In my last blog, I offered the diagnosis that the medical community suffers from cognitive dissonance when it comes to patients and radon communication. To be clear, this cognitive dissonance arises from two facts. First, the medical and public health communities are aggressively advocating against behaviors, such as smoking, that cause lung cancer. Second, the medical community has not taken an aggressive approach to radon counseling, even though radon is the second leading cause of lung cancer. In this blog, I would like to explore two of the more important reasons why I believe that this situation exists. In later blogs, I will discuss some ideas about a cognitive dissonance cure.
To gain a better understanding about why radon communication is not routine in medical counseling, we first need to get a better idea about the world in which the physician works. It may seem obvious, but it is worth pointing out that the doctor’s occupational environment is important for and influences how she interacts with her patients. While I am not a physician, I have been able to learn a great deal about this world from the published literature.
Physicans today work in a high pressure, time squeezed profession. Anyone who has taken a look around during a recent office visit has probably noticed the constant activity that characterizes a general practitioner’s office. There are patients to log in, tests to be taken, medicines to be dispensed, follow up appointments to be scheduled, and payments to be made. Time with the doctor is often limited, and the interaction can be one-way: the doctor talks and the patient listens. The medical literature demonstrates that this method of exchanging information is very ineffective, because patients often do not understand what the doctor is telling them and are not able to ask the doctor questions that are important to them.
To make matters worse, physicians are paid very poorly for counseling, except perhaps in special situations dealing with disease management. Managed care has shortened visits and in many cases reduced patient-physician rapport to a business contract. All of these factors create a situation in which one of the most complex and significant relationships – the doctor/patient connection – is shortchanged and undervalued.
This is not the best foundation on which to build a radon counseling and communication program. But beyond this problem there is another critical issue that revolves around the bad and the good of this phenomenon known as radiation.
As a community dedicated to reducing radiation exposure through radon testing and remediation, we are trained to think that radiation exposure is a bad thing. We need to take a step back and remember that in medicine, radiation is very often a useful tool. For example, in the form of CT (computerized tomography), it is an extremely valuable technique. CT uses radiation to take a series of internal pictures to give physicians essential information to help them decipher diagnoses and recommend treatments. The use of CTs has exploded over the past two decades and, while there are times when CT is overused, there is little doubt in the medical community about its value. In addition to CT and other diagnostic radiological procedures, radiation is used in disease treatment, too. What this means is that there is such a thing as good radiation, and almost every physician is using, or will have used, radiation in some form for diagnosis and/or treatment. This good radiation is also delivered at doses that are much higher than the mere 4 picocuries per liter action level at which radon remediation is recommended.
The widespread use of radiation in medicine at higher doses for the benefit of the patient creates difficult terrain for physicians who want to counsel about radon risk reduction. They are immediately faced with a risk communication problem writ large. How do you explain to patients that intentionally given, higher doses of radiation (CT scans) are good, while lower, unintentional, natural doses of radiation (radon) are bad? And how do you negotiate this communication challenge in a pressure filled environment that puts a premium on reducing doctor-patient counseling time?
By peering into the physician’s world, we can see more clearly why radon counseling is not routine. In my next blog, I will suggest ideas for overcoming these and other challenges and offer some suggestions for radon professionals who want to work with the medical community.
Dr. Paul Locke is a radon leader who has over 20 years of experience in radon science, policy and law. Dr. Locke is an Associate Professor at Johns Hopkins Bloomberg School of Public Health.
United States