tag:blogger.com,1999:blog-55025099726723885502024-03-06T02:51:59.781-05:00EmpathyWorksFocuses on the value and impact of empathy and related skills, particularly in health care settings. Topics will include clinician-patient communication, patient-centered care, patient activation, health behavior change and clincian-patient relationships.Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.comBlogger77125tag:blogger.com,1999:blog-5502509972672388550.post-68783238586668744132018-05-28T13:44:00.000-04:002018-05-28T13:44:54.607-04:00Bill Miller's Book, "Listening Well" is Worth a Post, and ReadIt's been about a year and a half since I last posted here. I can't tell you why I have lapsed, though I have been preoccupied with work, my family and current events. All have contributed to the challenge of staying "posted" on developments in the world of empathy.<br />
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Plus, Ed Rutsch and his sites, <a href="http://cultureofempathy.com/"><i>Center for Building a Culture for Empathy</i></a>, and <a href="https://www.scoop.it/t/empathy-and-healthcare"><i>Empathy and HealthCare</i></a> are both awesome and comprehensive sources for posts and developments.<br />
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It was actually <a href="http://cultureofempathy.com/References/Experts/William-R-Miller.htm">a post by Ed on Culture for Empathy</a> that featured Bill Miller and his new book, <b><i><a href="https://www.amazon.com/Listening-Well-Art-Empathic-Understanding/dp/1532634846/">Listening Well: The Art of Empathic Understanding</a></i></b> that stimulated me to resume blogging and write this post.<br />
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Bill Miller is the primary force behind Motivational Interviewing, a highly effective motivational counseling method that features an empathic patient-centered style. I highly recommend Bill's little new book, which serves as a primer on the core empathic listening skills that are central elements of MI. There is so much wisdom in this little book, as well as great examples of empathic listening and valuable suggestions for skill practice.<br />
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Enjoy!<br />
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<br />Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com2tag:blogger.com,1999:blog-5502509972672388550.post-43091307587520364282016-11-12T09:39:00.001-05:002016-11-12T09:42:45.103-05:00Empathy and Compassion Matters.Marina Sampanes Peed, a friend and fellow person with a MPN, shared her reactions to the recent US election on her <a href="http://marinapeed.com/">website</a>. Marina's comments are compassionate and inspiring.<br />
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I shared her post on Facebook - see my embedded post below.<br />
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<iframe allowtransparency="true" frameborder="0" height="521" scrolling="no" src="https://www.facebook.com/plugins/post.php?href=https%3A%2F%2Fwww.facebook.com%2Fgoldsteinm52%2Fposts%2F10154823608219739&width=500" style="border: none; overflow: hidden;" width="500"></iframe>Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com3tag:blogger.com,1999:blog-5502509972672388550.post-77887836620042703382016-08-20T10:18:00.000-04:002016-08-20T10:20:32.392-04:00Why We Train & Coach Clinicians in Communication Skills and Motivational Interviewing<iframe allowfullscreen="" frameborder="0" height="270" src="https://www.youtube.com/embed/WTm4bSK8mDc?list=PL9FF73EC555CB6855" width="480"></iframe><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="background-color: white; color: #3d3d3d; font-size: 13px; line-height: 19.5px;">This video was developed by the Veteran Health Administration (VHA)'s National Center for Health Promotion and Disease Prevention (NCP) to help VHA clinicians and leaders recognize the value of participating in</span><span style="background-color: white;"><span style="color: #3d3d3d;"><span style="font-size: 13px; line-height: 19.5px;"> NCP's patient-centered communication training. NCP developed two training programs to meet clinicians' needs: 1) </span></span></span><em style="border: 0px; color: #3d3d3d; font-size: 13px; font-weight: inherit; line-height: 19.5px; margin: 0px; padding: 0px; vertical-align: baseline;"><strong style="border: 0px; font-style: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">TEACH for Success</strong></em><span style="background-color: white; color: #3d3d3d; font-size: 13px; line-height: 19.5px;"> </span><strong style="border: 0px; color: #3d3d3d; font-size: 13px; font-style: inherit; line-height: 19.5px; margin: 0px; padding: 0px; vertical-align: baseline;">(TEACH), </strong><span style="border: 0px; color: #3d3d3d; font-size: 13px; font-style: inherit; line-height: 19.5px; margin: 0px; padding: 0px; vertical-align: baseline;">which features basic communication skills in health education and health coaching<b>: </b></span><span style="background-color: white; color: #3d3d3d; font-size: 13px; line-height: 19.5px;">and</span><span style="background-color: white; color: #3d3d3d; font-size: 13px; line-height: 19.5px;"> 2) </span><b><em style="border: 0px; color: #3d3d3d; font-size: 13px; line-height: 19.5px; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; font-style: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Motivational Interviewing (</span></em><span style="border: 0px; color: #3d3d3d; font-size: 13px; font-style: inherit; line-height: 19.5px; margin: 0px; padding: 0px; vertical-align: baseline;">MI</span></b><span style="border: 0px; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; color: #3d3d3d; font-size: 13px; font-style: inherit; line-height: 19.5px; margin: 0px; padding: 0px; vertical-align: baseline;"><b>),</b></span><span style="border: 0px; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="color: #3d3d3d;"><span style="font-size: 13px; font-weight: inherit; line-height: 19.5px;"> a clinical method for identifying and </span><span style="font-size: 13px; line-height: 19.5px;">building</span><span style="font-size: 13px; font-weight: inherit; line-height: 19.5px;"> patients' motivation to actively engage in self-care and health behavior change. VHA's TEACH and MI programs were specifically </span></span></span></span><span style="border: 0px; color: #3d3d3d; font-size: 13px; line-height: 19.5px; margin: 0px; padding: 0px; vertical-align: baseline;"><span style="border: 0px; margin: 0px; padding: 0px; vertical-align: baseline;">designed for VHA primary care clinicians providing care in Patient Aligned Care Teams (PACT), VHA's version of the patient centered medical home.</span></span></span><br />
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<span style="background-color: white; color: #3d3d3d; font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: 13px; line-height: 19.5px;">The patient-centered communication skills featured in TEACH and MI training enhance clinicians' capacity to provide </span></span><span style="background-color: white; border: 0px; color: #3d3d3d; font-family: "arial" , "helvetica" , sans-serif; font-size: 13px; font-style: inherit; line-height: 19.5px; margin: 0px; padding: 0px; vertical-align: baseline;">personalized, proactive, patient-driven care (PPPDC). These skills include relationship-building skills (e.g., open-ended questions to explore patient needs, values and concerns; reflections, empathy, respect); health education skills (e.g., sharing information, teach-back), shared decision making skills, and health behavior counseling skills (e.g., evoking change talk, goal setting, problem-solving).</span><br />
<span style="border: 0px; color: #3d3d3d; font-family: "arial" , "helvetica" , sans-serif; font-size: 13px; line-height: 19.5px; margin: 0px; padding: 0px; vertical-align: baseline;"><br /></span>
<span style="border: 0px; color: #3d3d3d; font-family: "arial" , "helvetica" , sans-serif; font-size: 13px; line-height: 19.5px; margin: 0px; padding: 0px; vertical-align: baseline;">In addition to participating in face-face, experiential TEACH and MI courses, clinicians are offered opportunities to participate in </span><span style="color: #3d3d3d; font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: 13px; line-height: 19.5px;">follow-up <b><i>clinician coaching</i></b> to help them apply TEACH and MI skills in clinical encounters with Veterans.</span></span><span style="background-color: white; color: #3d3d3d; font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: 13px; line-height: 19.5px;"> To disseminate TEACH and MI training and follow-up clinician coaching, NCP trains and supports over 300 active TEACH and MI Facilitators, who are also extensively trained to provide learner-centered clinician coaching. TEACH and MI facilitators/coaches also serve as VHA facility-based Veterans Health Education Coordinators (VHECs), Health Behavior Coordinators (HBCs) and Health Promotion Disease Prevention Program Managers (HPDP PMs), and work collaboratively with PACT teams to integrate TEACH and MI skills with other tools, resources and programs that support PPPDC. These tools and resources include: an online health risk assessment tool, goal-setting and decision-making tools, an online Veterans Health Library; and access to VHA and community-based programs in tobacco cessation, weight management, self-management and other health behavior change areas.Training and clinician coaching in TEACH and MI is a key component of PACT's "roadmap" for operationalizing PPPDC in primary care.</span></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-weight: normal;"><span style="color: #3d3d3d;"><span style="font-size: 13px; line-height: 19.5px;">In the "Why Train" video, PACT leaders, PACT clinicians and Veterans share reflections about the value and impact of TEACH and MI training on Veteran experience, the quality of care and health outcomes. Clinicians also share how training and coaching has enhanced their skills, their morale and even their overall satisfaction with their work!</span></span></span></span></h4>
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Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com1tag:blogger.com,1999:blog-5502509972672388550.post-83201178204982601572015-12-08T00:12:00.002-05:002015-12-08T00:20:52.382-05:00EmpathyWorks Reaches 25,000 Views!<span style="font-family: inherit;">Since my <a href="http://empathyworks.blogspot.com/2009/07/my-first-post.html">First Post on EmpathyWorks</a> on July 11, 2009, the blog has now reached 25,000 views!</span><br />
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<span style="font-family: inherit;"><i>My 79 posts on EmpathyWorks have covered a range of topics that reflect my interest in the role of relationship-building in health care and the impacts of empathy, compassion and patient engagement on patient experience and health outcomes.</i></span></blockquote>
<span style="font-family: inherit;">Some posts have shared new research findings on the value of clinician empathy or have featured the wisdom of Carl Rogers, <a href="http://empathyworks.blogspot.com/search?q=halpern">Jodi Halpern</a>, <a href="http://empathyworks.blogspot.com/2013/12/a-short-video-on-empathy-featuring.html">Bren<span style="background-color: white; color: #222222;">é</span> Brown</a>, <a href="http://empathyworks.blogspot.com/search?q=lown">Bernie Lown</a>, <a href="http://empathyworks.blogspot.com/2014/05/jessie-gruman-true-champion-for-patient.html">Jessie Gruman</a>, and many others who have made empathy, compassion or patient engagement a focus of their professional careers. </span><br />
