Managing your summer reading

If the newest John Grisham or Danielle Steele novel isn't your preference for beach-side reading, pick up one of these new releases from the Faculty of Management.

The human touch

Balbir Gill | The idealized myth of Florence Nightingale is that of someone who cools the fevered brow and calms the spirit. It turns out that the emotional sensitivity associated with this type of "human touch" has a very real and measurable impact on patients. But we all know that this quality is something you are born with and cannot be taught the same way medical treatment is.

McGill professors Debbie S. Moskowitz, Gilbert Pinard, Laurette Dubé and Université de Montréal professor Guylaine Ferland.
Owen Egan

The editors of a newly released book, Emotional and Interpersonal Dimensions of Health Services: Enriching the Art of Care with the Science of Care, (McGill-Queen's University Press), would beg to differ.

Debbie S. Moskowitz, McGill psychology professor, Guylaine Ferland, a professor of nutrition at Université de Montréal, and Laurette Dubé, the James McGill professor of consumer psychology and services marketing management, have just released their book, which focuses on how emotions and social interactions affect health.

"When you talk about the human touch people think you're either born with it or not," says Dubé. "There are also individuals who are born with better cognition than others, but that's no reason to not study how people think." She says there are ways to understand the human factor in health care and there is scientific evidence that shows emotional and interpersonal behaviour has a measurable effect on a person's well-being.

Dubé's first collaboration with Ferland and Moskowitz was on a study of nutrition and geriatric patients in hospital settings. Ferland, who is also director of clinical research at the Institut Universitaire de gériatrie de Montréal, says, "The objective was to document the degree and prevalence of malnutrition, excluding people with medical conditions that would lead to malnutrition. When people are fed properly their health does not deteriorate." Ferland says that financial cuts to a hospital's kitchen affect the patient's diet and their health. In the case of patients who need assistance with feeding, staff need to be available at mealtimes. If there is a staffing shortage, both patients and health care workers feel the impact, Ferland adds. "The health care to patients is definitely influenced by the personnel available and the personnel are affected as well, as in the issue of nurse burnout."

Moskowitz focused on emotions and interpersonal dynamics and how those affected food intake: "How is the physical help delivered and how is the patient feeling? Is the patient comfortable making requests of the care providers and how are the requests responded to?" She found that the patient's feelings and interactions with the caregivers affect how well the patient does.

Moskowitz says using effective interpersonal strategies would lead to patients following medical advice and getting healthy faster. In her role as a supervisor, she follows her own advice. "I try to minimize the negative experience of students who are in a subordinate role by encouraging students to take actions such as identifying barriers to completion of their work, and by making suggestions for how they can structure their work to complete it by mutually determined deadlines. So my goal is to support the students' independence in achieving goals we set together."

Gilbert Pinard, senior psychiatrist at the Allan Memorial Institute and a McGill psychiatry professor, wrote a chapter about the emotional states of patients and how their emotions affect their health. "There are some psychiatric disorders that are important to the outcome of medical illness. The research done here at the Montreal Heart Institute shows that people who suffer from depression have a greater chance of dying over the next year than people who aren't depressed," he says.

"In the health care system we have such a scientific zeitgeist that we need evidence to get our attention, and I think this book goes a long way to doing that."

Dubé points out that the norm in health research is to do randomized trials with large samples. Studies on human aspects of health care need to be held to the same evidence-based findings in other health care research.

She says that because people often avoid whatever threatens or frightens them, patients may not follow instructions well. In order to get them to comply with medical advice, their emotions have to be taken into account. Dubé has researched the use of humour in disease prevention work - such as the promotion of sunscreen use to prevent skin cancer or condom use to reduce HIV risk - and found that humour is an effective technique to get people to follow health advice.

Dubé's upcoming research will put emotional and interpersonal theories to the test. She will do the equivalent of a randomized clinical trial in order to see if generating positive feelings in subjects who were tested for breast cancer will lead them to make healthy lifestyle changes.

Just as for medication trials, the groups will be divided into two, one that gets intervention and the other that serves as a control group. "When we want to change a habit there's nothing like starting at a period when there is vulnerability and then reassure them and influence them to establish healthy habits."

The E-Health Challenge

Dubé, Moskowitz and Ferland collaborated on a workshop in 1999 that focused on integrating the human aspects of care. This workshop formed the basis for their new book and was a precursor to what is now the McGill Integrative E-Health Challenge.

Faculty of Management dean Gerald B. Ross spoke April 15 at the closing of the first track of the 2004 Challenge, explaining its origin. "I found that almost all the research areas were in functional silos: finance, marketing, accounting. We said we should do some research in health management. People wondered, 'Is that finance? Is that strategy? What is that?' So we got together with [the Faculty of] Medicine and called this a consortium so it could include practitioners from other universities and people from other countries. The Challenge is one of the major initiatives emerging from this."

The faculties of Management and Medicine co-organize this yearly consortium on health management that shares research findings, enhances leadership and management skills of health care professionals, and provides the chance for specialists to meet and share their knowledge across disciplines.

The Challenge brings together experts in a variety of fields from other universities and countries in order to tackle a subject in an integrated fashion. About 40 people are selected to participate in this event by invitation only.

A clinical context is selected that informs the discussion. This year's workshops focused on respiratory health, such as asthma and chronic lung disease.

The Challenge is divided into two parts. The track one theme, "Closing Management Gaps at the Level of the Patient, Provider and Health System," took place April 14 and 15. Guest speakers discussed a range of issues that affect respiratory problems. Specialists presented their research and clinical experiences in areas such as public health education, air quality, management of symptoms, education and differences in ethnicity and socio-economic status between the health care provider and patient.

Track two of this year's Challenge, "Closing Management Gaps at the Emergency Department and its Interfaces," was scheduled for April 28 and 29, and focused on respiratory health and emergency care.