A-S-C-E-N-D: A new communication framework for both patients and providers

by Karen Knops, MD

This is an introduction to the A-S-C-E-N-D framework, offering six concrete steps as a guide to communicating with your medical team.

We had been friends since the age of five. A master storyteller, J.Y. enjoyed a love of tarot, reading from a deck she had acquired, she said, from a gypsy during a trip through Russia. “Ask a question,” she would say. “Otherwise, it’s all nonsense.” The cards are placed in a certain order; the layout follows a sequence to transform random images of archetypes into a story that combines the yearnings of the seeker with the ancient wisdom from the cards.

Soon after her 35th birthday, and just before mine, she sent me a text: “can i ask you a quick medical question.” I called her a minute later.

A-S-C-E-N-D Guide to communicating with your doctor by Karen Knops, MD

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As soon as she told me her story – months of vague nausea and fatigue, along with painless jaundice – a tarot card flashed in my mind: The Wheel of Fortune, figures ascending and descending as the wheel turns. Life changes in an instant. I knew her symptoms could only mean a dangerous form of cancer.

In the months and years that followed, I fell back and forth between the role of doctor and the role of grieving friend. It struck me that while medical professionals receive many hours of instruction in “effective communication,” we receive no training in communication when our loved ones or we ourselves face chronic and life-threatening medical issues.

Patients are plunged into an unfamiliar world of uncertainties, foreign vocabulary and concepts, and life-changing decisions. Their ability to communicate serves as the basis for the diagnosis, determines whether the full picture of risk and benefit can be understood, and separates informed decisions from heartbreaking mistreatment. A job in healthcare is challenging, but patients often have the hardest job of all.

We cannot control the turns of fate, but we can absolutely choose how we – patients and clinicians alike – face them. Our stories are the foundation of healing.

My dear friend ascended this life as a result of her cancer, but she taught me a few things before she died. She would want me to share the wisdom that served her well ­– as a patient and as a provider of answers to complex questions.

I’ve folded that wisdom into a framework that fits either patient or provider. Represented by the acronym A-S-C-E-N-D (Anticipate, Summarize, Concerns, Explore/Explain, Needs, Document), these insights can set the stage for patients to gain information about medicine, and for health professionals to gain information about the patient.

Empowered patients and their healthcare providers can then bolster each other to find higher ground. From the moments before a visit to the time when we reemerge to our “regular” lives, patients and providers share a journey that is worthy of examination.

In the next six blog posts, I will elaborate on each component of A-S-C-E-N-D. These tips are designed to help us communicate more deliberately as patients and as providers, steps that can make a real difference in on this difficult path we are on together.

Read on: “A” for Anticipation.