<span style="font-family: inherit;"><br /></span><span style="font-family: inherit;">Other EmpathyWorks posts have featured the experience of people, like myself, who are coping with the challenges of living with a chronic condition. </span><span style="font-family: inherit;">When I first started blogging, several posts were linked to a column I wrote for </span><a href="http://mpnforum.com/" style="font-family: inherit;">MPNforum</a><span style="font-family: inherit;">, an online magazine for people, or loved ones of people, with myeloproliferative neoplasms (MPNs). </span><br />
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<span style="font-family: inherit;"><i>My heart goes out to my fellow "MPNers", who regularly demonstrate empathy and compassion for others in their posts on support sites </i></span><i>on Facebook, </i><i style="font-family: inherit;">such as <a href="https://www.facebook.com/groups/529471207133456/">Polycythemia Supportive Friends</a>, and <a href="https://www.facebook.com/groups/529471207133456/">MPN Foum</a>.</i></blockquote>
Since I have started blogging, I have found many inspiring and helpful blogs, websites and social media sites that address the topics of empathy, compassion and patient engagement. Links to these sites are available in the right column of the EmpathyWorks blog page. I particularly recommend Edwin Rutsch's <a href="http://cultureofempathy.com/">Culture of Empathy website</a>, a treasure trove of links, resources and commentary on empathy and its application to a wide range of topics, from health care to education to international relations.<br />
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<i>You will also find links to organizations that focus on training clinicians in patient-centered communication skills, such as the <a href="http://www.aachonline.org/dnn/default.aspx">American Academy on Communication in Healthcare (AACH) </a>and the <a href="http://healthcarecomm.org/">Institute for Healthcare Communication</a> (IHC). IHC and AACH have played critical roles in my personal and professional development as an educator and advocate for patient-centered communication training.</i></blockquote>
Other organizations, such as <a href="http://www.cfah.org/">Center for Advancing Health</a> and the <a href="http://www.ipfcc.org/">Institute for Patient and Family-Centered Care</a> offer approaches and resources for advancing patient and family engagement at all levels of health care, from patient involvement in self-care and self-management to patient and family engagement in health care policy and health system redesign.<br />
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<i>I hope you will continue to visit EmpathyWorks and that you will also share your reactions, insights and resources.</i></blockquote>
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Enjoy!<br />
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MichaelMichael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com6tag:blogger.com,1999:blog-5502509972672388550.post-30995950127340019532015-11-14T17:34:00.002-05:002015-11-15T17:15:30.112-05:00When Empathy Doesn't Work:The Paris AttacksThe recent bombings in Paris are maddening, sickening, disturbing and deeply troubling. The attacks targeted innocent unsuspecting people attending a concert, a soccer game, dining or simply enjoying a warm fall Paris evening at a local cafe or bistro.<br />
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And or course, it is natural to respond to these brutal senseless killings with fury, hate and a desire to inflict revenge upon those responsible. </blockquote>
ISIS has taken responsibility for the carnage, so our anger and calls for retribution are directed at them...whoever and wherever they are.<br />
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I understand this....I too, feel pain and anger as well as disgust and worry, though of course, my pain and anger is only a fraction of what is experienced by those who have been directly impacted by the losses, or by the threats of further loss. </blockquote>
My visit to Paris last month, my first visit to France, to the very hospital that is across the street from one of the cafes that was hit by the terrorists, has heightened these feelings,<br />
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I feel a connection to Paris that seems to grow stronger with each passing hour and each story that I hear or read about the tragedy. </blockquote>
Yesterday, I sent an email to the physician and his assistant who generously consulted with me during my visit to Paris, letting them know my thoughts were with them.<br />
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I imagined what they might be feeling, and I was moved to reach out to them to let them know that I support them. </blockquote>
This, I believe, is an attempt to express empathy. Hopefully, my attempt to express empathy was received and was experienced as helpful, as emphatic. If so, it's an example of how empathy can "work".<br />
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However, I am having difficulty understanding how humans, the terrorists who both planned and executed these acts of violence, could act so ruthlessly, with such blatant disregard for human life.<br />
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I can't even imagine this...how a human brain, a human heart, a human soul could allow someone, anyone, to act in this way. </blockquote>
In this instance, empathy fails me. It's missing. It doesn't work. Perhaps, I am missing something?<br />
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<br />Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com3tag:blogger.com,1999:blog-5502509972672388550.post-30509666980894763252015-06-22T19:00:00.000-04:002015-06-23T20:54:52.989-04:00For Empathy!As a follow-up to a previous blog post, <a href="http://empathyworks.blogspot.com/2014/09/against-empathy.html">Against Empathy?</a> , I would like to share a column by Denise Cummins, PhD, a cognitive scientist and author. Dr. Cummins is an elected Fellow of the Association for Psychological Science and her research specialty is decision-making and thinking. <br />
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<i>In her <a href="https://www.psychologytoday.com/blog/good-thinking/201310/why-paul-bloom-is-wrong-about-empathy-and-morality">column</a>, which appeared in Psychology Today in 2013, Cummins argues that Bloom is wrong when he concludes "empathy is prone to <a href="https://www.psychologytoday.com/basics/bias">biases</a> that render moral judgment potentially harmful.” </i></blockquote>
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As Cummins points out in her column, Bloom errs when he posits that empathy for the suffering of individual victims that we can identify with because they are "like us" produces biased and faulty moral reasoning that can lead to mass retribution and violence.<br />
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Cummins argues that Bloom places too much value on reasoning, which is certainly not immune from faulty moral judgements. Cummins suggests that it is the pairing of empathy with "good" reasoning that leads to humanitarian actions.<br />
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<i>"The answer is to expand our empathy to include those who are not like us. That is what drove so many white Americans to argue for the abolition of slavery, the end of Jim Crow laws, and the institution of civil rights.......It is precisely our ability to imagine the plight of the nameless and faceless that elicits our empathy and our desire to act."</i></blockquote>
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Dr. Cummins ends her column with the following call for embracing <i>both</i> our capacity for empathy and our ability to reason when engaging in moral reasoning.<br />
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<i>"Instead, it is the <a href="https://www.psychologytoday.com/basics/marriage">marriage</a> of empathy to principle that has always been and will continue to be our salvation. It is our ability to generalize and to direct our empathy through the use of reason that is our saving grace. Without that, it is easy to create a holocaust, a crusade, or a jihad.</i></blockquote>
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<a href="http://cultureofempathy.com/References/Experts/Denise-Cummins.htm">More on Dr. Cummins' illuminating views on the value of empathy can be found on the Culture of Empathy website.</a><br />
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Dr. Cummins wrote Good Thinking: Seven Powerful Ideas that Influence the Way We Think (Cambridge University Press, 2012).</div>
Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com1tag:blogger.com,1999:blog-5502509972672388550.post-52503539800642874042015-02-26T21:24:00.001-05:002015-02-26T21:57:23.309-05:00Hawking Identifies Empathy as Key to Civilization's Survival<blockquote class="tr_bq">
<a href="https://www.blogger.com/"></a><span id="goog_1668465724"></span><span id="goog_1668465725"></span>See this <a href="http://features.aol.com/video/stephen-hawking-human-aggression-will-destroy-civilization?ncid=txtlnkusaolp00001348">AOL feature on Stephen Hawking's views about the importance of empathy</a> as an antidote to aggression and a key to civilization's survival. Clearly, Hawking's brilliance extends beyond "hard science". Thanks to Vaughn Keller for sharing this piece on Facebook.</blockquote>
Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com1tag:blogger.com,1999:blog-5502509972672388550.post-91864187230932752382014-12-26T12:25:00.000-05:002014-12-26T12:27:21.939-05:00Keeping up with Empathy in Health CareWant to keep up with the latest article or blog post that addresses <a href="http://www.scoop.it/t/empathy-and-healthcare">Empathy in Health Care</a>? Click here: http://www.scoop.it/t/empathy-and-healthcare<br />
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<a href="http://www.scoop.it/u/edwin-rutsch">Edwin Rutsch</a> is, as far as I can tell, the world's greatest purveyor, or "scooper" of empathy-related news. </blockquote>
Edwin is a master at utilizing online resources to collect and link up with the those who conduct research, develop curricula or write about empathy, compassion and related topics. He uses "Scoop it!", a service for "scooping", organizing and sharing news and resources. See his page on Scoop it! - http://www.scoop.it/u/edwin-rutsch'<br />
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You can also get a eyeful by visiting his <a href="http://cultureofempathy.com/Projects/Conference/">Culture of Empathy</a> webpage: at: http://cultureofempathy.com/Projects/Conference/<br />
or by visiting <a href="https://www.facebook.com/edwin.rutsch?fref=ts">Edwin' facebook page</a>: https://www.facebook.com/edwin.rutsch?fref=ts<br />
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Warning....if you visit on of Edwin's pages, plan to spend a big chunk of time exploring, reading and learning!</blockquote>
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<i><b><span style="color: red;">Happy Holidays!</span></b></i><br />
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MichaelMichael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com1tag:blogger.com,1999:blog-5502509972672388550.post-48007810371222509372014-12-08T10:31:00.001-05:002014-12-08T10:35:03.681-05:00Empowered or Powerful? My Mini-Lesson from Jessie Gruman.<div style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0); background-color: white; color: #666666; font-family: Lato, sans-serif; font-size: 1.0625em; margin-bottom: 1em;">
