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We often hear horror stories about doctors who are in a rush and not caring enough for a patient. While that might leave a bad taste in the mouth, will that affect the treatment being received? Here’s a case scenario to that question.
The ENT team had called for a psychiatric consultation for a patient who had been admitted for a throat malignancy (cancer) and was currently suffering from insomnia (unable to sleep) for the past few days. The surgical removal of the lump was successful; however the patient subsequently developed multiple post-operative complications which resulted in prolonged hospitalisation when he had already been admitted for the past two months prior to us attending to him. He did not experience the insomnia until recently and the ENT team had feared that he had developed depression.
Due to the operation, the patient had difficulties in vocalising his words. A pen and paper was used to communicate instead. He explained that he had accepted his condition and the complications that occurred. He prayed daily and his family had also been very supportive. He denied being sad, but he is worried about his insomnia as it is making him feeling very tired. When asked what might be the cause of the insomnia, the patient explained that it is because of his fears that kept running through his mind.
Two days ago, he had developed another complication that required him to undergo a radiological intervention. The attending doctor had explained the procedure to him and told him there is a risk of death (as per standard taking consent). That detail about death had persisted in the patient’s mind for the past two days. He was afraid that his struggle for the past two months will just end like that. On the other hand, he was also afraid that if he did not go ahead with the procedure, his complication will worsen. He did not tell the doctor due to his inability to vocalise properly.
The ENT team was briefed about the patient’s fears. They gladly sat down with the patient and spent some time with him to clear his doubts and questions. The patient’s insomnia resolved that night.
Empathy, to put it in the simplest of terms, is being able to put oneself in another person’s shoe. It is a valuable trait for doctors and it is done by listening and understanding what the patient is going through. With empathy, a doctor will be able to gain the trust of the patient and thus develop what is known as a therapeutic alliance. This alliance will influence the interaction between the patient and their illnesses. As the above case scenario had showed, it can even cause symptoms to manifest.
So how do doctors practise empathy? By active listening.
Active listening involves giving the patient the chance to express their grievances or worries and then re-confirming with the patient what is understood from the patient. There are many ways to achieve this. Some techniques include asking open ended questions to allow some space for the patient to tell their side of the story; giving the patient some time before continuing when there is silence during an interview; acknowledging that the patient’s worries are real; summarising what was said and confirming with the patient whether it is correct.
What then can patients do to improve their own therapeutic alliance? Firstly, understand that the doctor will probably have a limited time with you due to their workload. However, that doesn’t mean they are not willing to provide answers. Do not be afraid to approach and ask your treating doctor about your condition and worries. If you think you might forget, write those questions down on a paper. That very same paper can be shown to the doctor too. If there is a medication that you think is causing problems, record down the name of the medication or, even better, bring the packaging to show to the doctor. Explore with your doctor any possible treatment that you feel might be beneficial, even if it’s an alternative or complementary medicine.
In the end, it is important that a good clear line of communication is developed between patient and doctor. That in turn, will affect the outcome of the illness that the patient is suffering.
Dr. Eugene Koh (MB BCh BAO, Penang Medical College) is a psychiatric trainee lecturer in a local university.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]
References
- J Halpern. What is Clinical Empathy? J Gen Intern Med. 2003 (18): 673-674.
- F Lang, M R Floyd, K L Beine. Clues to Patient’s Explanations and Concerns About Their Illnes. American Medical Association. Arch Fam Med. March 2000 (9): 222-227.