As market transformations continue to take hold within the health care industry, new patterns of organizing to meet the increasing complexity of service delivery are needed. As a result, great pressure is being placed on researchers, practitioners and patients to develop new ways of talking, listening and working within the clinical environment.
Last week, Verlyn Klinkenborg’s NY Times article about the lost art of reading aloud circulated the web. The article has lessons for everyday talk as well as for understanding new ways of organizing within the medicine 2.0 and “e” movements. Specifically, the words in the article shed light on a pattern health reform should take note of – the life of language.
The article states a significant number of Americans these days read by listening, or listening aloud as she calls it. From this perspective, there is something interesting and even lonely that is part of a larger pattern. As she states, “instead of making music at home, we listen to recordings of professional musicians. When people talk about the books they’ve heard, they’re often talking about the quality of the readers, who are usually professional. The way we listen to books has been de-socialized, stripped of context, which has the solitary virtue of being extremely convenient.” 
But listening aloud is not the same as reading aloud. Although both are important ways to learn something about the rhythms of language, “one of the most basic tests of comprehension is to ask someone to read aloud from a book.” Further, “reading aloud recaptures the physicality of words. To read with your lungs and diaphragm, with your tongue and lips, is very different than reading with our eyes alone.” In short, the language becomes a part of your body. Because, words are the “breath and mind, perhaps even the soul, of the person who is reading” and I would add, the person who is healing or being healed in the clinic.
Among the social media movements, practitioners and patients are being encouraged to respond to a lot of things in an attempt to become participatory or go “e.”
And clearly, “e” is providing a new way of organizing and therefore a response to many market demands. First, as e-patient Dave underscores, is the harmonious way Web 2.0 lets us discover, and help each other discover, new partnerships and resources. Second, The Hastings Center entered the blog-world (albeit late!) because of the need to start a public conversation about curbing health care costs and be a voice in health care reform “e” communities. Third, scienceroll discussed a recent e-course – how to create and manage a quality medical blog – that was the first e-course to be publicly accessible including tips about step-by-step tutorials into the realm of medical blogging and micrblogging. My point: “e” movements are indeed having an enormous effect on the way people communicate, the way people connect, the way people learn, the way people think of others and themselves and the way people care for each other and want to be taken care of.
This new way of organizing is being produced through a very active, playful and important language – the art of participation.
What then is the relationship between the art of participation and the art of speaking out loud?
As the patterns of “e” movements continue to be developed, altered, and maintained we might indeed have a new form and culture of medicine. Participation, however, needs to be worked out in these “e” movements. Specifically, what role is participation playing in reforming health care? Who can participate? Whose values are guiding our understanding about what it means to participate? What does participation sound like or look like? And what would a language of participation achieve in clinical practices?
These are questions for a very ambiguous and complex word that means different things to different people; yet a word and a discourse that is remarkably important for health care.
That said, the argument could be made that participating in social media forums or “e” communities, listening to podcasts, blogging, microblogging, commenting, twittering and so is a sign of a new prosperity in the 21 century and a new connection to medicine. But as our article reminds us, participating like reading is “incomplete, impoverish, unless we are also taking the time to read aloud” (talk out loud). There is something peculiar about talking out loud together, even empowering as we each navigate our ways through our own experiences of pain, suffering and hope.
I encourage you to take this practice seriously in your own communities and practices so that these forums for talking, listening and participating begin to translate into the clinic to allow patients and practitioners to move from being the consumers of health care information to the co- producers of resources such as advice for situations of uncertainty, uniqueness and conflict…
What kinds of words and actions do you think would constitute a vocabulary of participation??
Thanks to Keegan Jones and dalydose for their images…
Carey Candrian
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