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STOP, LOOK AND LISTEN Empathy is difficult to express unless it is truly felt. Although there are stock phrases that doctors use to empathise with patients, it is important that these are not repeated by rote, with little regard for the individual situation. Empathy as a taught skill can soon become formulaic emotion – something patients do not buy. Dr Pauline Leonard, a consultant medical oncologist at London’s Whittington Hospital, is leading a national programme, Connected, teaching doctors how to break bad news. She says: “There should be templates around empathy, but doctors should be encouraged to move the template to fit the patient – that is the art. “Doctors like templates because they


are nervous. Ultimately, doctors are scared that when they empathise really well, so much emotion is unlocked in the room that they don’t feel equipped to cope with the situation and put the patient back together again.” If you empathise well, however, all you


need to be equipped to do is sit and listen. Patients need to know that you are there to answer any questions, that you are not frightened of strong emotions. A good rule might be: don’t just do something, stand there. Tempting though it may be to bring an awkward conversation to a quick end, try not to brush off fear, uncertainty or anger with “Don’t worry, everything will be okay,” or “I know how you must feel”. Pausing and listening is more important, and more empathic.


IN SYMPATHY There is concern that


“too much” feeling can cause burnout among already overworked healthcare professionals. Little is said about how distressing situations can affect doctors emotionally


Empathy in medicine may have its place, but the jury is out on sympathy’s role. Sympathy, when a person experiences feelings as if they were the sufferer, involves emotional identification with a patient’s set of circumstances, eg, if your eyes fill up with tears when a patient recounts their illness, or you feel anger when a patient tells you of a preventable adverse incident. In complete sympathy, a doctor would be unable to help, as there cannot be complete equality or complete sharing.4


if they let their emotions get the better of them in the heat of the moment. He cites as an example a doctor who, when faced with a patient with a life- threatening haemorrhage in an ED, was accused of assaulting a colleague while hurrying and pushing him to release the required drugs. A complaint was lodged against the doctor to the hospital and, later, the Medical Council, despite an apology. In emergencies, it is important to retain your cool. The Hippocratic dictum of “do no harm” cannot be met if a doctor is consumed with their own emotional reaction to a situation, perhaps putting distressed patients and their families under added stress. At worst, sympathy can descend into pity, a condescending emotion that would serve to undermine the doctor–patient relationship. There is concern that “too much” feeling can cause burnout among already overworked healthcare professionals. Little is said about how distressing situations can affect doctors emotionally. Mr Berry argues: “More needs to be done to help doctors with considering the aftermath. The event of discussing bad news is well documented, but then it’s back to work and no more said.” Distressing conversations can prey on a doctor’s mind and, before moving on to the next consultation, or the patient in the next bay, doctors must be able to discuss these feelings if they wish. Similarly, it is important to know when to step back from a situation. Dr Brian Charles, consultant for MPS based in Barbados, says: “A common situation in the Emergency Department is the deathly sick child. Frequently, these cases affect staff, especially when they have young children or siblings of a similar age. I always advise the staff that it’s okay to have empathy and sympathy for the patients, but if it’s likely to affect judgment and objectivity, then someone else should take over. The difficult part is realising ‘when I can’t cope’ and when to call for help.”


If


you fully grieved for the loss of a parent’s young child, you would be overcome by the loss of the situation and wouldn’t be able to offer support. You would need support yourself. Dr Rahim explains: “It is difficult for a patient who has come to you to help contain their anxiety and distress to see their own doctor in extreme distress.” The more a doctor’s anxiety and aggression are under control, the calmer the patient is likely to be.5 Dr Ming-Keng Teoh, MPS Head of Medical Services (Asia), warns that doctors can present a risk to themselves


MAINTAINING BOUNDARIES An excess of emotion can blur boundaries. MPS medicolegal adviser Dr Richard Dempster explains: “There is a wide range of opinions as to what is appropriate professionally. Advice can at best only be general, because of the huge number of differing reactions to a doctor’s behaviour by patients. How doctors react and support patients will depend on the previous relationship they have had, and the knowledge that a doctor has of the patient’s personality.” In the UK, the GMC stresses that to fulfil your role in the doctor–patient partnership


ARTICLE


UNITED KINGDOM CASEBOOK | VOLUME 19 | ISSUE 1 | JANUARY 2011 www.mps.org.uk


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