This blog is part of our Working Better Together series and was authored by Dr. Sherry Thompson, Story Collective Writer at Legal Aid of Arkansas. This blog series is intended to provide our Health Law Partnerships with a platform to highlight successes, challenges, and innovative approaches to furthering health access and health equity in the states where they work.
The “Medicaid Experiences” project referenced in this blog series is a collaborative endeavor of the National Health Law Program and eight state-based legal aid organizations. The purpose is to better understand the direct experience of individuals as enrollees and applicants for Medicaid and advocate for improvements.
I remember when my daughter brought her boyfriend home for dinner. They were in high school – he was cute and polite. I understood why she liked him right away. The two of them asked if he could prepare our meal that evening. I agreed and sat at our kitchen bar, watching them cook together.
This teen took a nervous glance my way and then asked a very interesting question, “What are the rules in your kitchen?”
Surprised, I replied, “There aren’t really any rules. I’m pretty laid back.”
The evening was a little rough. And this is what I learned. I’m not laid back. I have a lot of rules for cooking in my kitchen – but those rules were invisible to me because my daughters and I simply followed them.
We all have rules. We have ideas in our heads about the right and wrong way to do things; and we surround ourselves with like-minded people. Life runs pretty smoothly – until somebody comes along who doesn’t understand the (mostly invisible) rules that everyone else is following. That “somebody” interrupts the culture and misinterprets what is happening. They do not understand the heuristics of that specific culture.
Heuristics are – in simple terms – those mental shortcuts your mind takes to simplify problems and avoid cognitive overload. It is where bias, cultural norms, and judgement dwell. Heuristics can be used as a shortcut to let another person know we understand them because of shared lived experiences. But heuristics can get in the way of getting a good interview.
Everyone has a story. And every story is layered and nuanced. As we collect stories for the National Health Law Program’s Medicaid Experiences project, we are engaging the people on the ground – those who use Medicaid in their daily lives. These stories are invaluable because they give voice to actual customers of the Medicaid program. Sharing their lived experiences can help everyone to better understand Medicaid recipients.
When engaging in an interview, the storyteller will typically share a portion of their story and wait for your subtle cues and reactions. If they feel bias or judgment creep in, they will adjust. The story will be incomplete or altered. This is why heuristics matter when interviewing. It’s what professors and instructors mean when they tell you to learn cultural competency. Qualitative researchers use a technique called bracketing when they are collecting stories for their research. This is a skill that can help you connect with your storytellers, overcome your personal heuristics that may bias the interview, and improve your stories overall.
He came to a Name Change Clinic we were holding with his daughter in tow, and I offered to listen to his Medicaid-related story. He cautiously agreed, and the three of us sat down to speak. “I don’t want you asking my daughter any questions. Her life isn’t the story I want to share.” I agreed, and he relayed how he and his two children had used Medicaid in the past few years – after his wife had deserted them. As we neared the end of what appeared to be a very brief interview, he mentioned that he received a lot of judgment for allowing his daughter to transition. Using bracketing, I replied, “You know, I have three children of my own. I know how hard it is to make decisions for your kids. Regardless of the decisions I would make, someone was always telling me I was doing it wrong. I finally just realized it was none of their business – but that was hard for me to do.” He relaxed a bit, glanced at his daughter, and said, “This wasn’t ever a choice that I felt was mine to make. And it was difficult for me to get to the point where I would agree to Hormone Replacement Therapy.” From that point on, he shared a very deep and nuanced story about their experiences and how having Medicaid had helped his children to achieve academically, overcome anxiety and depression, and enjoy improved health. My bracketing had given him a shortcut – he didn’t have to talk about the uncertainty, frustration, and worry parents go through when raising children – we shared that. But my actual experience (and my opinions – good or bad – about his choices) didn’t matter; only the heuristic.
Bracketing, in short, means that you create a space in your interview wherein you tell the storyteller something about yourself that helps to overcome cultural, personal, and societal differences in order to collect an accurate, unbiased story.
Bracketing your heuristics during an interview is difficult – because what you put in those brackets must necessarily remain neutral. In my interview, I didn’t insert my opinion regarding whether that father was doing the right or wrong thing with his daughter. A neutral response creates space for the storyteller who then decides what they want to share. Bracketing allowed the storyteller to relax because our shared commonalities (i.e., we both have kids; people always like to judge parents) signified a shared heuristic. It put him at ease. But then I quickly removed myself – recentering our focus on his family and their lived experiences. It is a skill that takes years of concentrated work to develop. You, in essence, become a neutral – which creates more space wherein your storyteller can tell their story and trust you to see them without inserting yourself into that story. It is the essence of cultural competency.
There is no place for personal heuristics when interviewing – this is not the time to reveal your personal values or opinions. It’s important for you to understand your personal rules and biases and come to terms with the fact that they are yours, and only yours, and you are in charge of neutralizing them throughout the interview. This is not your story. Ask open-ended, clarifying questions (e.g., What is HRT? I’m not really familiar with that diagnosis, can you tell me more about it?) and never insert your opinions (whether negative or positive) into their narrative. It is their story and your ability to open a neutral space in which they can tell it will determine how much of their story you will hear.
Oh, and that boy who tried to cook a meal in my rule-filled, “no rules” kitchen? He’s my son-in-law now, and, understanding the family heuristic, he no longer tries to cut meat in my non-stick pan with a butcher knife. And I will be forever grateful to him for his unintended lesson in heuristics.