A change in tone is needed to facilitate conversation between experts and a literate public

“Promote the notion that more info literacy is a practical answer to the growing info pollution.” (Rheingold, Net Smart, p.89)

“Conversations among human beings sound human. They are conducted in a human voice.”

“…Markets are getting smarter, more informed, more organize. Participation in a networked market changes people fundamentally.”

(Levine, Locke, Searls & Weinberger, The Cluetrain Manifesto: The End of Business as Usual, Thesis 3 and 10)

Last year I had an experience as a patient that changed the way that I thought about communication, specifically between experts (the doctors) and the increasingly informed public (the patients).

I had recently been through screening that revealed something worrisome. Since my healthcare provider is laudably transparent, I had access to the test results describing the discovery weeks before I had the chance to meet with a doctor and discuss. This, of course, gave me quite a lot of time to do my own research.

When it comes to researching health and medical issues on my own, I know that the internet is filled with misinformation, and that the doctors are the experts. I don’t panic, self-diagnose or jump to conclusions, but I do like to be as informed as possible when I meet with a doctor so that I can participate in conversation and ask relevant questions. I turn on my internet crap-filters and come walk into the doctor’s office prepared.

The day of my first informational appointment, the doctor swept into the room and introduced herself and her accolades. Then she described her observations from my test results, many of which matched nicely with my own research. However, the way she explained my situation and the tone of her voice made me feel like she was talking to a child. When I asked questions she quickly swept them aside and assured me that there was nothing to worry about. At this point I surprised myself and the doctor by starting to cry. The doctor was shocked, as she had just told me that everything manageable. It wasn’t the content of her presentation to me that caused my reaction. It was her tone of voice, and her dismissal of my worry that deeply upset me. She pointed me to a tissue box and made her exit. I changed doctors.

I was nervous about my second appointment. I knew that I was working with someone new, but my last experience was so upsetting. The new doctor came into the room, introduced herself and then knocked my socks off by her next statement. She said, “I’ve looked at your charts and I’ve formed my opinions, but first I would like you to tell me what you already know so that I can make sure we’re on the same page.” I felt like she was inviting me into a conversation, that she valued me. She didn’t diminish my perception of her expertise by asking me what I already knew. Instead she gave me credit and brought us both to a place where we could productively move forward.

The relationship between experts and amateurs, and the “company” and the “market” has shifted since the common people have had more access to information and better connection to each other. The authors of The Cluetrain Manifesto brought forward 95 theses that explored the shifting balance of power between corporations and the consumers who they market to, declaring that the people want to be treated like humans. Companies need only to look within to find employees that share a voice with the public that they are trying to reach. The consumer is getting so savvy that they can identify when they are being pandered to in a way that is insincere. “Companies need to come down from their Ivory Towers and talk to the people with whom they hope to create relationships.” (The Cluetrain Manifesto, thesis number 25.)

On the other side of the coin, the people have a responsibility to become savvy consumers of information. We have access to more information than ever before, but it also runs the gambit in terms of quality and truthfulness. In the chapter on “crap detection” in his book Net Smart, Howard Rheingold champions many techniques that consumers can use to ensure that the fruit of their online research is as reputable as possible. Among them are methods like researching the credibility of the author (p. 78), triangulating information by checking three reliable sources (p. 79), using fact checking tools (p. 90) and finding resources that experts endorse as reliable (p. 91).

When specifically discussing the phenomenon of patients doing their own research before speaking with a doctor, Rheingold is cheered that at least one respected medical source “has publicly advised doctors to teach their parents the kind of crap detection that licensed practitioners learn to do early in their medical careers.” (p. 91). If doctors can help their patients to be savvy consumers of available information they empower people to make better healthcare decisions.

In my case, it mattered to me to have a doctor who acknowledged that I was coming into the conversation having done my research. My desire to be prepared with a basic understanding as well as with questions doesn’t undermine my respect for the expert opinion. The first doctor had made me feel like she lecturing me, rather than bringing me into a conversation. The second doctor wanted to connect with me so that we could move forward together.

This is a lesson that I can bring into my work with end-consumers as well as with colleagues that are coming from different realms of expertise. Defaulting to lecturing only alienates the listener. Perhaps asking instead, “What do you already know?” is a better way to enter a productive dialogue.

