Urgent message: Even with the utmost attention to proper protocols, current data, and vast clinical experience, patient emotions are the unforeseeable x factor in a positive encounter (and, sometimes, even positive outcomes).
Author: Bob Stuart, MD and Bob Bichler, RN
As providers, we have been trying to understand how we can be more helpful and effective with the patients to which we provide care. How can I best provide care which will feel most satisfying to my patients? After all, we want our patients leaving with a sense that the provider engaged with them in a kind and caring manner, was truly concerned with them as an individual in addition to getting the diagnosis correct.
The concept is this: Effective interaction with patients requires not only a physical assessment, but also an emotional assessment in as far as it relates to their presenting physical medical complaint. The identification of a patient’s emotional mood or feelings as it relates to their physical illness will provide a more effective overall outcome regarding their care. Increased attention to and identification of the emotional undertone of the patient will provide a much better experience for the patient and a more effective outcome for the provider.
Studies have shown that, for a patient, the effectiveness of the interaction with the providers—the experience—is equally important as the accuracy of the diagnosis. Think of the provider’s task as 50% clinical diagnosis and treatment, and 50% emotional assessment and connection.
Patient Emotions: The Missing Key
Traditionally, so much of our training has been focused on accurate medical assessment and diagnosis. We have been trained to be clinical diagnosis “machines.” But there is more—much more—to the make-up of the patient which needs to be understood.
Patients tend to present with one predominant emotion or feeling, such as fear, sadness, or anger, along with their physical complaint. They may also have additional significant, overriding feelings of physical pain, discomfort, or fatigue.
Their specific complaint, the length of their illness, its effect on their ability to work or be involved in activities such as sports (especially for younger patients) are significant clues to their emotional psyche. The patient’s apparent attitude—their facial expression and body language—might give you the insight as to the emotion at hand.
The ability to rapidly identify the specific overriding emotional component with which a patient presents and to engage them regarding this emotion facilitates a kind and caring approach with your patient. It also has a significant effect on their sense of trust and caring from you.
Try it. Look for the frown. Watch for the sense of worry or sadness. Listen to the style of their voice. Pick up on it and engage with the patient.
Active listening: Focus completely on listening to and helping the patient. Leave personal biases at the door. Time with the patient is about assessing what they need, not just getting the diagnosis right.
Introductory statements: After noting the physical complaint and briefly assessing the patient’s affect, try to connect with what the person may be feeling. Let the patient validate his or her feelings, not jumping too quickly to conclusions. Some examples of statements or questions from you that might encourage the patient to put those feelings into words include:
- “It looks like you feel really crummy.”
- “You’ve been sick for seven days. You must be really tired of feeling this way.”
- Is your throat really hurting?
- “I can see from your frown that you seem pretty upset.”
- “You look pretty worried.”
- “I can tell you don’t feel well.”
- “Is your ankle really hurting you?”
- “You look scared.”
Share personal stories—or even just empathetic comments like “Me, too”—that relate to the patient’s presentation. Letting patients know you can relate to what they are going through can be reassuring. It has been our experience that patients truly appreciate when we show our personal side and share related personal experiences.
Silence can be non-verbal agreement with what the patients has said. After you’ve asked a question, wait for the patient to express what they are feeling. Smile and nod. Grimace and shake your head. This shows you are connecting to what they are experiencing.
Share in the patient’s emotions (which, admittedly, may be more comfortable for some than others).
- Laugh together. Be sad together.
- True relational empathy is to share the feeling. Think of what you like when you are in a difficult situation.
Discernment, or having a keen insight or understanding. Does the patient have a misconception I can clarify?
- Explain their diagnosis, being careful to ensure they understand.
- Use of visual aides. Show them something in a book or teaching materials.
- Validate their reason for coming to be seen.
- Provide hope/treatment options.
- Tell the patient what they can expect (e.g., “I think this will only last for the next two days”).
- Be sure they have and understand a follow-up plan. The patient should understand that they have a safety net; “This is how you can reach our clinic if you have questions.”
We are convinced that our patients need, want, and appreciate any and all attempts we can make to get down to a more personal level with them. Demonstrating that we understand how they are feeling, showing kindness and sensitivity, being careful to explain their diagnosis and their treatment carefully, and ensuring that they truly understand that you are concerned will greatly enhance the patient’s experience—and what they tell their friends and family about that experience.
Dr. Stuart is a medical director with responsibility for multiple urgent care centers in the Aurora Medical Group system in Milwaukee, WI. Mr. Bichler is also with Aurora; in addition to his nursing training, he is a graduate of the Froedtert Hospital Pastoral Care Volunteer Program, which he credits with introducing him to “listening to emotions.”