Saturday, July 11, 2009

My First Post

With much trepidation, I write this first post to my own blog. I have to admit that, though I have been hesitant to create a blog, I have secretly wanted to have a public space to share my views.

For a long time, I have been been a passionate advocate for patient and family-centered health care and have spent the last 25 years trying to learn, and teach, skills that foster strong clinician-patient relationships. I have been very fortunate to have had many wonderful teachers, mentors, colleagues and patients who have helped me along the way. Though I believe I have become a pretty decent communicator, and some might say a very good teacher, I am humble enough to realize that I still have a lot to learn

In my efforts to enhance my own skills as a clinician and educator, I have hungrily sought out training, scoured the clinician-patient communication research literature, conducted some research myself and experimented with a variety of teaching techniques and formats. Relatively early on in my personal journey as a clinician-educator, I realized that the most basic skills were also the most important. If we can't communicate well, can't connect with patients on a personal level, can't understand the patient's concerns, how can we hope to help them heal, cope and recover?

The most basic skills are linked to what my colleagues and friends Steven Cole and Julian Bird have call the 3 functions, or tasks, of the clinician-patient encounter (which I have adapted a bit):
  1. Eliciting the patient's story/problems/concerns/needs
  2. Building a strong clinician-patient relationship
  3. Developing a shared understanding of the problem/condition and collaborating on a plan for treatment and self-management

Each of these tasks can be accomplished though the use of specific skills....a long list of skills i might add, though some are more basic than others.

Empathy, in my humble opinion, is THE most important and powerful skill that clinicians can employ to enhance communication and forge strong healing relationships with patients and families. Empathy helps us to truly understand the experience of patients so we can ultimately help them. Through empathy, we strive to "stand in another's shoes" and see the world through their eyes. To be truly empathic this requires us to maintain an open heart and an open mind. This is not easy....and requires clinicians to be willing to spend the time it takes to understand, remain relentlessly curious and suspend all judgement. However, the payoff is immense....shared understanding, stronger relationships, and even better diagnosis and treatment outcomes.

So, I continue striving...and learning...and here as well.



  1. To be provocative -- of course the old argument is that there is also a role for "confrontation" when helping patients. Can there be "empathic confrontation"? or is this a different concept? Does empathy ever stop working?

  2. Hi Cathy,

    Important question. Bill Miller developed (or discovered) Motivational Interviewing (MI) after learning that traditional interventions that featured confrontation aimed at helping people with substance abuse enter treatment didn't work well, at least not in controlled clinical trials. Confrontation (e.g, providing clients with strong personalized evidence about the impact that their substance abuse is having on their health, life and others) actually often increased client's resistance to change.

    On the other hand, Miller also found clinicians who used an empathic style produced better outcomes....more clients entered treatment.

    This is not to say that feedback to patients regarding the impact of their behavior on health, etc. is not effective. As you suggest in your comment, when feedback is provided in the context of a motivational intervention that includes a heavy dose of empathy, it can enhance motivation.

    The MI developers also suggest key way to combine empathy and feedback, while also supporting autonomy. Ask permission before providing feedback (e.g, "Would it be ok if I shared some infomation with you about how your drinking is effecting your liver?") Again, if you have created an empathic, non-judgemental connection with the client, this opens the door and increases the receptivity and power of the information.

    Thanks so much for commenting and contributing!


  3. Hi, Michael,

    I saw this link on the MPD list newsletter. I also have a blog about my husband's MPD which is PV and ET. It's been a long haul the last two years which started with a splenectomy. You may feel free to link to that, although it is mainly for family, but open to the public, hoping that it would help anyone who was going through the same thing. I also created a website for MPD's. I have it in hopes that people can find information. When I was searching for all kinds of information, I couldn't get enough.

    My blog link is

    You may have to scroll down quite far to find the MPD stuff because my husband has been going through other issues, but are on the road to recovery for that.

    Please feel free to contact me if you'd like the link to my website. Best of luck to you.

  4. Thanks, Mary for following and for the link.

    I became a follower of your family blog and also registered with the MPD website you created. It is wonderful that you have taken the time and effort to share these resources with others. Have you let Robert and the others on the MPD site know about the website?

    I am glad to learn that John's biopsy was negative and certainly hope the antibiotics help to quell his infection. Seems like you and John have been through quite a difficult time over many months.

    My best wishes and hopes go out to you, John and your family. Let me know if you have any questions or issues that you feel I could help with.