BONUS: “Crap detection” was just one of many useful subjects discussed by Howard Rheingold in his book Net Smart. After reading the first chapter I actually bought my own copy of the book so that I could highlight more liberally and keep his advice at hand after the end of the course. Chapter 3 covers the importance of being proactive with your online presence. Rheingold discusses keeping up with Twitter and how he tries his best to be responsive to every post involving him (here he gives his twitter handle). I just had to put this to the test. Three years after publishing this book, would he live up to his claim?

Twitter response from Rheingold

It took him six minutes to respond to me personally. Needless to say, I am very impressed.

Does this qualify for extra credit?

Posted on October 18, 2015, in Uncategorized. Bookmark the permalink. 6 Comments.

  1. Hi Allie,

    I found it interesting how your post this week broached on the topic of experts versus the literate public. As your example demonstrated, communication centered on medical issues is one of the many areas where expert opinions and the literate public can converge.

    While I often jump to conclusions when Googling my medical symptoms it seems like you were level headed in your research.

    Similarly, I also would have been frustrated with the first doctor who talked down to you and didn’t want to hear your input. I think regardless of your background knowledge, it is important to have both sides of the conversation heard. This is what the second doctor who invited you to share your knowledge of what you already knew did better. Overall, the concept of an open dialogue between participants regardless of their level of expertise can be beneficial. While one party may be more knowledgeable, having everyone’s opinions heard can put all parties at ease.

    P.S. I am impressed that you bought Rheingold’s book, but I’m even more impressed that you were able to connect with him on Twitter. Props to you! 🙂

  2. Hi Allie,

    That’s awesome you got Rheingold to respond!

    Regarding crap from medical professionals I had a similar experience last week with a doctor who not only blew me off, but gave me an “inaccurate diagnosis” I’ll say it that way instead of fake diagnosis because she wasn’t an expert in the issue. After taking an x-ray, she proclaimed I had a sprained hand and looked right through me as she went to leave. But not only had I done my research but I’d had four carpel tunnel surgeries previously – I knew what was wrong. I immediately thought of other patients who must come in with no idea of their issue and just take what they’re told. Anyway, I called my insurance carrier, reported her, will tell everyone about this experience, and never go back. Just like the crap detection needed for Internet sources and sites, I needed to be ready with an “expert.” And just like my response to her, I’ll always take my business elsewhere when faced with crap sites.

  3. Hi Allie! I think your example parallels the idea of consumer acquisition of information. You are, in my own humble opinion, a rarity consumer who prefers to be fully educated. For the other half of the world, they hope that they can focus on the aspects of their lives that don’t require added research – why not leave that to the experts? That’s why they get paid, right? I can see this same shift within technology. We have people in our organization who are consumers of information. They will go out to find enough information, but essentially want to confirm with the IT experts. Others, don’t want any change or impact. I think this shift is a common shift that we will see more and more.

    My concern with this consumerization of information is that the technical experts will think that all consumers have this same level of information acquisition desire. But the truth is, consumers don’t all think like that, but I am starting to see this shift within technology realm. Should we be concerned if doctors were to try and teach all of their patients about this crap detection, even if those patients don’t want to learn that? If we wanted to learn that, would we not have gone on to get our medical degrees?

    • That’s a good point! I think your comments do even more to highlight the genius in my second doctor’s practice of asking what I already know. If I had responded by saying that I’d rather leave the facts to the expert, then she would know to start from the beginning. I appreciated that she took into account that her patients (the consumers) were all coming from different places, and that she took the time to learn about who she was addressing. No assumptions.

      • Chelsea Dowling

        I think that type of attitude is very mixed in today’s professional, technical subject matter experts. You either have the people like your first doctor, or the one’s like your second doctor. It think academia will need to shift in order to help educate technical experts on how to identify and share information with this new millennial of information seekers. But who know – maybe they already are?

  4. Allie, way to go for taking the initiative to discover additional information about your results. With the plethora if information available at our fingertips as close as our own smart phone, why wait weeks for a single opinion from a single expert, especially when the research topic is as important as our own body. Professionals should assume most people will have similar initiative such as with your second doctor. It is true that there exists an overabundance of “crap” and personal opinion on the internet, and that most should be taken with a grain of salt as just that, an outside opinion. We would be irresponsible not to search for other opinions as well as technically sound online information from professionals. Professionals do often come across as the sole expert in their field and often invalidate any other opinion, but I agree it’s time to recognize and validate the commoner as at least somewhat intelligent enough to have asked a question or two on their own.

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