In a post on this blog over 3 years ago, <a href="http://empathyworks.blogspot.com/2010/08/can-clinicians-empower-patients.html">Can Clinicians Empower Patients?</a><u>, </u>I noted that many who work in the area of patient engagement, including Jessie Gruman, the founder of the <a href="http://www.cfah.org/">Center for Advancing Health</a>, believe that clinicians can't empower patients, only patients can empower patients.<br />
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Though I understand the argument that patients already have substantial power and ultimately are already in control over whether to follow through with treatment and self-care, I believe that clinicians can take proactive steps to encourage patients to be more engaged in decision and care.</blockquote>
Why ask clinicians to "empower patients"? Though it is desirable for patients to take an active, and even the lead role in health care decisions and plans, many are reluctant to take charge or feel unprepared or unsure about how to play a more active role in self-care and self-management of chronic conditions. (See an <a href="http://www.ncbi.nlm.nih.gov/pubmed/15987329">article by Wendy Levinson and colleagues</a> for data on patient preferences for involvement in decision making.)<br />
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Clinicians can help their patients understand the benefits of active involvement in decisions and self-care. Engaging patients in decisions and care is even more valuable when patients have serious life-threatening illnesses or chronic conditions that require ongoing self-management. Self-management can be quite challenging for any person with a single chronic condition and most people, particularly older adults, have multiple chronic conditions that they must manage simultaneously.<br />
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Self-management requires considerable expertise, effort, energy, expertise, coping, problem-solving and juggling. I have only 2 chronic conditions, yet I have spent a lot of time and energy on learning and actively managing my conditions.</blockquote>
Moreover, when clinicians actively include patients in the decision making and care, they are also "supporting autonomy", which has been recognized as an important determinant of motivation and subsequent behavior change. (<a href="http://www.ncbi.nlm.nih.gov/pubmed?cmd=historysearch&querykey=5">Patrick & Williams, 2012</a>) Supporting autonomy and building partnerships with patients are key elements of <a href="http://www.selfdeterminationtheory.org/">Self-Determination Theory</a>, <a href="http://www.motivationalinterviewing.org/">Motivational Interviewing</a> and models of <a href="http://www.informedmedicaldecisions.org/">Shared Decision Making</a>.<br />
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In my teaching and writing, I have used the term, "empowering patients" as a way of helping clinicians consider inviting patients to participate in decisions and learn strategies that will increase their capacity to manage their conditions and stay well.</blockquote>
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Last April, however, my views about using the term, empowering patients, changed forever. In April, I had the opportunity to chat briefly with Jessie Gruman just after she was awarded the inaugural <i>Jessie Gruman Health Engagement Award </i>at the Society of Behavioral Medicine (SBM) Annual Meeting in Philadelphia. During the award ceremony, the SBM Board acknowledged and celebrated Jessie's wisdom, guidance and lifetime contributions to the fields of both behavioral medicine and health engagement. See my previous <a href="http://empathyworks.blogspot.com/2014/07/jessie-grumans-legacy.html">EmpathyWorks post</a> for more on Jessie's legacy.<br />
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Jessie's death in July, 2014 was a huge loss for all those who advocate for greater patient engagement in care, though her legacy lives on through the <a href="http://www.cfah.org/">Center for AdvancingHealth</a>.</blockquote>
Jessie has written passionately about the importance of understanding what it is like for patients to live with a chronic condition and what they need to be successful in coping with illness. In a <a href="http://www.cfah.org/blog/2014/are-we-cowboys-or-managers-of-our-chronic-conditions">blog post</a> written at about the same time she received the SBM Health Engagement award, Jessie wrote:<br />
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<i><span style="color: #454545; font-family: Arial, Helvetica, sans-serif; font-size: 14px;">"The idea that I should "manage" my chronic disease has always struck me as optimistic daffiness on the part of those who want me to do this...</span><span style="color: #454545; font-family: Arial, Helvetica, sans-serif; font-size: 14px;">My image of having a serious chronic disease is of a cowboy riding a rodeo bull.....</span></i><span style="color: #454545; font-family: Arial, Helvetica, sans-serif; font-size: 14px;"><i>You call that management? No. But it gives you a pretty good idea of what it feels like to have a serious chronic disease. Most of us are just trying not to fall off the damn bull.</i>"</span></blockquote>
During our brief conversation at SBM, Jessie reminded me of the importance of viewing patients as the source of power for promoting health. She understood that, from the patient's perspective, the clinician can't empower a patient. Offering education, sharing decisions, and teaching self-management skills only go so far. Power comes not from the clinician, or a caregiver; it comes from within. Patients are already powerful, though they can become more prepared and skilled when they seek information, participate in decisions, prepare for visits, and learn and practice self-care skills. <br />
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Clinicians can empower health, not patients. Patients are already powerful!</blockquote>
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Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com0tag:blogger.com,1999:blog-5502509972672388550.post-45637865840331097512014-09-01T11:56:00.000-04:002014-09-01T11:58:02.148-04:00Against Empathy? <span style="font-family: Georgia, Times New Roman, serif;">Paul Bloom, Professor of Psychology and Cognitive Science at Yale University, recently wrote a thought provoking (and emotion provoking) post on Boston Review, entitled, <a href="http://www.bostonreview.net/forum/paul-bloom-against-empathy">Against Empathy?</a>. He writes about the downside of relying on empathy, particularly "emotional empathy", as a guide to action. Emotional empathy, he argues, is biased, clouds our thinking, and promotes moral errors, which may have dire consequences. He writes:</span><br />
<blockquote class="tr_bq">
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span><i><span style="font-family: Georgia, Times New Roman, serif;">"Empathy is biased; we are more prone to feel empathy for attractive people and for those who look like us or share our ethnic or national background. And empathy is narrow; it connects us to particular individuals, real or imagined, but is insensitive to numerical differences and statistical data."</span> </i></blockquote>
<blockquote class="tr_bq">
<i><span style="font-family: Georgia, Times New Roman, serif;"> </span><span style="font-family: Georgia, Times New Roman, serif;">"Our policies are improved when we appreciate that a hundred deaths are worse than one, even if we know the name of the one, and when we acknowledge that the life of someone in a faraway country is worth as much as the life a neighbor, even if our emotions pull us in a different direction."</span></i></blockquote>
<span style="font-family: Georgia, Times New Roman, serif;"><br />Too much emotional empathy, he notes, can also produce "empathetic exhaustion", particularly among those who try to apply empathy as a clinician or aid worker. Some may also experience "pathological altruism" and seek to heal or soothe others at their own expense.</span><br />
<div>
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<div>
<span style="font-family: Georgia, Times New Roman, serif;">Bloom concedes that it is appropriate for clinicians to respond to a patient's pain or angst, though he argues that too much clinician empathy will generate burnout and promote ineffective and even unwanted clinician behavior. </span></div>
<blockquote class="tr_bq">
<span style="font-family: Georgia, Times New Roman, serif;"><i>Bloom contrasts emotional empathy with <b>compassion</b>, which he describes as "concern and love ....., and the desire and motivation to help" which need not involve mirroring or experiencing the anguish of others. Compassion, he argues, is a more effective, and more sustainable response.</i></span></blockquote>
<div>
<span style="font-family: Georgia, Times New Roman, serif;">Personally, as I read his blog, I found myself arguing against Bloom and for empathy. </span><span style="font-family: Georgia, 'Times New Roman', serif;">When I think about the application of empathy in clinical settings, I have trouble seeing the cognitive and emotional components of empathy as separate processes. </span><br />
<blockquote class="tr_bq">
<i><span style="font-family: Georgia, 'Times New Roman', serif;">Though there may be distinct neural pathways for these 2 aspects of empathy, </span><span style="font-family: Georgia, 'Times New Roman', serif;">clinical empathy is a therapeutic</span><span style="font-family: Georgia, 'Times New Roman', serif;"> <b>interactive </b></span><b style="font-family: Georgia, 'Times New Roman', serif;">process </b><span style="font-family: Georgia, 'Times New Roman', serif;">that integrates eliciting, exploring, listening, observing, perceiving, imagining AND responding to others' expressed emotions, values and needs.</span></i> </blockquote>
<span style="font-family: Georgia, Times New Roman, serif;">As I noted in a <a href="http://empathyworks.blogspot.com/2013/12/a-short-video-on-empathy-featuring.html">previous EmpathyWorks blog post</a>, Brene Brown has described empathy as having 4 critical elements:</span><br />
<ol><span style="font-family: Georgia, Times New Roman, serif;">
<li>perspective taking</li>
<li>staying out of judgement</li>
<li>recognizing emotion; and</li>
<li>communicating what you notice</li>
</span></ol>
<span style="font-family: Georgia, Times New Roman, serif;">
</span></div>
<div>
<span style="font-family: Georgia, Times New Roman, serif;">In another <a href="http://empathyworks.blogspot.com/2014/02/more-on-brene-brown-empathy-video.html">EmpathyWorks post,</a> I cite others' conceptualization of clinical empathy as a <b><i>relational process</i></b> that includes both cognitive and emotional elements. See: Suchman AL, Markakis K, Beckman HB, Frankel R. A model of empathic communication in the medical interview. JAMA: 1997;277(8):678-682.</span><br />
<blockquote class="tr_bq">
<span style="font-family: Georgia, 'Times New Roman', serif;">Jodi Halpern, another clinical educator, emphasizes the relational </span><span style="font-family: Georgia, 'Times New Roman', serif;">process of <i><b>"emotional attunement" </b></i>that comes from perspective taking (the cognitive aspect) together with exploring and responding to the "meaning" of the feeling. </span></blockquote>
<span style="font-family: Georgia, Times New Roman, serif;">For those interested in learning more about clinical empathy, I also recommend the book, Empathy Reconsidered, New Directions in Psychotherapy (Eds: Arthur Bohart & Leslie Greenberg. American Psychological Association, Washington, 1997) which provides further perspectives on the role of empathy in clinical encounters, particularly in psychotherapy. </span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<br />
