Friday, March 14, 2008

Testing boundaries: how much is too much? Challenge

Sometimes you're sitting with a patient or family member, conducting your reference interview so you can determine what their information needs are, perhaps trying to find a balance between what their health care provider suggested they be given (say, information about hormone replacement therapy), and what they themselves are truly or additionally interested in learning about (say, returning to a normal sex life after surgery), and it becomes clear that what's really important here is not the information but the time spent talking to someone, being heard.

There are times when I find myself talking with someone for far longer than it took to meet their information needs. One person will want to tell me about his children, how they're doing at school, how he met his wife, another might go into more detail than necessary about a previous surgery, about a seemingly unrelated health issue, or about her love of gardening. On the surface it all seems unrelated, but if you put yourself in their shoes for a moment, then it's clear that everything is intimately related because it's their life we're talking about, not just their illness, and the one cannot be separated from the other.

So I listen, and I listen for clues to what might be hidden information needs. Sometimes what seems on the surface like chit chat is secretly or unconsciously a question. My job is not only to help people find information but to show them what kind of information is available, and even to help them figure out what it is they really want to know, because this is not always clearly formulated from the get go.

On rare occasions it feels like I'm having hundreds of questions fired at me all at once, and I can't be sure which to take seriously. When this happens I try to bring things back to the matter at hand and keep things focused. I have to wonder though, where exactly to draw the line. Is an hour too long if all of it is spent researching the question? Is it too long if 30% of it is spent researching the question? How many questions can reasonably fit into one session? And how much do I want to know? What is it appropriate for me to know? Is okay for this to be dependent on my own personal and professional sensibilities balanced with the desires of the person I'm helping?

Other times I get asked difficult questions, like "what would you do?", or "what should I do?" In these cases I must be extremely careful to not give any answer other than, "I am not a health professional. I cannot give you advice about what to do or how to interpret this information. Your doctor or nurse will be happy to go over this with you." Sometimes I have to say this over and over.

It's tough. I want to help people and feel that they're satisfied with my help, but in these cases everyone involved is left with a feeling of dissatisfaction. I know that their doctor or nurse will not always be able to go over it with them in the kind of depth they want or need, not because they don't wish to but because there isn't the time. I also know that consultations with doctors and nurses are often stressful and all the hundreds of questions can fly straight out of a person's head when it comes time to ask, even if they've been organized and proactive and have brought a list with them. But I still cannot give any other answer. It helps that I genuinely don't know it.

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