Why comprehension is just as important as communication
Am I explaining my multiple sclerosis in a way that can be understood?
I recall one of my college classes from years ago, when the professor covered a subject that was rather difficult to understand. At the end, she paused, looked around the room, and asked if we all understood.
We must have had blank expressions on our faces or our heads tilted like inquisitive dogs, because she quickly added, ”If you don’t feel that you understand, please tell me and I’ll be glad to go over it again, or you can come see me after class, but don’t leave here without a firm grasp of this concept. I can explain it to you, but I can’t understand it for you.”
The passage of time has erased the topic discussed that day, but I’ll always remember her secondary lesson. My professor understood that communication sends the message, but receiving it requires comprehension. Knowledge isn’t truly passed from one person to another without both clear communication and proper comprehension. I’ll always be grateful that she insisted on both.
In a classroom setting (or anywhere else, for that matter), communication without comprehension is meaningless. It’s the same in life with multiple sclerosis (MS). In everyday interactions as well as visits to healthcare providers, our goal shouldn’t be merely to be heard, but to be understood.
That goes both ways. We should strive to understand what’s being communicated to us and ensure that what we’re saying is being fully comprehended. Neither is easy, because a few things always seem to get in the way — especially for me.
Ensuring understanding on both sides
In last week’s column I said that I asked a lot of questions and even wondered if I asked too many, but that isn’t always the case. There have been times during a visit with my neurologist when I’ve caught myself nodding along as though I comprehended what was said, even when I didn’t.
In my case, it might be just my ego. After a decade of living with MS, I’d like to pretend that I know all the big words and as much about the disease as anyone. Fortunately for me, my neurologist is a professor of neurology and, like the professor from the first paragraph, can usually see right away if I’m not grasping something.
Even with that good fortune, it’s still my responsibility to seek clarification until I comprehend. Likewise, my doctor and any other healthcare provider should ask questions of me if something isn’t understood. That applies to my neurologist, of course, but especially to providers who have little experience with multiple sclerosis. A general practitioner, for example, may not be as familiar with MS symptoms, the medications I take to control them, or my abilities and disabilities.
Comprehension can be skewed by perception. If your only tool is a hammer, every problem looks like a nail. I tend to think that everything is the fault of multiple sclerosis. Last year I let a urinary tract infection spread to my kidneys because I assumed I was feeling run down from MS fatigue. Looking back, I might’ve been diagnosed with MS sooner had I not believed that I couldn’t have the disease because no one in my family had it.
Our providers aren’t immune to being swayed by perception, either. An orthopedic surgeon could easily assume that my problems with movement, weakness, and joint pain were because of musculoskeletal problems. An ophthalmologist might be tempted to blame my double vision on the weakness of certain eye muscles. A physical therapist might have treated other MS patients and assume that I’m just like the last one.
This process would be easier if our disease wasn’t quite so incomprehensible and difficult to explain. Out of necessity, I’m getting better at both communicating and sensing when my audience doesn’t comprehend. I’m proud when I’m successful at that, but I feel as though I’m turning into a professor of a subject that I don’t particularly like and am being forced against my will to teach.
See? Not all my stories and examples are from the Army.
Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, Bionews, and are intended to spark discussion about issues pertaining to multiple sclerosis.
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Cynthia MacFarlane
Great column ! Thanks
Benjamin Hofmeister
Thank you for reading it and taking the time to leave a comment! It means the world.
Janet Harszlak
As a former professor who has seen blank faces a few times in my classroom over the years and as a person living with MS, I loved this article. Well done; keep on writing!
Benjamin Hofmeister
Thank you for the comment Janet. I was never a professor, but as an instructor in the Army I remember another instructor letting me know about the 33% rule. It was our rule and understanding that only about 33% of the class was paying attention at any given time and it was never the same 33% at the same time. This explain perfectly why something we had just discussed was not completely understood by any member of the class. I remember telling him that three times 33% was only 99%. He just smiled and said that that 1% wasn't paying attention to any of your lecture.
Shara Sand
This was a good piece about the early years of MS. and how to talk to medical professionals. I find problems occur after 30 years living with MS and talking to junior physicians with knowledge of MS. I have had them call my neurologist or refuse to leave their office. I live in NYC and may be less patient or polite than in AL.
