by Randy Olson, PhD June 23, 2022

You want to know how bad communication has been throughout the pandemic? In February I appeared on the podcast "Medicine and the Machine," with host Eric Topol, MD. When it came time to talk about pandemic communication, he referred to it as a "historic botch job."

This communication failure has brought a predictable loss of public trust. By 2021, news headlines and opinion essay titles made the level of public confusion clear: "The CDC Needs to Stop Confusing the Public," declared a guest essay in the New York Times; "Everyone Is Confused," said Reuters; and a Washington Post article cried out that the CDC Director was, "Under Fire for Confusing Guidance." Beyond just the COVID-19 pandemic, the confusing communication from our agencies abounds -- just look at the mixed messaging and confusing narrative around monkeypox. This poor communication will continue to plague public health until it is effectively addressed.

Revisiting Topol's "historic botch job" assessment, he made his comment in part because his guest 2 months earlier, former senior COVID-19 advisor to the Biden administration, Andy Slavitt, said he would give the White House an "A" on the science side of their COVID-19 response, but an "F" on the "social science" side of their efforts.

Throughout the pandemic the biomedical community has unleashed a veritable fire hose of information on the public. Experts of all sorts have appeared on national television with countless explanations of the science. But for most of the public, it has simply been TMI: too much information. Not TMI of the silly personal type, but rather the more dangerous public health variety.

I got a glimpse at the TMI problem last month when I was on a panel for a government agency seeking advice on communication. In preparation, I contacted a friend who works for the agency.

The first thing she said was, "Tell the people at the top they are swamping us with too much internal communication." She backed this up with a list of 14 updates, briefings, newsletters, and other emails they are inundated with on a daily, weekly, and monthly basis. "It's just too much," she concluded.

Both internally and externally, government agencies need to get a hold on their TMI problem. The same holds true for just about every organization today. So, how do we realistically address this issue? The answer is narrative structure. Here is the three-part prescription I recommend, based on the eight books I've published on communication.

The challenge of limiting the amount of information revolves around the basic decisions of "what stays in, what comes out." The criteria you use for making these decisions is narrative structure. If something "advances the narrative," you want to keep it in. If something does not advance the narrative, reduce it or take it out.

There are three basic elements to narrative structure: Set Up, Problem, Solution. This tripartite shape underpins everything from argumentation and logic to storytelling and the scientific method.

The key practical tool in understanding narrative structure is the ABT (and, but, therefore) narrative template. I have written about the value of this powerful communications tool for scientific researchers, doctors, and just about everyone else. The ABT provides the narrative understanding needed to cut back on the information fire hose.

Scientists communicated better a century ago. This is a point made by a postdoctoral researcher at the Salk Institute in 1975 in a paper titled, "Medical Obfuscation: Structure and Function," in the New England Journal of Medicine. The author knew a few things about communication -- he was Michael Crichton, MD, who would go on to author the novel Jurassic Park and dominate Hollywood movie-making. In the span of his short paper he said, "Even as late as the 19th century physicians stated their views with strength and conviction. Only in the 20th century has obfuscation become widely acceptable."

A century ago the scientific community displayed a clear understanding of the importance of narrative structure by establishing the convention of the IMRAD template (introduction, methods, results, and discussion) for writing papers. Today, the use of templates has moved to a deeper level through the increased use of "structured abstracts" where the abstract itself is also structured. Templates can be seen in news sources such as Axios. The emergence of templates are a response to the information fire hose -- breaking down the information into more manageable units. If you accept the value of templates, then the question you face is who is going to implement them, which leads to my third recommendation.

Narrative is leadership. People don't follow leaders who are confusing or boring. They follow leaders who know how to shape material into the basic set up, problem, solution form for effective communication.

This means that every organization, ideally, should appoint or hire one person who is given a title along the lines of "Narrative Officer." This is a trend that began a decade ago in the business world with Microsoft hiring a "Chief Storyteller." Countless other companies have followed suit, appointing single individuals to provide narrative guidance.

For medicine, it's a little too soon to get caught up in the concept of "storytelling." Scientists are rightly suspicious of the idea of telling stories with facts. But narrative structure isn't storytelling, it's only the inert forces inside all forms of communication.

So, the time has come to confront the decades-old problem of TMI. It has plagued the pandemic and other recent crises, but it is not intractable. It merely requires a more strategic approach than just turning on the information fire hose and spraying the public with more information than they can handle.

If we can develop a better command of narrative structure, then the information fire hose can be reduced to more of an information garden hose. It can then be used to once again bring life to the world and reverse the damage done previously by a "historic botch job."

Randy Olson, PhD, is the director of the ABT Framework Narrative Training program (ABTFramework.com), author of Houston, We Have A Narrative, and 2020 recipient of the John P. McGovern Award for Excellence in Biomedical Communication from the Southwest Chapter of the American Medical Writers Association.

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