Communicating with people whose emotions have become uncontrollable is hard work, yet it is a situation which medical staffers encounter all the time. We have come a long way from the caricature heartlessness of former years, but it is still easy for a hard-pressed professional, who is probably tired and may be emotional themselves, to slip up and unintentionally cause even more pain to patients or their relatives.
Medical care is not just about the science, it is about the people, and people are emotional creatures. In a medical environment emotions will always be near the surface, so be prepared for them to spill over.
Expect people to be frightened, and for fear to manifest itself in many negative ways, especially in anger and frustration. This sort of response can sometimes seem to come out of nowhere, so be alert to the signs that emotion is building: wringing hands, clenched jaws, frowns, touching the face and head.
Expect people to be irrational and unpredictable when they are in the grip of strong emotion. A simple repetition of the facts will not be helpful at these times, as the brain is not geared up to process logical information when the instincts for survival are taking over.
Listen, Listen, Listen
People need to have their feelings recognized, and that means you have to listen to them. This is not easy when you have other pressing demands on your time, but it is essential if the situation is to be handled well. A long silence does not mean they have said everything and that you can now leave—more likely they need your help to continue.
Listening means asking the right questions, which should be as open-ended as possible. Get the patient to see that you are doing your best to understand how they feel and why. Listening skills do not come naturally to many people but can be practiced in many different situations besides the doctor/patient relationship, which is why general communication courses such as those at www.ServiceSkills.com can be helpful.
Recognize that your own emotions are a factor. An angry person can come across as a threat, and your fight or flight reaction is liable to set in. You can fight by offering a barrage of undeniable facts, or you can flee by letting it all wash over you and getting away as quickly as possible. Neither response is helpful.
Keep calm and keep focused. If anger seems to be personally directed at you, remember that it is not—it is directed at the institution you represent or, more probably, at the unfairness of the universe. Remind yourself, and communicate in words, facial expression, and gestures, that their distress is understandable.
Reflect and Respond
Keep seeking to assure the patient that you want to understand their feelings, but avoid second-guessing what they are really upset about. Try to put into your own words what they have just told you and ask if that is what they meant. If they say you have got it all wrong, don’t get defensive, for it is all part of the communication process. Keep trying until they accept that at least you are making an effort.
Ask what they would like you to do. Hopefully, if you have kept things calm, they will accept that some things can’t be changed and will attempt to make a reasonable request. Consider it carefully and make a response—you probably will not be in a position to guarantee everything they want, but you can tell them what you can do and promise to do it.
When the time comes to bring the conversation to the end, thank them for being honest with you, and repeat what you are going to do.
Finally, try to make a brief written record of the conversation as best you can recall, including the substance of the problem, the material facts that were conveyed on both sides, and what you offered to do. Avoid being judgmental about the patient or appearing dismissive of their concerns.
It’s All About People
The medical profession has built a great reputation over many generations for being trustworthy and faithful in the handling of patients’ ill-health and in providing treatment that is in their best interests. Increasingly it is being appreciated that there is more to health than keeping the body functioning well. An understanding approach to emotional well-being can have a significant influence on recovery and on the fullness of life that all doctors want for those in their care.