“e-Patient Dave” deBronkart

Being Heard as Possibility

Generating a Conversation in Medicine for

Partnership with Patients Rochelle Frank, MD

acknowledging the support of Lorin Bacon, NP

The Question: How does one speak

into a predominant network of conversations

in a way that occurs as insight and not as a threat

to be defended against?

2007: My “Incidental Finding” Routine shoulder x-ray, Jan. 2, 2007

“Your  shoulder      will  be  fine  …      but  there's        something        in  your  lung”  

Classic Stage IV, Grade 4

Renal Cell Carcinoma

Illustration on the drug company's

web site

Median Survival: 24 weeks

“My doctor prescribed ACOR” (An online community of my patient peers)

Note: the ACOR group is now at SmartPatients.com

Equipped Engaged Empowered Enabled”

“e-Patients are

Pt of future

The idea of empowered patients

continues to gain acceptance:

2011

2013

2015

And yet many – like the Belgian government! –

still say “don’t google it”

Belgian government’s Google Ad campaign, 2014

http://bit.ly/belgiangoogle

Insulting image from the campaign

showing a man who googled a symptom

and ended up scaring himself,

thinking he had this imaginary disease

What do you say in a situation with

such conflicting views?

Things look different when you shift your perspective

Source: Wikipedia, Copernican Revolution

Things look different when you shift your perspective

Source: Wikipedia, Copernican Revolution

They might even get way simpler

What could be said that would make any difference?

The question to ask if you want to generate a new conversation:

There really is no point saying anything else – right?

Also known as… Listening for Workability

First: Get in their world.

See things as they do.

“How can this be, if things are the way

we’ve been trained to think??”

Next: Ask a paradigm-busting question

How can it be

that the most useful and relevant and

up-to-the-minute information

can exist outside of traditional channels?

The one I use:

My answer slide for that question:

(The internet’s “capillaries” have changed how information can flow)

Point out precedents that they can see have been all around

Next: “This is not new”

“E” is not a new idea

•  Doctor Spock’s Baby and Child Care (1946)

•  Our Bodies, Ourselves (1973) “We weren't encouraged to ask questions, but to depend on the so-called experts,” Hawley told Women’s eNews. “Not having a say in our own health care frustrated and angered us. We didn't have the information we needed, so we decided to find it on our own.”

The one I use:

In short, remember: you want to generate

a conversation

First get in their world

“I don’t know what I said until I know what you

heard”

A lesson from international diplomacy – being responsible for how you’re heard

To transform their view, see life as they do and then point out

something new.

Answer an unanswerable question in a way they can get

and a new view of life emerges.

The constraints the past imposes on their view of life disappear.

Their experience of being alive can transform.

This is transformation: the genesis

of a new realm of possibility.