Benjamin Hofmeister
Thanks for the comment Shara. Believe me Healthcare Providers aren't always more polite and this ZIP code. LOL
I was very lucky and I know it, to initially see an MS specialist who is also a professor of Neurology at the local med school. In my early days with MS I remember saying, "I'm hesitant to mention this because it sounds crazy.", and the doctor telling me that a lot of the symptoms that go with MS just sound crazy, or like no other symptom I've ever had before. Some of it does sound crazy to providers that vaguely remember learning about MS in 1 hour lecture in med school years ago. The really good providers have been the ones that look at me and tell me that they don't understand. I prefer that to the ones who pretend to understand or just write me off as a complainer.
Malika Bourne
Wow! You nailed this better than anything else I have read. Great job. I'm so sorry to understand that you are going this this, too.
And thank you for serving in the US military.
I'm going to read your article to my 50-year-old son who has optic neuritis due to primary progressive MS. I continue to be his caregiver and roommate for years past my prime. Quite frankly, it is hard to find trustworthy help who are willing to follow directions that best suit my son's specific needs due to how his MS affects his pain, fatigue and remaining abilities.
He gets frustrated with people who assume and judge him on their own personal bias whether they are old friends or medical professionals who come out to home.
In my efforts to support my grown-up child, I'm always trying to advocate for the most relevant and appropriate care for him from outside sources. I'm a retired 74-year-old retired RN. Soon I won't be able to do everything he needs by myself. I feel he needs to be ready to "communicate" to future caregivers who "don't comprehend." Those who do "comprehend" empathetically are a blessing that are too few and far between.
I've put together dozens of 3-ring binders of supporting articles that validate the fact that he is not making up complaints nor am I making up nursing orders to take more time out of an employee's short shift.
Benjamin Hofmeister
Thanks Malika. My heart goes out to you and your son because my wife who is also an RN is my primary caregiver and we find ourselves going through much of the same thing preparing notes Etc for healthcare providers and family. She goes with me to nearly every single appointment because it concerns her as much as it does me. For the most part we've been fortunate as to healthcare providers, but it isn't always that way and probably won't always be that way in the future. You think I'd be used to it now, but it blows my mind sometimes how providers sometimes think I am exactly like the last MS patient they saw. "oh, he was in a wheelchair too? All that means is we use the same Mobility Aid. Other than that, or similarities began and ended with the wheels."
Donald Norris
Thank for your service, sir! I wish you well with your M.S. Thanks for article.
Benjamin Hofmeister
You are very welcome Donald! Thank you so much for reading them.
Sharice Lee
Thank you for the reminder that listening isn't the same as understanding. There is a worthwhile book on this topic by the actor Alan Alda, who took a great interest in this topic later in his life. Like you, he has a good sense of humor and lots of helpful stories. The book is called "If I understood you, would I have this look on my face?" A long title, but not such a long book. I prefer the audio version as Mr. Alda reads it himself. And...I like your army stories.
Benjamin Hofmeister
Thanks Sharice! I like my Army stories too, but I figured I better give people a break. It'll crop up again in no time. After all, I did it for 20 plus years, there's a lot of stories there.
Thanks also for suggesting that book. I am definitely going to check it out on Kindle.
Shiryl Dean
Interesting points you raised. I think I've always thought that if you're communicating effectively then comprehension is a given. It's something I need to consider when I'm tutoring students. As far as facing the challenges within the medical profession, I find that their lack of comprehension is hard to overcome. I've had orthopedists who won't address my knee problems because they think it's all related to the MS. I've had a physical therapist literally give up on working with me because she kept saying, "Well it's progressive, so..." The first neurologist I visited when I had the MS hug (before I knew I had MS) said that I was "getting old." I was 43. Four years later I got my diagnosis. It's frustrating when you believe what you're communicating is being truly understood by the medical person you're speaking to, but maybe their eyes are just glazing over because they really don't understand. How do we overcome that challenge?
Benjamin Hofmeister
Great comment! I go between two different modes. On one hand I catch myself saying "does that make sense?", not because I think the other person isn't bright enough to comprehend, but because I think I may be incomprehensible. On the other hand sometimes I know that I'm making sense and the other person has either shut me off because they don't agree, don't care, or they're just not listening to me. In those cases, it sometimes seems to be a matter of we're both speaking English but somehow we're not talking the same language.
I think I'm getting better at telling when someone just isn't listening and when someone just isn't comprehending. If it's just a matter of not listening because they may or may not care, I'll find somebody who does. Wish that was easier sometimes.