In the Ring

in the ringThere is a Spanish expression that goes: It is not the same to speak of bulls as it is to be in the bull ring. I’ve always liked it, because it seems to capture quite fundamentally the difference between being a spectator and a participant, an observer and an actor. I have paid my money and taken my seat at any number of events, sporting and otherwise; the few times I’ve been the one in the ring, literally or metaphorically, it was a considerably greater investment of self at that moment, and it occupied a lot more of my attention.

Often, I believe that the truth in this phrase applies to our line of work, medical communications, most clearly in the case of patients. We can argue or opine or assume what is best for someone facing difficult medical decisions, based on what we know and see, but until we are facing the same or similar situations and choices, it’s all just theory. Debating a hip replacement, or putting a child on therapy for ADHD? It’s easy to have an opinion, but much harder to know that it’s your choice to make, and your consequences to live with if you choose wrong.

This is why fellow patients are such critical sources of information for patient-centered decision making; it is the value of “experience by proxy,” of hearing from someone who faced the same challenges and choices that you did, and who is now living with those choices, that makes YouTube one of the most important channels for health information.

But what of the healthcare professional? Are they not, too, bullfighters in their own right, making decisions that deal with death and life, in big ways and small, every single day? I find myself in too many meetings in which we deliberate over the patient journey and decline to do the same for the physician, reducing them to a sentence or two, a professional epigraph and no more: “Neurologists like puzzles; psychiatrists don’t like touching patients; oncologists are like chefs.” These basic insights are helpful, up to a point, but I don’t believe that they capture what it’s really like to diagnose a patient with Alzheimer’s disease, bipolar disorder, or prostate cancer, not once, but many times a month, a week, or even a day. I’ve never done it, but as a field researcher have been an observer to many intricate, challenging moments that take place in hospitals and offices, and more than once, as a translator, have been asked directly, “What would you do?” The answer is never easy, and with the fourth wall down, you find yourself wondering if you are capable of making the right call.

It is these moments that most stick with me, as bringing home the gravity of the daily work of healthcare professionals. And I often try to remind myself of these feelings when discussing how best to reach a professional audience, to help them or to change the way they see a specific disease, or treatment, or test. We can make recommendations, but they have to live with the consequences of success or failure if they follow them. If we want to communicate effectively with our professional audiences, it is worth remembering that they face bulls every day; mostly, we just talk about them.

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