Our
patient looked at us with anger, resentment and defiance. His voice overpowered
our own when he yelled, “I just need to get out of this hospital. No one else
has ever kept me in the hospital and I will never f***ing stay here again. Take
out this IV now. I’m leaving. I will not sign your f***ing paperwork.” We tried
to reason and compromise with our patient. We explained the benefits of staying
in the hospital and the potential risks of leaving the hospital before we found
the source of his infection. Any explanation seemed to enrage the patient
further. He quickly unbuttoned his gown and threw it to the side. Sitting now
in just jeans, he tried to determine how to remove his own IV so he could leave
as quickly as possible.
Empathy
is a useful skill for a healthcare provider and is defined as “engaged
curiosity about another’s particular emotional perspective.” Research has shown
that it can lead to better therapeutic outcomes and patient adherence to
medications because empathy enhances trust between patient and provider.
Additionally, patients’ are more likely to share information with providers who
are emotionally present. It is easier for providers to be empathetic when
patients are compliant, well mannered and kind. Negative emotions, such as
anger and frustration, spread quickly from person-to-person and lead to
deterioration of empathy and increased emotional distance between providers and
patients.
While
difficult, it is important for providers to empathize with patients who are
displaying negative emotions. Providers should analyze the patients’ potential
reasoning for their negative emotion. This subsequently leads to increase in
helping behavior by the providers, which reduces overall anger and increases
the therapeutic impact. This display of empathy can allow physicians to uncover
patients’ unspoken panic, angst and suffering.
Jodi
Halpern, in her article entitled “Empathy and Patient-Physician Conflict”
describes a method that physicians can use to increase their empathy when the
patient is exhibiting negative emotions. The first step is recognizing one’s
own emotion by cultivating self-awareness. Additionally, over time providers
should reflect on these emotions and the meaning that these feelings have on
their life and the life of the patient. Providers should then make a conscious
effort to find the patients’ nonverbal emotional messages implicit in their
anger. Finally, and often most difficult, providers should be receptive to the
patients’ negative feedback. This feedback should be accepted without defense.
The deferment of our defensive impulses to blame or anger provides a gateway to
increased empathy.
Dr.
Halpern’s framework can be applied to our patient. My first reaction to our
patient’s angry outburst and medical noncompliance was frustration. The patient
clearly needed additional medical attention that he was not willing to receive.
Since negative emotions are highly transmissible affects, my increased
frustration likely escalated his anger. The patient had multiple reasons to act
upset. From his history, he clearly suffered from abuse during his childhood.
He reported smoking a pack of cigarettes per day beginning at age seven. At age
22, he had no teeth because infection and rotting made it necessary for a
dentist to pull out all his teeth. Even these two facts make it apparent that
parents were not present to encourage good behaviors, but they likely fostered
an environment filled with vices and a blatant disregard for their child’s
health or his general wellbeing. The patient also reports that he and his
mother were over $65,000 in debt and this hospitalization would further
contribute to their financial problems. The patient’s basis for his current anger
was probably rooted in an upbringing where health was a low priority and
financial problems caused family disputes and increased stress. The combination
of these reasons likely contributed to his decision to leave the hospital against
medical advice. Finally, I should accept this patient’s negative feedback and
use it as a reminder to be aware of how social factors and suffering affect
patients’ current emotional state. If I am cognizant, I can use empathy to at
least partially offset patients’ negative emotions.
Reference
Halpern,
Jodi. Empathy and Patient-Physician Conflicts. Society of General Internal
Medicine. 22:696-700. 2006.
No comments:
Post a Comment