<blockquote class="tr_bq">
<i><span style="font-family: Georgia, Times New Roman, serif;">In my own experience, empathy happens when I:</span></i><br />
<ul>
<li><i><span style="font-family: Georgia, Times New Roman, serif;">allow myself to be fully present,</span></i></li>
</ul>
<ul>
<li><i><span style="font-family: Georgia, Times New Roman, serif;">listen generously,</span></i></li>
</ul>
<ul>
<li><i><span style="font-family: Georgia, Times New Roman, serif;">seek to fully understand the meaning of the patient's feelings,</span></i></li>
</ul>
<ul>
<li><i><span style="font-family: Georgia, Times New Roman, serif;">respond with genuine reflections about what I am hearing and experiencing, and</span></i></li>
</ul>
<ul>
<li><i><span style="font-family: Georgia, Times New Roman, serif;">allow the patient to correct, refine or elaborate upon my attempts to understand. </span></i></li>
</ul>
</blockquote>
<br />
<span style="font-family: Georgia, 'Times New Roman', serif;">This process may continue for a bit, as the patient elaborates about the meaning of their situation or feeling. More often than not, the patient eventually responds by saying, <i>"Yes, that's it, exactly". </i>Afterwards, some will indicate that they felt better being heard and responded to.</span><br />
<span style="font-family: Georgia, 'Times New Roman', serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">In previous posts on EmpathyWorks, I have shared the evidence for clinicians' use of empathy and a wide variety of positive outcomes, including enhanced patient satisfaction, increased patient follow through, positive health behavior change and even improved illness outcomes. For just 1 example, see: Hojat, M., D. Z. Louis, et al. (2011). "Physicians' empathy and clinical outcomes for diabetic patients." Acad Med 86(3): 359-64.</span><br />
<div>
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<span style="font-family: Georgia, Times New Roman, serif;">Whether or not you agree with Bloom's arguments, the post is worth reading, as are the many insightful and often brilliant responses written by a broad spectrum of commentators, including: Marco Iacoboni, neuroscientist; Peter Singer, ethicist; Barbara Fried, law professor and public policy expert; Maryanne LaFrance, psychologist and women's studies expert; Nomy Arpaly, philosophy professor; Christine Montross, physician/poet; and Leslie Jamison and Simon Baron-Cohen, writers/commentators with strong interests in empathy.</span></div>
</div>
Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com1tag:blogger.com,1999:blog-5502509972672388550.post-37907007296895029242014-08-01T18:59:00.002-04:002014-08-02T14:19:21.824-04:00Learning and Practicing Spiritual Empathy<span style="background-color: rgba(255, 255, 255, 0);">Follow the link below to a moving post is by an Israeli rabbinical student intern who is completing an internship as a hospital chaplain. He shares his struggles to comprehend, connect with and ease the suffering of patients, a challenge that is even more difficult in the setting of the current Israeli-Palestinian conflict.</span><br />
<span style="background-color: rgba(255, 255, 255, 0);"><br /></span>
<a href="http://www.huffingtonpost.com/avram-mlotek/spiritual-empathy_b_5619383.html">http://www.huffingtonpost.com/avram-mlotek/spiritual-empathy_b_5619383.html</a>Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com0tag:blogger.com,1999:blog-5502509972672388550.post-60147509786848138772014-07-17T14:23:00.002-04:002014-07-17T17:42:39.235-04:00Jessie Gruman's LegacyLast May, I wrote a post, <a href="http://empathyworks.blogspot.com/2014/05/jessie-gruman-true-champion-for-patient.html">Jessie Gruman, A True Champion for Patient Engagement</a>, highlighting the extraordinary contributions that Jessie has made as a tireless advocate for this cause.<br />
<br />
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.<br />
<br />
<blockquote class="tr_bq">
<i>I, too, am deeply saddened by this news. All those who knew her will all miss her wisdom, perspective, advocacy, and passion. </i></blockquote>
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. <br />
<blockquote class="tr_bq">
<i>One might say that Jessie's "way of being" epitomized effective engagement! </i></blockquote>
As I noted in my post in May, the Jessie is the founder of the <a href="http://www.cfah.org/">Center for Advancing Health</a>, 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 <a href="http://www.cfah.org/blog/">Prepared Patient Blog</a>, 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.<br />
<br />
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:<br />
<br />
<blockquote class="tr_bq">
<i><a href="http://www.aftershockbook.com/">Aftershock: When the Doctor Gives you - or Someone You Love - a Devastating Diagnosis(2007)</a>,<br /> Cancer Survivorship: What I Wish I'd Known Earlier (2013)<br /><a href="http://www.cfah.org/jessie-gruman/books/slow-leaks-missed-opportunities-to-encourage-our-engagement-in-our-health-care">Slow Leaks: Missed Opportunities to Encourage Our Engagement in Health Care (2013)</a><a href="http://www.cfah.org/jessie-gruman/books/a-year-of-living-sickishly-a-patient-reflects">A Year of Living Sickishly: A Patient Reflects (2013)</a></i></blockquote>
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.<br />
<br />
<br />Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com2tag:blogger.com,1999:blog-5502509972672388550.post-26247547026004613062014-07-06T20:56:00.001-04:002014-07-06T20:56:32.550-04:00More Strategies for Expressing and Teaching Empathy<br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">In a previous <a href="http://empathyworks.blogspot.com/2014/04/strategies-for-expressing-empathy.html">EmpathyWorks blog post</a>, I addressed the question, <i>"Can you actually teach empathy?". </i></span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">As i noted in the column, the answer is a resounding, "</span><i style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Yes!"</i><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> , at least for medical students and health care professionals.</span><br />
<blockquote class="tr_bq">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Research has demonstrated that courses like, <i>"The Healer's Art</i>", (see: <a href="http://www.ishiprograms.org/programs/medical-educators-students/">The Healer's Art</a> webpage), developed by <a href="http://www.rachelremen.com/">Rachel Remen</a> at the University of California San Francisco, profiled in <a href="http://empathyworks.blogspot.com/2013/10/rachel-remen-healers-art-and-healing.html">EmpathyWorks</a>, and also in a New York Time <a href="http://opinionator.blogs.nytimes.com/2013/10/02/who-will-heal-the-doctors/">feature article</a>, are effective in promoting humanistic attitudes and practices among medical students. </span></blockquote>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtULukUtFcAnIFvWzNAvyL4RDDa6iGQO1yWRgoA-XYzzBS6bjp21r4DrUdfXC6LX481aT1rLkNSebt7BFC63ZooFw9WfDGisQt4AYTuIvjGaNE6B1xu4cb2-feth5JpOLUaSQswplbLyAJ/s1600/Rachel-Naomi-Remen-Headshot-226x300.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtULukUtFcAnIFvWzNAvyL4RDDa6iGQO1yWRgoA-XYzzBS6bjp21r4DrUdfXC6LX481aT1rLkNSebt7BFC63ZooFw9WfDGisQt4AYTuIvjGaNE6B1xu4cb2-feth5JpOLUaSQswplbLyAJ/s1600/Rachel-Naomi-Remen-Headshot-226x300.jpg" height="200" width="150" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Rachel Remen</td></tr>
</tbody></table>
<blockquote class="tr_bq">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">And there is strong evidence that </span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">skill training and practice can promote patient-centered skills, including empathy, among practicing clinicians. (See:.</span><a href="http://www.ncbi.nlm.nih.gov/pubmed/23235595" style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">http://www.ncbi.nlm.nih.gov/pubmed/23235595</a><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">)</span></blockquote>
<br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><a href="http://www.motivationalinterview.org/">Motivational Interviewing</a> skills were featured in my previous <a href="http://empathyworks.blogspot.com/2014/04/strategies-for-expressing-empathy.html">post </a>on strategies for teaching empathy. </span><br />
<br /><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">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, <a href="http://www.amazon.com/Smiths-Patient-Centered-Interviewing-Evidence-Based/dp/0071760008/ref=sr_1_1?ie=UTF8&qid=1404694155&sr=8-1&keywords=robert+c+smith+patient-centered">Patient-Centered Interviewing</a>. You can also read an recent article on this approach in the medical journal, <a href="http://www.ncbi.nlm.nih.gov/pubmed/23352913">Patient Education and Counseling</a>: </span><br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">See below for a modified version of the NURS approach, NURSE. The E is for Empower</span><br />
<blockquote class="tr_bq">
<ul>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><u><b>N</b>ame</u> the emotion - reflect what you heard or noticed non-verbally.</span> </li>
</ul>
</blockquote>
<blockquote class="tr_bq">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> Examples include:</span></blockquote>
<br />
<ul><ul><ul>
<li><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">"You feel frustrated..."</span></i></li>
<li><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">"You're angry....".</span></i></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><i>"You seem pretty sad..."</i> </span></li>
</ul>
</ul>
</ul>
<blockquote class="tr_bq">
<ul>
<li> <span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><u><b>U</b>nderstand</u> - express understanding, or normalize, without trying to fix</span></li>
</ul>
</blockquote>
<blockquote class="tr_bq">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> Examples include:</span></blockquote>
<br />
<ul><ul><ul>
<li><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">"It's understandable that you are frustrated, considering all you have been through."</span></i></li>
<li><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">"I can understand you why you would be angry about...."</span></i></li>
<li><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">"Many of my patients have experienced deep sadness for a long time after losing a loved one."</span></i></li>
<li><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">"I think I can understand how distressing this has been for you."</span></i></li>
</ul>
</ul>
</ul>
<blockquote class="tr_bq">
<ul>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><u><b>R</b>espect</u> - affirm and express respect for the patient's efforts to cope</span> </li>
</ul>
</blockquote>
<blockquote class="tr_bq">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> Examples include:</span></blockquote>
<br />
<ul><ul><ul>
<li><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">"I'm impressed with your efforts to manage your diabetes, despite the challenges"</span></i></li>
<li><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">"It's remarkable that you were able to.....".</span></i></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><i>"I appreciate how hard this has been for you..."</i> </span></li>
<li><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">"Thanks for letting me know"</span></i></li>
</ul>
</ul>
</ul>
<div>
<blockquote class="tr_bq">
<ul>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><u><b>S</b>upport</u> - let the patient know that you are willing to help </span></li>
