About Bryan Whaley, Ph.D.: Bryan Whaley is a Professor of Communication at University of San Francisco (USF), where he also serves as the Director of the Health Studies Minor. He earned his Bachelor’s Degree in Speech Pathology and Audiology (i.e., Communication Disorders) from California State University, Los Angeles, his Master’s in Communication Theory, also at Cal State, LA, and his Ph.D. in Interpersonal Communication from Purdue University.
His primary areas of research are investigating the communicative factors that are relevant to explaining illness to patients, message variables that optimize communication between patients and their health-care providers, and the role that messages have in persuasion and social influence. At USF, he teaches courses in health communication, experimental research methods, communication and disability, persuasion and social influence, and public speaking for the health professions.
Dr. Whaley is the editor of the following books: Explaining Illness: Research, Theory and Strategies; Research Methods in Health Communication: Principles and Application (both of which have won the Distinguished Book Award from the Health Communication Division of the National Communication Association); Explaining Communication: Contemporary Theories and Exemplars (with Wendy Samter); and Interpersonal Message Design: Theories, Evolvement, and Modern Application (with Chris Morse).
[MastersinCommunications.com] How did you first become interested in interpersonal communication?
[Dr. Whaley] I’ve always been interested in how people talk. I majored in Communication Disorders as an undergrad, for I wanted to go to grad school for a Masters in Deaf Education. But, toward the end of my degree, I had an experience in the speech clinic that drove me to want to study interpersonal communication—the factors that contribute to message design and communication between people. And, as I continued to study interpersonal communication, I wanted to examine the effect analogies have in messages.
Analogies serve several functions—informative functions, expressive functions, and persuasive functions. My dissertation dealt with the informative function of analogies. You can use analogy to help someone visualize the mechanics of what goes on in their body. For example, a doctor or nurse could explain to a patient, “Water through a garden hose is like blood flowing through an artery. If you keep the hose clear of obstructions and kinks, the water flows without a problem. But if there is a kink or a block of some kind, the pressure will build up, and that can severely damage the hose. In similar ways, when you have plaque in your arteries, the pressure can build up and it can really harm your artery walls, and sometimes even lead to a rupture.” A is to B as C is to D—that form, the analogy, can be a powerful way of driving home a key health or medical point.
[MastersinCommunications.com] You have also researched the use of rebuttal analogies in political and interpersonal discourse, as well as persuasive communication. What is a rebuttal analogy, and in what ways is it significant in interpersonal and professional relationships?
[Dr. Whaley] My colleague Rachel Holloway, who is at Virginia Tech, and I had identified a previously unidentified form of analogy called the rebuttal analogy. Years ago, there’s an article I read, where the author of the article gave an example of the use of an analogy to drive home a counterargument. This was when people were trying to obtain permission to use marijuana for medicinal purposes. The author of this piece was arguing in favor of the use of medicinal marijuana for people with glaucoma, certain cancers, and AIDS, conditions where treatment of the condition can lead to nausea or loss of appetite.
At the time, the government was only allowing the use of THC in pill form, with the argument that there was not a need to allow patients to smoke marijuana. In response to this argument, the author of this piece essentially said that asking patients who are nauseous to take a pill and keep it down for 30 minutes in order to feel better was ludicrous. He made the following analogy: “Using a pill to treat vomiting is like using a suppository to treat diarrhea.” A vivid and perhaps rather lurid analogy, but one that unequivocally gets his point across. A is to B as C is to D. This is an example of a rebuttal analogy: he’s rebutting the opposition’s argument in analogy form, and that just fascinated me.
I conducted one extremely large study, and a couple of other smaller studies on this concept. The larger study had close to 800 research participants, while the smaller studies had around 250 or so. And the data from these studies suggested that, when people use rebuttal analogies, whoever the speaker is, that speaker is seen as less credible, less intelligent, less persuasive, less likeable, less polite, and the message is seen as weaker and less persuasive, and even unethical. And that was also quite fascinating to me, because it felt counterintuitive. When I conducted the large study, I predicted the opposite findings—as a researcher, I have a great respect for people who use rebuttal analogies, as I find them to be highly effective in getting a particular point across. But almost across the board, rebuttal analogies were perceived negatively. I have considered several theories about why this might be the case.
