This blog post was authored by HMA clinicians
Margaret Kirkegaard, MD, MPH, and Jeffrey Ring, PhD.
Patient: I am anxious about my results, Doctor.
Doctor: Let’s take a look … Yes, you do indeed have cancer. I will refer you to the surgeon for an evaluation as fast as possible. You must have questions.
Patient: (Silent, in shock)
Doctor: OK, well hang out here for a few minutes, and our medical assistant will bring you contact information for the surgeon. We are backed up with patients today, so this may take a short while.
This brief exchange illustrates missed opportunities for healthcare clinicians to provide empathic relationship-centered care. First, the physician does not acknowledge the patient’s expressed worry. Many patients are wary or unable to express their fears and worries. Despite this patient taking a risk of self-disclosure, his anxiety is met unheeded and unrecognized. Missed is the opportunity for the provision of reassurance, education and support in a moment of great distress.
Think for a moment about what you would want and need from your healthcare practitioner in a moment like this. Think for a moment about what you might say to this patient while providing whole-person care.
The use of feeling words can dramatically enhance empathic care. Here are a few examples of responses to the patient. Note how each one reflects the doctor’s appreciation of what the patient is saying and feeling:
- “I am not surprised you are worried. I have been thinking about you this week, worried as well.”
- “Thank you for letting me know you are feeling anxious. This helps me better take care of you. I want to hear from you about how I can help at any point.”
- “I want to know more about what is worrying you the most.”
The physician’s comments about a backup in the office also distract from optimal relationship-centered care by minimizing the uniqueness and importance of the patient – lumping him in with the many others being seen today. This can feel disrespectful, frustrating, and feed a sense of anger and hopelessness.
There are many barriers to the provision of relationship-centered care for all members of the healthcare team, including lack of training, time concerns, and decreased mindful practice. Sadly, medical education has not always provided the basic communication tools to enhance relationship-centered approaches to care. Many healthcare practitioners do not learn the value of integrating feeling words into how they speak with patients. In the case above, the physician could have drawn from a number of feeling words to reflect her understanding of what the patient is going through: scared, anxious, worried, fearful, sad, angry, bitter, unsure or alone.
Time concerns are real and daunting barriers to patient care these days. Productivity demands push the clinician in one direction, while quality of care, safety concerns and patient satisfaction push in the opposite direction. The truth is that patients often need and deserve an encounter with a practitioner who takes the time to sit down, make direct eye contact, take their hands off the computer, and listen and respond to expressed or anticipated concerns. Today, healthcare is a team sport. Healthcare providers who do not have the time to build relationships with their patients and to respond empathically will do well to build a team that can fill in the missing elements – providing emotional support, education, problem solving, and resources and offering a caring quality of attention.
A mindful approach to care is one in which the patient in front of the clinician receives full attention. While healthcare practitioners may see many patients each day, the patient only sees the physician once. This is a big deal. The encounter with the physician holds importance and often happens only after much waiting, challenging transportation, and missing work. Providers who are overwhelmed with productivity demands, who are burnt out, and emotionally overwrought are not likely to want to hear more about a patient’s anxiety about the road ahead navigating a new cancer diagnosis.
Fortunately, all members of the healthcare team can be trained and supported in providing that relationship-centered care that very likely initially drew them to this profession. Empathy training, mindfulness training, and education in the skills of motivational interviewing and shared decision making actively invite patients to play an important role in their own health and healthcare. Thoughtful re-thinking of clinic workflow and patient flow through a typical office can also yield enormous improvements in the satisfaction with healthcare for patients and practitioners alike.
Patient: My name is Sarah, and I am calling in for my lab results.
Medical Assistant: Yes, Sarah. I see here that your cholesterol is still higher than is desirable.
Patient: Really? I have been trying so hard to exercise and eat carefully.
Medical Assistant: I can hear the frustration in your voice. This is a pretty daunting challenge for you. It must be aggravating.
Patient: Yes, I am really frustrated.
Medical Assistant: How about we explore a couple of other options? Perhaps a follow-up appointment with your nurse practitioner, a meeting with our dietician, information on our health behaviors classes, or even educational materials about healthy food choices. Do any of these options appeal to you?
Here the medical assistant beautifully demonstrates good listening skills, empathic responses, a respectful approach to the patient’s autonomy in shared decision-making, and the provision of practical resources.
Our team is poised and ready to assist your team in enhancing empathic and relationship-centered care through education and a consideration of workflows and touch point opportunities to improve communication and care delivery.
More resources to help you assess the degree to which relationship-centered care is currently practiced at your site are available. For more information, click here to access our paper The Case for Relationship-Centered Care and How to Achieve It, or contact us directly at [email protected] and [email protected].