</ul>
</blockquote>
<blockquote class="tr_bq">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> Examples include:</span></blockquote>
<br />
<ul><ul><ul>
<li><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">"I want to help in any way I can."</span></i></li>
<li><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">"I am here for you."</span></i></li>
<li><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">"I am willing to help you get through this".</span></i></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><i>"I will work with you to figure out a way to help." </i><i>(Some educators call this "Partnership")</i></span></li>
<li><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">"Let's work together to address your concerns" (Some educators call this "Partnership")</span></i></li>
<li><i><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">"What can i do to help?" (Asking this question reflects your willingness to explore how you might be helpful)</span></i></li>
</ul>
</ul>
</ul>
<div>
<blockquote class="tr_bq">
<ul>
<li><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><u><b>E</b>mpower</u> - identify and support strengths and capabilities</span></li>
</ul>
</blockquote>
<blockquote class="tr_bq">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> Examples include:</span></blockquote>
<br />
<ul><ul><ul>
<li><i>"<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">What are you currently doing that is helping?"</span></i></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><i>"What have you done in the past that has been helpful</i>?"</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><i>"What success have you had?" </i></span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">When strategies are mentioned:</span><i style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> "It's good that you have been able to xx"</i></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">"<i>How can you build on previous success</i>?"</span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><i>"What else can you do?"</i></span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><i>"Who can help you?"</i></span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><i>"What can i do to support you?</i></span></li>
<li><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">When resources are identified: <i>"You h</i>ave been able to identify some helpful resources and sources of support."</span></li>
</ul>
</ul>
</ul>
</div>
</div>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">As always, i am interested in hearing about your feedback and in learning about your favorite strategies for teaching empathy.</span><br />
Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com0tag:blogger.com,1999:blog-5502509972672388550.post-5773988305520510832014-05-22T01:46:00.000-04:002014-05-22T01:46:53.487-04:00Jessie Gruman: A True Champion for Patient Engagement Jessie Gruman has been a outspoken and articulate advocate for people's engagement in health care for several decades. Actually, Jessie is more than an advocate. She is a visionary, a beacon, a once in a lifetime voice for millions of patients and caregivers who struggle with serious health care conditions.<br />
<blockquote class="tr_bq">
Jessie is the founder and president of the Center for Advancing Health which, since 1992, has has focused people’s engagement in their health care from the patient perspective. Prior to founding CFAH, Jessie addressed health engagement, as well as the effects of behavior on health for the public sector (National Institutes of Health), the voluntary health sector (American Cancer Society) and the private sector (AT&T). </blockquote>
In April, I had the opportunity to chat briefly with Jessie at the Society of Behavioral Medicine (SBM) Annual Meeting in Philadelphia. During this year's meeting, the SBM Board acknowledged and celebrated Jessie's lifetime contributions to health engagement by awarding her the inaugural <i>Jessie Gruman Health Engagement Award</i>.<br />
<blockquote class="tr_bq">
In a moving brief ceremony, Jessie was acknowledged for her passionate and highly effective advocacy as well as for her wisdom, guidance and contributions to the fields of both behavioral medicine and health engagement.</blockquote>
The <a href="http://www.cfah.org/">Center for Advancing Health</a> website is a great place to find research reviews, policy briefs, news, blogs and fabulous resources on patient and caregiver engagement, as well as other topical health care issues. If you visit, you will have a hard time leaving and you won't be able to avoid bookmarking at least 1 of the resources you will find there.<br />
<blockquote class="tr_bq">
Be sure to sample Jessie's <i>Prepared Patient Blog. </i>Jessie makes frequent entries, often sharing stories about her own experiences coping with 5 life-threatening conditions. The Prepared Patient Blog also features guest bloggers, including leaders in the fields of health engagement, health policy, patient advocacy and health behavior change.</blockquote>
I also recommend Jessie's books, written from the patient perspective, chronically her journey as a patient and her insights as a researcher, advocate, consultant and policy expert. Her books include:<br />
<div>
<ul>
<li><a href="http://www.aftershockbook.com/"><i>Aftershock: When the Doctor Gives you - or Someone You Love - a Devastating Diagnosis</i> (2007)</a>, </li>
<li><i>Cancer Survivorship: What I Wish I'd Known Earlier </i>(2013)</li>
<li><i><a href="http://www.cfah.org/jessie-gruman/books/slow-leaks-missed-opportunities-to-encourage-our-engagement-in-our-health-care">Slow Leaks: Missed Opportunities to Encourage Our Engagement in Health Care (2013)</a></i></li>
<li><i style="font-family: Arial, Helvetica, sans-serif; font-size: 14px; text-decoration: none;"><a href="http://www.cfah.org/jessie-gruman/books/a-year-of-living-sickishly-a-patient-reflects">A Year of Living Sickishly: A Patient Reflects (2013) </a></i></li>
</ul>
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I will share more about Jessie, CFAH and <i>The Prepared Patient Blog</i> in upcoming posts.</div>
</div>
Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com0tag:blogger.com,1999:blog-5502509972672388550.post-68157848452006771602014-04-06T14:16:00.000-04:002014-04-06T14:19:23.723-04:00Strategies for Expressing Empathy<blockquote class="tr_bq">
<span style="font-family: inherit;"><b><i>"So you think you can actually teach empathy to doctors?"</i></b></span></blockquote>
This is a question I have been asked scores of times during my 30+ years as a a medical educator. <br />
<br />
And my answer is:<br />
<blockquote class="tr_bq">
<b><i>"Yes, it is possible to teach empathy to clinicians, even doctors."</i></b></blockquote>
Though many students, and practicing clinicians, are naturally empathic, and express empathy consistently during encounters with patients, others need help identifying how to respond to patients' expressed emotions, values and concerns, both verbally and non-verbally. And many others, though fully capable of responding effectively, have learned to suppress their natural empathic responses, both consciously and unconsciously, during training. Researchers have shown that the rigors of training and its intense focus on acquiring biomedical knowledge and skills can erode humanistic attitudes and practices. (See Rabin MW, Remen RN, Parmaelee DX and Inui TS. Professional Formation: Extending Medicine's Lineage of Service into the Next Century. Academic Medicine: 2010; 85:310 - 317. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20107361">http://www.ncbi.nlm.nih.gov/pubmed/20107361</a>)<br />
<br />
For those who need help in learning how to express empathy, research has shown that skill training and practice (with feedback) can help, even among "seasoned" practicing clinicians. (See Dwamena, FM, Holmes-Rovner, et al. (2012). "Interventions for providers to promote a patient-centred approach in clinical consultations." Cochrane Database Syst Rev 12: CD003267. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23235595">http://www.ncbi.nlm.nih.gov/pubmed/23235595</a>)<br />
<br />
Though a single communications skills workshop is not a sufficient "dose" of training for most learners, providing opportunities for repeated learning and practice can help many clinicians to adopt and regularly employ empathic skills in their interactions with patients, especially if personalized feedback is offered in the context of a supportive learning environment.<br />
<blockquote class="tr_bq">
<b><i>So,how do you teach empathy?</i></b></blockquote>
<div>
In my teaching, I have found the following strategies to be particularly valuable. They can help clinicians "find the words" to use when opportunities arise in encounters with patients.<br />
<blockquote class="tr_bq">
<b><i>Open-ended questions</i> </b>help the clinician explore and elicit the patients feelings, concerns, values or beliefs. Here are some examples:</blockquote>
</div>
<blockquote class="tr_bq">
<ul>
<li>How are you holding up?</li>
<li>What has this been like for you?</li>
<li>Tell me more about how you are feeling.</li>
<li>What else have you been experiencing?</li>
<li>How has this impacted your…..(relationships, condition, work, school, life)</li>
<li>Tell me more about what this means to you.</li>
</ul>
</blockquote>
<blockquote class="tr_bq">
When a patient expresses an emotion, value or belief, (either spontaneously, or in response to a query), the clinician may respond with a <b>"<i>reflection</i>"</b> that reiterates what the patient has said, either in the patient's own words, or with an approximation. </blockquote>
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<blockquote class="tr_bq">
<h4>
<b><i>Reflections (with "stems" to help form the reflections<u>)</u></i></b></h4>
</blockquote>
<blockquote class="tr_bq">
<ul>
<li>I can see you are ..…(upset, sad, frustrated, worried, anxious, distressed, angry, etc.)</li>
<li>You seem ..…(upset, sad, frustrated, worried, anxious, distressed, angry, etc.</li>
<li>I hear you saying that you feel.(upset, sad, frustrated, worried, anxious, angry, etc.)</li>
<li>Sounds like it’s been ….(.upsetting, depressing, frustrating, worrisome, nerve- wracking, distressing, maddening, awful, etc.)</li>
</ul>
</blockquote>
</div>
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<blockquote class="tr_bq">
<i></i></blockquote>
<blockquote class="tr_bq">
<i><b>Reflections (without stems)</b></i></blockquote>
<blockquote class="tr_bq">
<ul>
<li>You are…(upset, sad, frustrated, worried, anxious, distressed, angry, etc.)</li>
<li>It’s been…(upsetting, depressing, frustrating, worrisome, maddening, awful, etc.)</li>
<li>This is important to you…</li>
</ul>
</blockquote>
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<div>
<blockquote class="tr_bq">
<b><i><u>After a reflection, WAIT to allow the person to correct, confirm, elaborate, continue</u>. </i></b>(This is challenging for many clinicians who want to follow a reflection with a question)</blockquote>
</div>
<div>
<blockquote class="tr_bq">
<i><b>Affirmations </b></i>(with genuineness) are a type of reflection that also recognizes the patient's efforts or achievements. Patients generally appreciate this. </blockquote>
<blockquote class="tr_bq">
<ul>
<li><i>You put a lot of effort into this….</i></li>
<li><i>You have worked so hard on this….</i>· </li>
</ul>
</blockquote>
<blockquote class="tr_bq">
<b><i>“Non-verbal” responses·</i></b><br />
<ul>
<li>Eye contact</li>
<li>Sitting down, leaning in, moving closer,</li>
