Thursday, July 17, 2014

Jessie Gruman's Legacy

Last May, I wrote a post, Jessie Gruman, A True Champion for Patient Engagement, highlighting the extraordinary contributions that Jessie has made as a tireless advocate for this cause.

This week, after a long illness, Jessie died, generating both great sadness and wonderful tributes from those who had the good fortune to know her, work with her or benefit from her myriad contributions to the fields of patient engagement, health policy, behavioral medicine and public health.

I, too, am deeply saddened by this news. All those who knew her will all miss her wisdom, perspective, advocacy, and passion. 
I, personally, have been forever changed as a result of my interactions with Jessie. Jessie had a unique capacity to connect with others on a personal and emotional level, while also offering her input, feedback and perspective in a way that was precise and powerful.
One might say that Jessie's "way of being" epitomized effective engagement! 
As I noted in my post in May, the Jessie is the founder of the Center for Advancing Health, an organization which has developed, collected and disseminated fabulous resources and tools on patient engagement, health behavior, health policy and other related topics. See also Jessie's Prepared Patient Blog, where an In Memoriam statement has been posted from M. Chris Gibbons, MD, MPH, Chair of CFAH's Board of Trustees. You will also find many wonderful tributes from colleagues and respected leaders from the many fields that have been touched by Jessie's work.

Jessie's has also left us several several books, written from the patient perspective, in which she shares her insights as a patient, researcher, advocate, consultant and policy expert. Her books include:

Aftershock: When the Doctor Gives you - or Someone You Love - a Devastating Diagnosis(2007),
Cancer Survivorship: What I Wish I'd Known Earlier (2013)
Slow Leaks: Missed Opportunities to Encourage Our Engagement in Health Care (2013)A Year of Living Sickishly: A Patient Reflects (2013)
I am fortunate to have known and been impacted by Jessie. Her clear, articulate voice and pearls of wisdom will be with me forever. As a result, I am more committed than ever to furthering her vision of patient and health engagement.

Sunday, July 6, 2014

More Strategies for Expressing and Teaching Empathy

In a previous EmpathyWorks blog post, I addressed the question, "Can you actually teach empathy?".  As i noted in the column, the answer is a resounding, "Yes!" , at least for medical students and health care professionals.
Research has demonstrated that courses like, "The Healer's Art", (see: The Healer's Art webpage),  developed by Rachel Remen at the University of California San Francisco, profiled in EmpathyWorks, and also in a New York Time feature article, are effective in promoting humanistic attitudes and practices among medical students.  
Rachel Remen
And  there is strong evidence that skill training and practice can promote patient-centered skills, including empathy, among practicing clinicians. (See:.

Motivational Interviewing skills were featured in my previous post on strategies for teaching empathy. 

Another strategy for helping students and clinicians learn how to respond with empathy has been disseminated by Robert C. Smith, MD and colleagues at Michigan State University. The approach, NURS,  is a mnemonic that stands for Name, Understand, Respect and Support. This approach is described in detail in Dr. Smith's textbook, Patient-Centered Interviewing. You can also read an recent article on this approach in the medical journal, Patient Education and Counseling

See below for a modified version of the NURS approach, NURSE. The E is for Empower
  • Name the emotion - reflect what you heard or noticed non-verbally. 
          Examples include:

      • "You feel frustrated..."
      • "You're angry....".
      • "You seem pretty sad..." 
  •  Understand  - express understanding, or normalize, without trying to fix
           Examples include:

      • "It's understandable that you are frustrated, considering all you have been through."
      • "I  can understand you why you would be angry about...."
      • "Many of my patients have experienced deep sadness for a long time after losing a loved one."
      • "I think I can understand how distressing this has been for you."
  • Respect - affirm and express respect for the patient's efforts to cope 
          Examples include:

      • "I'm impressed with your efforts to manage your diabetes, despite the challenges"
      • "It's remarkable that you were able to.....".
      • "I appreciate how hard this has been for you..." 
      • "Thanks for letting me know"
  • Support - let the patient know that you are willing to help 
          Examples include:

      • "I want to help in any way I can."
      • "I am here for you."
      • "I am willing to help you get through this".
      • "I will work with you to figure out a way to help." (Some educators call this "Partnership")
      • "Let's work together to address your concerns" (Some educators call this "Partnership")
      • "What can i do to help?"  (Asking this question reflects your willingness to explore how you might be helpful)
  • Empower - identify and support strengths and capabilities
          Examples include:

      • "What are you currently doing that is helping?"
      • "What have you done in the past that has been helpful?"
      • "What success have you had?" 
      • When strategies are mentioned: "It's good that you have been able to xx"
      • "How can you build on previous success?"
      • "What else can you do?"
      • "Who can help you?"
      • "What can i do to support you?
      • When resources are identified: "You have been able to identify some helpful resources and sources of support."
As always, i am interested in hearing about your feedback and in learning about your favorite strategies for teaching empathy.