I have theorized that perhaps any attack to face by a speaker, whether he or she is correct, is seen problematically. It might come down to a politeness issue, where rebuttal analogies do not seem like polite discourse, because at their root they are insulting the intelligence of an individual—thinking back to the pill vs. suppository analogy, that statement is clearly meant to portray the government’s argument as ridiculous. And whenever you cast someone and/or someone’s argument in a ridiculous light, there is pushback. If you think about it from a political standpoint, attacks on people’s face (by which I mean attacking their dignity through disrespect) is seen rather negatively. So even if the person making the rebuttal analogy is right, even if they’re being truthful, the attack on someone else’s face is just not seen well.
[MastersinCommunications.com] That’s fascinating. Out of curiosity, have you ever encountered a case in which a rebuttal analogy was used and it was polite and not taken offensively?
[Dr. Whaley] That is a good question, and my answer is no. The very nature of rebuttal analogy is that it is an attack on face. I think there’s a continuum of politeness in argumentation, but the whole nature of rebuttal analogy is you’re telling the other person in a very clear and direct way that their argument is weak and fallacious. And right there, you’re telling somebody something that may diminish their public image or their sense of their own competence. And everybody inherently wants to appear competent, to save face. I’ve seen many rebuttal analogies that are on a continuum, where some are just a little more graphic than the others, but all of them seem to elicit a negative reaction, from what I have seen.
[MastersinCommunications.com] When and how did you become interested in health communication? May we have more information on your book Explaining Illness: Research, Theory, and Strategies and the impact it has had among medical practitioners and their practice, as well as scholars of health communication?
[Dr. Whaley] I published the book entitled Explaining Illness: Research, Theory, and Strategies back in 2000, and this book is essentially about the different methods for explaining illness to different patient groups. The book is divided into chapters based on different populations—for example, there are chapters on explaining illness to children, to the elderly, and to different cultural groups.
As mentioned, my dissertation concerned how we process analogies in persuasive messages. Along the process I would find articles suggesting that analogies are effective in explaining illness. Once I got to USF, I published a few articles in the journal Health Communication regarding the use of analogy in explaining illness to children. I got a number of emails from people around the country and world to this effect . . . “I read your article(s). Do you know anything about explaining illness to older adults or people with less health literacy?” And I had to respond that I didn’t, and to me that felt like an opportunity, so I thought to myself, “Why don’t I do an edited book on what we know about explaining illness, the linguistic strategies for making illness and disease clear to everybody, all ages and sectors of society?” And so that’s how the book Explaining Illness came to be.
From this background, I developed an interest in health communication. To me, health communication is really about effective messages—more specifically, about patient-provider interactions and the messages that are conveyed through those interactions. When you go into a healthcare context, what are the messages that people in healthcare use for medical instructions, reassurance, bad news delivery, social support, etc.? Those questions really intrigued me and compelled me to study health communication, which to me is just interpersonal communication in a health-related context.
[MastersinCommunications.com] What are your responsibilities as a Professor of Communication and the Director of the Health Studies Minor at University of San Francisco?
[Dr. Whaley] As a Professor, my duties are research, teaching, and service. One detail I would like to mention is that I designed a course called Public Speaking for the Health Professions, which serves as the core university public speaking requirement for the health-related degrees at University of San Francisco. Health communication is relevant to the training of nursing students, kinesiology students, chemistry students who want to go into pharmacological studies, and both medical and physician assistant students. In this class, we have a large focus on medical animation, because people in healthcare now generally use visuals to explain anatomy, physiology, and disease.
[MastersinCommunications.com] What opportunities do health communication research and health communication training/education present to medical and health professionals such as doctors, nurses, physical therapists, etc.?
[Dr. Whaley] As a researcher, I am interested in messages that we as human beings use to get things done—the intent of those messages, the purpose of those messages, and what is it about certain features within those messages that makes one message more effective at its purpose than another. These concepts are highly relevant to individuals in all health-related and helping professions. For my research, one of the populations I focused on the most was nurses, because there are more nurses than any other healthcare practitioner, and nurses interact directly with patients more than any other healthcare professional.