<li>Nodding, verbal facilitation (“oh”, “hmm”, “uhh”, “gosh”)</li>
<li>Matching (reflecting non-verbal gestures, without mimicking)</li>
<li>Touch, when appropriate</li>
</ul>
</blockquote>
These strategies are featured in Motivational Interviewing (MI), an evidence-based clinical method that promotes partnership, acceptance, compassion and an evoking (as opposed to directing style). See my favorite links or go directly to: <a href="http://www.motivationalinterview.org/">http://www.motivationalinterview.org/</a> for more information, tools and resources on using MI.<br />
<br />
What are your favorite strategies for helping others to express empathy?<br />
<br />
<br /></div>
Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com0tag:blogger.com,1999:blog-5502509972672388550.post-86859415076193880412014-02-15T20:08:00.001-05:002015-12-07T08:18:32.938-05:00More on the Brene Brown Empathy Video<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">My last post was about a brief video on expressing empathy that featured Brene Brown, PhD. You can find the video at:</span><span style="font-family: helvetica neue, arial, helvetica, sans-serif;">https://www.youtube.com/watch?v=1Evwgu369Jw</span><br />
<span style="font-family: helvetica neue, arial, helvetica, sans-serif;"><br /></span>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">Many liked the video, though some colleagues who are experts in clinician-patient communication felt that Dr. Brown was off target in her conceptualization of sympathy. Dr. Dennis Novack, Professor of Medicine and Associate Dean of Medical Education at Drexel University College of Medicine, wrote: </span><br />
<blockquote class="tr_bq">
<i><span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">"I like what she says about empathy, but disagree completely with her definition of sympathy, which really undermines the value of the video for me. Sympathy is derived from the Greek sympatheia which means "feeling with." In one sense it might be empathy on steroids. We send a sympathy card to someone because we feel the loss as well. We feel sorrow for and with another, though maybe not as deeply, and in some ways identify with the other.</span></i> </blockquote>
<blockquote class="tr_bq">
<i><span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">The classic studies of Nightengale et al show that physicians who adopt a more sympathetic stance toward patients’ emotional situations do too many tests and perform CPR longer – they lose their objectivity (Nightengale, S.D., et al. JGIM:1991; 6:420-23.)<br /> </span><span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">Empathy is conceived as a more objective process. All the actions you listed are components of the empathic process, that allow the physician to feel for patients and communicate that understanding, while still being able to make good decisions about their medical care free of the effects of the emotions elicited.</span><span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">By the way, a recent study Suely Grosseman and I and others recently did suggests that another component of the empathic process is checking to ensure that the patient got the empathic communication. We found that residents’ self-assessment of their empathic communication to standardized patients in 5 OSCE stations had zero correlation with SP assessments of their empathic communication."</span></i></blockquote>
<div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">Richard Frankel, Professor of Medicine, Indiana University School of Medicine noted the value of focusing on the interactional dynamics of empathy and referred interested folks to Jodi Halpern's use of the concept of "attunement" in her 2003 Journal of General Internal Medicine article (Halpern J. What is clinical empathy? Journal of general internal medicine. Aug 2003;18(8):670-674.) He added:</span><br />
<blockquote class="tr_bq">
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><i>"Our group in Rochester also published a paper in 1997 in which we described the interactional dynamics of empathy, (Suchman AL, Markakis K, Beckman HB, Frankel R. A model of empathic communication in the medical interview. JAMA: the journal of the American Medical Association.1997;277(8):678-682.).<br /> </i></span><span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><i>The model was later validated by Hilde Eide (Eide H, Frankel R, Haaversen AC, Vaupel KA, Graugaard PK, Finset A. Listening for feelings: identifying and coding empathic and potential empathic opportunities in medical dialogues. Patient education and counseling. Sep 2004;54(3):291-297)</i></span></blockquote>
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<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><br /></span></div>
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<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">Rich also endorsed the empathy video created by the Cleveland Clinic, featured in my March 23 2013 post:</span><br />
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><br /><a href="http://empathyworks.blogspot.com/2013/03/watch-this-wonderful-video-empathy.html">http://empathyworks.blogspot.com/2013/03/watch-this-wonderful-video-empathy.html</a></span><br />
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><br /> </span></div>
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<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">I agree with both Dennis and Rich about the importance of both the cognitive and interactional aspects of emapthy and I, too, have found Jodi Halpern's conceptualization of clinical empathy quite helpful. Her thoughtful and erudite book, From Detached Concern to Empathy: Humanizing Medical Practice (Oxford University Press, New York, 2001) is highly recommended for all those interested in promoting and studying clinical empathy.</span></div>
<div>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">For those interested in learning more about clinical empathy, I also recommend the book, Empathy Reconsidered, New Directions in Psychotherapy (Eds: Arthur Bohart & Leslie Greenberg. American Psychological Association, Washington, 1997) which provides further perspectives on the role of empathy in clinical encounters, particularly in psychotherapy. I especially recommend the introductory chapter by the editors, in which they describe 3 different types of therapeutic empathy: </span><br />
<ol><span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">
<li>"empathic rapport" - the clinician expresses understanding and acceptance of the client's feelings (this is closest to what Brene Brown was describing in the video);</li>
<li>"experience - near understanding of the client's world" - a deeper understanding of the client's experience or "world". This usually results from exploration of the client's perceptions and reactions, including how the client's past experiences may have shaped their current emotional response; and</li>
<li>"communicative attunement" - characterized by moment-moment attunement based on reflections or other attempts to understand what the client is trying to communicate.The therapist is actively trying to, not only understand what the client is saying, but also trying to "help the client make sense of their ever-emerging experience."</li>
</span></ol>
<span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">
</span><span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;">In a future post, I will share some simple strategies and approaches clinicians might use to enhance their capacity to develop empathic rapport.</span><span style="font-family: "helvetica neue" , "arial" , "helvetica" , sans-serif;"><br /> </span><br />
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Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com8tag:blogger.com,1999:blog-5502509972672388550.post-31663683602693963142013-12-28T19:33:00.003-05:002015-12-07T08:18:10.515-05:00A Short Video on Empathy Featuring Brené Brown<br />
<span style="font-family: "georgia" , "times new roman" , serif;">Sue Raffa, PhD, a colleague at Alpert Medical School, Brown University, recently shared a wonderful animated video on empathy with me. The brief video was created by the Royal Society of the Arts (RSA) and features Brene Brown, PhD, LMSW, a research professor at the University of Houston Graduate Colleage of Social Work.</span><br />
<span style="color: #3e3934; font-family: "georgia" , "times new roman" , serif; font-size: 15px; line-height: 24px;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif;"><span style="color: #3e3934;"><span style="line-height: 24px;">You can find the video at: https://www.youtube.com/watch?v=1Evwgu369Jw</span></span></span><br />
<span style="font-family: "georgia" , "times new roman" , serif;"><br /></span>
<span style="font-family: "georgia" , "times new roman" , serif;">The video offers a wonderful, quick,and amusing lesson on empathy and how if differs from sympathy. </span><br />
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<span style="font-family: "georgia" , "times new roman" , serif;"><span style="color: #3e3934; font-size: 15px; line-height: 24px;"><br /></span>I particularly like Dr. Brown's<span style="color: #3e3934;"><span style="font-size: 15px; line-height: 24px;"> </span></span> reference to the <span style="background-color: #fafbfb; color: #4e5665; line-height: 14px;">4 key qualities of </span>empathy<span style="background-color: #fafbfb; color: #4e5665; line-height: 14px;">:</span></span></div>
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<ol>
<li><span style="color: #4e5665;"><span style="line-height: 14px;"><span style="font-family: "georgia" , "times new roman" , serif;">perspective taking</span></span></span></li>
<li><span style="color: #4e5665; font-family: "georgia" , "times new roman" , serif; line-height: 14px;">staying</span><span style="color: #4e5665; font-family: "georgia" , "times new roman" , serif; line-height: 14px;"> </span><span style="color: #4e5665; font-family: "georgia" , "times new roman" , serif; line-height: 14px;">out</span><span style="color: #4e5665; font-family: "georgia" , "times new roman" , serif; line-height: 14px;"> </span><span style="color: #4e5665; font-family: "georgia" , "times new roman" , serif; line-height: 14px;">of judgement</span></li>
<li><span style="color: #4e5665; font-family: "georgia" , "times new roman" , serif; line-height: 14px;">recognizing emotion; and</span></li>
<li><span style="color: #4e5665; font-family: "georgia" , "times new roman" , serif; line-height: 14px;">communicating what you notice</span></li>
</ol>
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<span style="background-color: #fafbfb;"></span><br />
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<span style="background-color: #fafbfb;"><span style="font-family: "georgia" , "times new roman" , serif;">I also like her idea that empathy "fuels connection", contrasted with sympathy, which "drives disconnection". Empathy, she states, can be operationalized as "feeling with" other and requires a "vulnerable choice". She adds, "To connect with you, I have to connect with something in myself that knows that feeling", which can be painful. Empathy, she notes, is not about trying to make things better, it's about being present and expressing understanding to a person who is struggling></span></span></div>
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<blockquote class="tr_bq">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><i>"Rarely can a response make something better....what makes something better is connection."</i></span></blockquote>
