Healthcare Communication Genres

Introduction
Technical communicators must have a strong understanding of the rhetorical genres used in the particular field in which they are engaged. Put very simply, the term genre refers to a "typical way of organizing, presenting, and using language in situations that recur or repeat over time."[5] Genres can be regular and stable, or improvisational and changing over time, depending on the needs of the users (or groups of users) that utilize them. Communication genres that are particular to healthcare span a complicated range of verbal and written (paper- and digital-based) texts. Additionally, there are overlapping actor networks consisting of medical providers (doctors, nurses, technicians, aides), healthcare administrators (hospitals, insurance companies, equipment providers), and patients and their families. The communication genres used in healthcare settings depend largely on the situation and the relationship between the actors within the healthcare setting. Some situations to consider include patient visits to doctors' offices, patient hospitalization, and patient follow-up care. Relationships between actors within the healthcare setting to consider include patient relationships with their medical providers (doctors, nurses, technicians, aides), medical provider relationships with each other, and medical provider relationships with healthcare administrators.

Verbal Genres
Healthcare professionals must be able to communicate successfully verbally with their patients, with each other, and with the wider community. Two types of verbal communication may affect health outcomes: the language of medical discourse and patient healthcare literacy.

English as the Language of Medical Discourse
English is the de facto language of scientific research in much of the world and dominates medical discourse in the United States. Low proficiency in English in both patients and providers is one factor linked to negative health outcomes. If a patient is unable to understand or act on the information given by a medical provider, it negatively affects their prognosis. If a medical provider is unable to provide understandable information to patients as well as other medical providers, patient care is compromised.[9]

Healthcare Literacy
Healthcare literacy is another factor affecting healthcare outcomes. Patients with limited healthcare literacy are likely to be overwhelmed by medical providers that use sophisticated language and medical jargon, and, therefore, unlikely to seek clarification.[9] This kind of breakdown in communication contributes to negative patient outcomes. Additionally, providers should not substitute spoken, face-to-face communication with information leaflets and booklets, which patients may not understand. Technical communicators can research mediating tools (texts) that physicians can use to improve healthcare literacy in patients.

Improving Physician Communication
Poor physician communication is associated with lower levels of patient satisfaction, poorer adherence to treatment recommendations, and less favorable patient outcomes. Technical communicators can investigate ways to improve physician communication. Three examples of established methods of how to improve physician communication are detailed below.
 * 1) Education - Medical schools and residency programs teach communication skills to students using lectures, workshops, supervised patient interactions, and role-playing.[1]
 * 2) Structured Communication Tools - SBAR Pocket Card  - Provides a common framework for healthcare professionals to use to easily communicate important patient information with each other to improve the overall quality of care.[2]   An example of the SBAR Pocket Card appears below:

Written Genres
Written genres in healthcare communication are established as part of the information work that healthcare providers perform in the course of patient care. That information work includes collecting and organizing patient data, consultations with and reports to other healthcare professionals regarding patient care, making patient care decisions, and placing orders for patient care, tests, procedures, medications, etc. Written genres emerge from this information work that are both paper and computer-based, and are used by a range of healthcare providers for multiple purposes that are interrelated.

Examples of paper-based healthcare genres:

 * 1) Prescriptions - A direction, usually written, by a healthcare provider for the preparation and use of a medicine or remedy. (www.dictionary.com)
 * 2) Patient History and Physical - The written record of the "H&P," which is a collection of important health information taken from the patient by the healthcare provider and entered into the patient's records.
 * 3) Patient Information Leaflets - Printed healthcare information provided to patients by healthcare providers.  Examples can be found here.
 * 4) Posters - Large colorful, and informative printouts of medical information that healthcare providers place in prominent locations to communicate important facts to patients. Examples can be found here.
 * 5) Clinical Case Reports - A detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient that is a communication tool used by doctors to convey important healthcare information to other providers.[8]
 * 6) Patient Care and Office Forms - A variety of printed-out documents containing curated information used by healthcare providers and administrators in their day-to-day practice of patient care. Examples of many forms can be found here.
 * 7) Insurance Forms - Documents containing patient information which identify and quantify healthcare services for the purpose of financial payments and reimbursements. Examples may range from patient insurance ID cards to medical coding and billing statements.

Examples of computer-based healthcare genres:[6]

 * 1) Electronic Health Record - The EHR is primarily an electronic database containing a patient's information through which its input and output functions allow healthcare professionals easy access to stored patient information.[11]
 * 2) Tele-Medicine - Healthcare services provided remotely using real-time, two-way communication using electronic audio and visual means like telephones and computers. [3][10]
 * 3) Email - A method of exchanging messages between people using electronic devices.
 * 4) Pager - Also known as a beeper, is a wireless telecommunication device that receives and displays alphanumeric or voice messages.
 * 5) Text - An electronic message sent over a cellular network from one cell phone to another by typing words. (www.dictionary.com)

Electronic Health Record (EHR):
The EHR (sometimes also referred to as the EPR-Electronic Patient Record) is primarily an electronic database containing a patient's information through which its input and output functions allow healthcare professionals easy access to stored patient information. The EHR is a compilation of patient data that is input, organized, and used by healthcare providers based on information drawn from both verbal and written (paper and computer-based) genres. Technical communicators should know that the visual representation of patient data in the EHR is an important tool for healthcare providers to coordinate patient care in the multimodal and interprofessional collaborative healthcare setting.[11] The intended audience of the EHR includes patients, doctors, nurses, administrators, and insurers (and others) who use the same information for different purposes.

Role of the Technical Communicator in Healthcare Communication
Technical communicators need to know that healthcare communication genres do the information work that allows actor networks in the healthcare universe to fulfill their roles. These verbal and written genres function in repeating situations that may be simultaneously stable and improvisational depending on the needs of the differing communities.[7]  Those communities (actor-networks) use the same genres, but for different purposes, according to their roles in the administration of care. For example, physicians seeking to improve their communication skills may use the SBAR Pocket Guide to ensure patients with low healthcare literacy get the most from their meetings with their providers. Likewise, a nurse may give a patient a vaccine information leaflet to reinforce verbal information provided during an appointment. Both healthcare providers are using written genres to improve healthcare communication but in different ways. The EHR (also known as the Electronic Patient Record - EPR) is the healthcare genre that best demonstrates the complicated interplay between the many actor networks in healthcare and the genres they use to communicate. The Physician Genre Ecology illustration below from "Mapping the Genres of Healthcare Information Work: An Interdisciplinary Study of the Interactions Between Oral, Paper, and Electronic Forms of Communication."[11] shows how verbal communication plus the written genres of patient notes and lab results (which are located within the EHR) are "transformed" when they are used by the different actor-networks of doctors, nurses, and specialists, to achieve the outcome of another written genre: a medication order. Healthcare communication genres are used by all parties to achieve the desired outcome.

Role of the Technical Communicator in Healthcare Communication Technical communicators need to know that healthcare communication genres do the information work that allows actor-networks in the healthcare universe to fulfill their roles. These verbal and written genres function in repeating situations that may be simultaneously stable and improvisational depending on the needs of the differing communities.[7]  Those communities (actor-networks) use the same genres, but for different purposes, according to their roles in the administration of care. For example, physicians seeking to improve their communication skills may use the SBAR Pocket Guide to ensure patients with low healthcare literacy get the most from their meetings with their providers. Likewise, a nurse may give a patient a vaccine information leaflet to reinforce verbal information provided during an appointment. Both healthcare providers are using written genres to improve healthcare communication but in different ways.