There’s this concept of agenda-setting. When a doctor comes in, patients need to say, ‘Can we just take a minute to list my concerns, and then we can prioritize what needs to be done?’ If you want to be satisfied and for quality care to happen, that conversation has to happen upfront.

Who is your typical student?

I have two groups of students. At the undergraduate level, I teach a basic health communication class, and it is 50% health sciences students who are doing either public health or the bioscience track, so these are future practitioners. Then 50% are communication students who see health comm as an interesting elective. Usually they are surprised—they either just get a lot out of it personally and become more empowered patients and consumers or they decide that they want to do more study. We only have one health comm undergrad class, so they go into the MA program.

Those MA students tend to have an interest in health and promoting health. Often they have a dramatic health story in their background. They tend to go either into working directly with health care delivery organizations or into more of the public communications side, writing for patients or internal communications.

What needs to happen to make health care more effective?

Part of the struggle is that, particularly here in the United States, organizing health care as a business around a service delivery model just doesn’t work because the people who don’t have access to health care also don’t have access to health education or to communities where they can walk safely. They don’t have the time or the energy to prepare fresh food. All of these things stack up against certain groups within the population. We’re going to remain, as a country, spending more and getting less if we don’t start to think in terms of health promotion and interrupting cycles of poverty and violence.

Would you say that health communication is improving?

From the perspective of health care systems, there have been massive breakthroughs, particularly with respect to things like the patient portal so that patients have more direct access to a care provider and nurse triage, can schedule their own appointments, can see their own test results.

I also think that great effort is being placed on understanding how through things like biomonitoring devices or answering questions through technology, patients can become more engaged in their own health care, and how what patients are generating through their own health data can interface with the work of the clinician. That work is just starting, and there are a lot of technical and quality-of-data issues. But I think the right questions are being asked.

I’ve got two or three graduates who are working in the area of patient experience within a hospital or health care organization. They are looking at patient perceptions of quality and how to improve the system so that patients experience more quality.

Stakes are high, even for a parent who brings in a toddler who’s got an unexplained rash that might be completely benign. For that parent in that moment, the stakes are high, and so the communication has to be effective.