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<span style="font-family: "georgia" , "times new roman" , serif;">Awesome! </span></span></div>
Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com5tag:blogger.com,1999:blog-5502509972672388550.post-2643499057440175472013-10-06T11:34:00.003-04:002013-10-06T11:38:41.621-04:00Rachel Remen, The Healer's Art, and Healing Healers Two recent columns in the New York Times by David Bornstein highlight the work of Rachel Remen, MD, a physician, healer, educator and writer whom I deeply admire and respect.<br />
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David Bornstein is a journalist who has chronicled the impact of social entrepreneurs (I love his book, <a href="http://www.amazon.com/How-Change-World-Entrepreneurs-Updated/dp/0195334760">How to Change the World</a>). David writes a blog for NYT called <em>"Fixes".</em> In his September 18, 2013 column, <a href="http://opinionator.blogs.nytimes.com/2013/09/18/medicines-search-for-meaning/">Medicine's Search for Meaning</a>, he writes about burnout among physicians that results from the challenges of practicing medicine in the current environment, one that focuses on productivity and treatment outcomes, rather than on meeting the emotional and functional needs of patients. To paraphrase:<br />
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"....<em>healing involves far more than knowledge and skill. The process by which a doctor helps a patient accept, recover from, adapt to, or endure a serious illness is full of nuance and mystery......Great doctors don’t just diagnose diseases, prescribe medications and treat patients; they bring the full spectrum of their human capabilities to the compassionate care of others....."</em></blockquote>
Bornstein also writes:<br />
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<em>"As administrative and documentation burdens have exploded in the past three decades, doctors find themselves under pressures to work as quickly as possible. Many have found that what is sacrificed is the very thing that gives meaning to the whole undertaking: the patient-doctor relationship."</em></blockquote>
Bornstein quotes medical educators who note that these burdens produce high levels of distress, depression, loss of satisfaction, fatigue, and burnout, producing <em>"medical errors, substance abuse, and doctors quitting"</em> and asks, "<em>How could we help medicine overcome its own illness?"</em><br />
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Bornstein answers his own question by describing work of Rachel Remen, who, as I noted in my introduction, has been a source of inspiration and healing for me for many years. Rachel is a wonderful clinician, educator and writer who has dedicated her career to meeting the broad biopsychosocial and spiritual needs of her patients. Through her writings and trainings, she has also helped practicing clinicians, as well as clinicians in training, to recapture the core values...the "meaning" ... that often led them to choose medicine or nursing as a career.<br />
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The Healer’s Art course was developed by Rachel over 2 decades ago at the University of California, San Francisco medical school. As David writes, The Healer's Art:<br />
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<em>"is predicated on the idea that medicine is an ancient lineage that draws its strength from its core values: compassion, service, reverence for life and harmlessness. When students derive meaning and strength </em>.....[from these values, they]<em> can 'immunize' themselves against the assaults of the medical curriculum and even the health care system itself."</em></blockquote>
The Healer's Art has now spread to dozen's of medical and nursing schools in the US and to a growing list of professional schools around the globe. <br />
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A similar program for practicing clinicians, <em>Finding Meaning in Medicine (FMM), </em>provides a supportive forum for exploring core values and sharing positive experiences related to working with patients. I was a member of a <em>FMM</em> group for a few years and found it highly enlightening, rewarding and satisfying. Though I left the group when I changed jobs, I am still longing for participating in a group years later.<br />
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There were so many poignant and heartfelt responses by clinicians to the Sept 18th column that David wrote a follow-up column, <a href="http://opinionator.blogs.nytimes.com/2013/10/02/who-will-heal-the-doctors/">Who Will Heal the Doctors?.</a> This produced even more responses, reflecting the need for more programs like <em>The Healer's Art</em> and <em>FMM</em>. <br />
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As I noted in my comment, my heart goes out to all my colleagues who continue to make daily sacrifices to care for their patients, providing every ounce of compassion they can in the few minutes they have with patients.</blockquote>
I have been planning to attend the Healer's Art training program at Commonweal for several years now so I might serve as a facilitator of the program at Brown University's medical school. Just yesterday, I made a commitment to apply to attend the 2014 course, with Rachel, at <a href="http://www.ishiprograms.org/programs/">The Institute for the Study of Health & Illness</a> (ISHI). I am already excited about attending and experiencing some healing myself.<br />
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See more on Rachel, <em>The Healer's Art, FMM</em> and ISHI at:<br />
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<a href="http://www.rachelremen.com/">www.rachelremen.com</a> </blockquote>
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<a href="http://www.ishiprograms.org/" target="_blank">www.ishiprograms.org</a></blockquote>
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<a href="http://www.theheartofmedicine.org/" target="_blank">www.theheartofmedicine.org</a></blockquote>
<span style="color: #144fae;"></span><br />Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com0tag:blogger.com,1999:blog-5502509972672388550.post-55768902290650732042013-10-01T22:34:00.000-04:002013-10-01T22:44:26.601-04:00Danielle Ofri's Reflections on Fear Triggered by Illness<a href="http://www.slate.com/articles/health_and_science/medical_examiner/2013/09/fear_of_medical_procedures_doctors_need_to_acknowledge_emotions.html">Danielle Ofri's recent column on Slate</a>, the online magazine, addresses the topic of fear that results from uncertainty and the risks associated with medical illnesses and procedures, even minor ones. Danielle shares the distress and acute fear she experienced as a mom when her young son required minor ear surgery. Even though, as a physician, she understood that the risk of the procedure was low, she nonetheless imagined the worst and became gripped with raw fear that didn't abate till her son was fully recovered from his surgery.<br />
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<span class="Apple-style-span">Dr. Ofri's distress during that minor ordeal increased her awareness of the needs of her patients and their family for her support, empathy and compassion during episodes of illness, especially when tough medical decisions need to be made. </span><span class="Apple-style-span" style="-webkit-composition-fill-color: rgba(175, 192, 227, 0.230469); -webkit-composition-frame-color: rgba(77, 128, 180, 0.230469); -webkit-tap-highlight-color: rgba(26, 26, 26, 0.296875);">As Danielle points out, the process of shared decision making requires more than information sharing and collaboration. It also requires eliciting and responding to the emotions that are aroused by uncertainnty and risk. As she</span><span class="Apple-style-span"> she beautifully writes, </span><br />
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<span class="Apple-style-span" style="-webkit-composition-fill-color: rgba(175, 192, 227, 0.230469); -webkit-composition-frame-color: rgba(77, 128, 180, 0.230469); -webkit-tap-highlight-color: rgba(26, 26, 26, 0.296875); -webkit-text-size-adjust: 100%; color: #281b21; font-family: sl-ApresRegular; font-size: 15px; line-height: 27px;">"<i>When I sit with a patient now, deciding on a treatment, I still lay out the risks and benefits as systematically as I can. But then I take a moment to acknowledge the raw fear that cannot be assuaged by even the most convincing clinical data. This conversation can’t eliminate the necessary leap of faith. But at least there is some recognition of the stomach-plummeting sensation that occurs" </i>when a decision has to be made.</span></blockquote>
Thank, Danielle for your enlightening column! I also highly recommend Dr. Ofri's well written memoirs, including her latest book, <a href="http://www.amazon.com/gp/product/0807073326/ref=as_li_ss_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=0807073326&linkCode=as2&tag=slatmaga-20">What Doctors Feel: How Emotions Affect the Practice of Medicine</a> .Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com0tag:blogger.com,1999:blog-5502509972672388550.post-25090609199203594342013-08-27T08:19:00.002-04:002013-08-27T22:03:34.831-04:00EmpathyWorks Has Had 10,000 Views! On July 11, 2009, I wrote <a href="http://empathyworks.blogspot.com/2009/07/my-first-post.html">My First Post on EmpathyWorks</a> (click on text to view). <br />
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In the 57 posts that have followed, I have shared links and comments about articles, books and research studies on empathy and related aspects of relationship building. Many of my EmpathyWorks posts were links to a column I wrote for MPNforum, an online magazine for people who, like myself, are self-managing, or helping a loved one manage a myeloproliferative neoplasm. <br />
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<em><span style="color: #38761d;"><span style="background-color: white;"><strong>I have enjoyed writing and sharing these tidbits and hope they have provided readers with opportunities to become more aware of the ways in which empathy can be a tool for enhancing understanding and promoting compassion and caring, particularly in health care settings</strong>.</span></span></em></blockquote>
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I look forward to continuing to continuing to write and reflect on the impact and value of empathy here. <br />
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<em><span style="color: #38761d;"><strong>It would be great to have more comments and dialogue with readers, so please feel free to share your thoughts or ideas, either in the comment section on the blog, or via e-mail at </strong></span></em><a href="mailto:goldsteinm52@gmail.com"><em><span style="color: #38761d;"><strong>goldsteinm52@gmail.com</strong></span></em></a><em><span style="color: #38761d;"><strong>.</strong></span></em></blockquote>
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Enjoy!<br />
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MichaelMichael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com0tag:blogger.com,1999:blog-5502509972672388550.post-12456099701805147312013-08-18T21:32:00.000-04:002013-08-20T08:29:10.545-04:00Don Berwick Urges UK's NHS to Emphasize EmpathyIn a <a href="https://www.gov.uk/government/publications/berwick-review-into-patient-safety">report</a> commissioned by the British National Health Service (NHS) to address concerns about recent slippage in NHS's patient safety and quality ratings, Dr. Donald Berwick encouraged NHS leaders to focus on empathy, compassion and support for both patients and health care teams.<br />