We know that the effects of messages in healthcare, such as social support, reassurance messages, bad-news delivery, compliance, adherence, etc., have a great impact on patient health outcomes and also their healthcare experience. And almost 95 percent of what nurses do is speak with patients, support them and inform them. Nursing literally is communication, and so many nursing programs do not actually teach their students what comes to be about 95 percent of their job. These programs teach them the biomedical aspects, which are undoubtedly crucial, but not how to optimize the communications that make up such a huge portion of their job. In fact, I approached our Dean of the Nursing School at USF, and I told her my thoughts on this, and explained my idea for a journal on nursing communication, a journal that is dedicated to nurse-patient interaction. I’m working on my inaugural issue.
[MastersinCommunications.com] As a scholar of health communication, how would you say the field of health communication has evolved over the past two decades, and where do you see it going in the future? What role do you believe communication technology advancements will play in reshaping health communication and interpersonal communication?
[Dr. Bryan Whaley] A lot of the health practitioners who approach me ask me, “How can you help me create better messages for my patients? Can you give me a list of concrete steps that I can take to improve my communication with patients?” They want a formatted approach, and that’s just not how it works.
And, I’ve gotten a lot of pushback on that idea. When I’m invited to speak with medical practitioners about effective patient-provider communication, many of them ask if I have a handout. And no, there is no handout. If you understand the theory and if you understand the principles and concepts I’ve been talking to you about, you’ll be able to create more effective messages. I say, “You’ve been creating messages since you were about 12 months old, so you’re 99 percent there. All that my colleagues and I are going to do is provide you with the research on the latest factors that contribute to the effectiveness of health-related messages.”
If you think about the human body, it is a system. And what people learn in medical school or nursing school is that everything is connected–symptoms that manifest in one organ system are also connected to the entirety of the human body. Patients cannot be treated with a simple checklist, and with communication it’s the same way. It needs to be tailored to each patient situation, and therefore no checklist will fit all patients. But what health practitioners can do is learn about the latest research on what is effective and what is not effective in medical communication, and use that to tailor their communications with different patients.
To me, the study of communication is the study of messages, and messages are just what we as human beings use to get things done. And in medical settings and scholarship, there is a great dearth of research in health-related messaging and how to truly optimize it. To me, the field hasn’t progressed as much as it should because we’re not really studying the effects of messages on patients in different contexts. A two-unit course on bad-news delivery in a medical school program is frankly not enough, and doesn’t do justice to the importance of this form of communication and others that medical practitioners and their patients must deal with every day. Now, I’m going to put a caveat in there. There are some little pockets of research in social support with some very good colleagues in health communication and public health who are investigating the impact of different health campaigns, and asking, “Why is this campaign more effective than this campaign, with regard to the messages?” But all in all, I would like to see far more research on the effects of the messages we use in a healthcare setting.
For instance, the role of the pharmacist in America has changed drastically in recent times, and will continue to change. We’ve got robots filling prescriptions now, and therefore the role of the pharmacist has shifted. By law, the pharmacist must explain what certain medications do and how patients should use it. The person I am working with on The Handbook of Pharmacy Communication is Jon Schommer, and he wrote a chapter for me in my Explaining Illness book about 20 years ago, with regards to how pharmacists should explain illness to people. I am working with him and Erin Donovan from the University of Texas on this book to try and answer the question, “How does technology affect the impact and effectiveness of a message in pharmaceutical contexts?” We now have video conferencing, text messaging, Twitter, and online support groups, which can serve as substitutes for face-to-face contact with a medical practitioner or pharmacist. How does the use of technology change the relationship, and how does that change in relationship translate to health outcomes?
Everything we know about effective messages in person may be altered just by changing the medium. We don’t know that yet, as that research needs to be done. For example, say a doctor wants to give a reassurance message to a patient. Reassurance messages are messages that are designed to reduce someone’s fear and anxiety about an upcoming event or about their current health status. They are meant to help patients deal with the unknown, or the uncertainty that comes with illness or injury. If the doctor gives a reassurance message in person, it has a certain measurable impact. Now if that same message is delivered via teleconference, text, email, or through online social networking sites, does the effectiveness stay the same, or does it decrease? Or does it increase?
And how does that phenomenon of in-person vs. through technology-based mediums change depending on certain groups of patients—youth versus the elderly, or patients from different cultural groups or who speak different languages? We can increase the amount of information going out, and we can target the information going to the people that actually need it or want it. And also, we have to pay attention to how messages are altered in terms of content, shape, or form, depending on the medium.
Thank you, Dr. Whaley, for your insight into the impactful field of health communication research and your work in studying analogies in medical contexts!