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Helen Riess provides her perspective on the report in her blog post for The Huffington Post- <a href="http://m.huffpost.com/us/entry/3757483">http://m.huffpost.com/us/entry/3757483</a>Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com2tag:blogger.com,1999:blog-5502509972672388550.post-35648566205196310522013-07-20T15:44:00.000-04:002013-07-20T15:44:32.849-04:00Bernie Lown is My Hero<span style="background-color: rgba(255, 255, 255, 0);">Bernie Lown is my hero and a exemplary role model for physician healers, scientists, and social activists.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJ_dFJf2eBMx70yXlFAxW_gJsOUwxp9XxUSwkgsjcXriHq54oybsqayqfzXrws-HBKfgKf7i900a7Ai-VpS4pu5PnQh56e0ATrG9Jgf8c6paRR0W9dQncaomaQN1lDq-eqFjxbZrL93jVK/s1600/Dr.+Bernard+Lown.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJ_dFJf2eBMx70yXlFAxW_gJsOUwxp9XxUSwkgsjcXriHq54oybsqayqfzXrws-HBKfgKf7i900a7Ai-VpS4pu5PnQh56e0ATrG9Jgf8c6paRR0W9dQncaomaQN1lDq-eqFjxbZrL93jVK/s1600/Dr.+Bernard+Lown.jpg" /></a></div>
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<span style="background-color: rgba(255, 255, 255, 0);"></span><br />
<span style="background-color: rgba(255, 255, 255, 0);">As co-founder of <a href="http://en.wikipedia.org/wiki/International_Physicians_for_the_Prevention_of_Nuclear_War" title="International Physicians for the Prevention of Nuclear War">International Physicians for the Prevention of Nuclear War</a>, Bernie Lown accepted the Nobel Peace Prize for this organization in 1985. Before that, we was one of the founders of Physicians for Social Responsibility. An accomplished academic cardiologist, he actually has an arrhythmia named after him, the Lown-Ganong-Levine Syndrome. (Please don't ask me to describe it). Bernie is a medical inventor as well. He developed the first direct current defibrillator and still holds an academic position as </span>Professor of Cardiology Emeritus at the Harvard School of Public Health.<br />
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<span style="background-color: rgba(255, 255, 255, 0);">For decades, Bernie has been an outspoken critic of the growing medical industrial complex and the business of medicine. He writes eloquently about how these developments contribute to infatuation with and overuse of technology, overtreatment, waste of health care resources, escalating health care expenditures and, most importantly, unnecessary harms to patients. </span><br />
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<span style="background-color: rgba(255, 255, 255, 0);">Now in his 90s, Bernie is still voicing his concerns, as well as encouraging medical practitioners to return to the core values and behaviors that characterized medicine before it became a business. These principles include:</span><br />
<ul>
<li><span style="background-color: rgba(255, 255, 255, 0);">listen to your patients and to their "stories";</span></li>
<li><span style="background-color: rgba(255, 255, 255, 0);">put patients and their needs, values and preferences at the center of your attention; </span></li>
<li>build and nurture healing relationships with patients, using empathy and compassion; </li>
<li>evaluate new and emerging technologies carefully and choose wisely;</li>
<li>engage patients and caregivers in informed and shared decision-making; and</li>
<li>focus on enabling and empowering patients to help them stay healthy and engage in self-care and self-management.</li>
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These principles were the bedrock of good medical care when Bernie, and my dad, completed medical school in the 1940's. I dare say they were core elements of medical training in the days of Flexner and Francis Peabody, when my grandfather trained in the early 20th century. As Francis Peabody remarked in 1927, <em>"</em><span style="font-family: "Calibri","sans-serif"; font-size: 12pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><em>One of the essential
qualities of the clinician is interest in humanity, for the secret of the care
of the patient is the caring for the patient.</em></span>"<br />
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Recently, a wonderful interview with Bernie was published on a blog created by Melanie Lown, a communication specialist and Bernie's granddaughter. See: <a href="http://thelownconversation.com/">The Lown Conversation.</a> <br />
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Melanie is the daughter of Beth Lown, Bernie's daughter, a friend and colleague and a wonderful physician and educator. (See the photo on The Lown Conversation blog of Bernie and 6 year old daughter Beth, taken when Bernie arrived in Boston after accepting the Nobel Peace Prize.)<br />
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See also the following sources for more vintage Bernie:<br />
<ul>
<li><a href="http://bernardlown.wordpress.com/2012/04/29/social-responsibility-of-physicians/">Lown lecture on Avoidable Harms - 2012</a></li>
<li><a href="http://bernardlown.wordpress.com/">Bernard Lown's Blog</a></li>
</ul>
Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com2tag:blogger.com,1999:blog-5502509972672388550.post-36075455499019657572013-07-16T23:42:00.001-04:002013-07-16T23:50:02.956-04:00The Empathic Appreciative CloserTonight, after pitching a perfect 8th inning for the American League in Major League Baseball's All Star Game, Mariano Rivera told TV reporter Ken Rosenthal that he appreciated the standing ovation he received from fans, fellow players and even opposing players and coaches from the National League. Choked up with emotion, Mariano, who is retiring at the end of the season at age 43 after an amazing record setting career that all consider to be the best ever as a closer, told Rosenthal that the experience walking off the mound was "priceless" and "up there" with his experience closing World Series victories.<br />
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This show of emotion and sincere appreciation for the adulation he received from fans and peers is not an unusual response for this great athlete with a huge heart. See the article that appeared in The New York Times today to learn how Mariano has chosen to spend his last day in each of the cities he is visiting this year: <a href="http://www.nytimes.com/2013/07/16/sports/baseball/yankees-rivera-spends-his-goodbye-tour-saying-hello.html">http://www.nytimes.com/2013/07/16/sports/baseball/yankees-rivera-spends-his-goodbye-tour-saying-hello.html</a><br />
<br />Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com0tag:blogger.com,1999:blog-5502509972672388550.post-54422686064253456552013-06-07T09:34:00.001-04:002013-06-07T09:43:33.603-04:00Fear + Avoidance + Reflection + Courage = CompassionMy colleague, Anna Reisman, a practicing internist and talented writer, published a touching, revealing and instructive New York Times blog post that demonstrates the value of reflective practice. See: <span class="Apple-style-span" style="-webkit-composition-fill-color: rgba(175, 192, 227, 0.230469); -webkit-composition-frame-color: rgba(77, 128, 180, 0.230469); -webkit-tap-highlight-color: rgba(26, 26, 26, 0.292969);"><a href="http://opinionator.blogs.nytimes.com/2013/06/01/house-of-death/?nl=opinion&emc=edit_ty_20130603">The Death House</a></span><br />
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Anna writes movingly about her angst and ambivlance about visiting one of her patients at an inpatient hospice. Her ambivalence is rooted in her fears and anxieties about what she might experience during her visit, imagining suffering, sadness, hopelessness and a heavy dose of death (.."a steady line of hearses idling in the parking lot like taxis at a train station"..). Her avoidance is also linked, she reveals, to concerns that her patient will be suffering or too ill to acknowledge her presence, and she shares her worries that she will not know what to say to family members who may be present at his bedside. I would guess that most, if not all, caring and compassionate clinicians harbor similar feelings....I know I have had these fears and anxieties when I was clinically active and had patients who were dying. However, Anna also feels a strong desire to visit her patient to pay her respects and provide some measure of comfort to the patient or his family. So, she wills herself to visit the hospice, where she is pleasantly suprised to find a homey, supportive and even healing environment, and, most importantly, a patient who is grateful for her presence. I was deeply moved by her prose.<br />
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Anna's courage to share her inner thoughts and feelings in her blog is remarkable, and courageous. As you might expect, her post has stimulated many comments, and though most commend her for her compassion, there are also several posts that judge her harshly for having and sharing negative thoughts and feelings about the hospice. This is unfortuante, as I believe these critics are missing the point. The fears and worries that Anna reveals are ubiquitous among clinicians. These feelings often lead to avoidance of patients during the last stages of life, which is unfortunate for both patients and clinicians. Taking the time to reflect and acknowledge the feelings, in a non-self punitive way, is a step towards challenging them and summoning the courage to confront them. The result is often highly rewarding, and, hopefully, reinforcing.<br />
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I hope Anna's post will stimulate others to be mindful and perhaps help them free up their inner capacities for empathy and compassion.<br />
<br />Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com0tag:blogger.com,1999:blog-5502509972672388550.post-2949499494412881712013-05-27T11:02:00.001-04:002013-05-27T11:05:09.614-04:00Does Empathy Produce Poor Moral Decisions? I Think Not!In the May 20th issue of the New Yorker, Paul Bloom argues that empathy can lead to irrational decisions that are "parochial" and "narrow-minded". He concludes that, "a reasoned, even counter-empathetic analysis of moral obligation and likely consequences is a better guide to planning for the future than the gut wrench of empathy."<br />
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However, I agree with the point of view expressed by Michael Zakaras in his blog post, <em>The Case Against the Case Against Empathy, </em>which appeared on the <a href="http://www.huffingtonpost.com/michael-zakaras/the-case-against-the-case_b_3288394.html">Huff Post World</a> on May 16th. Zakaras reminds us that empathy is more than just a gut reaction; empathy involves cognitive processes similar to imagining and perspective taking. As Zakaras notes, empathy "requires careful thought, self-awareness, and real listening."<br />
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Zakaras continues, "But to truly empathize is not easy. In this sense Bloom is right: we're more likely to do so with those who look and think like we do. So rather than dismiss empathy, why not commit ourselves to practicing it more deliberately and more often, and expanding our spheres of empathy to those who are not just different but who challenge some of our very own moral foundations?"<br />
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I agree strongly with Zakaras. We need to practice and deepen our capacity for empathy. And, we must also use the understanding gained from empathy to choose and act wisely. As my colleague Vaughn Keller taught me, compassion is empathy in action.Michael Goldsteinhttp://www.blogger.com/profile/06469712482819823394noreply@blogger.com0