14 thoughts on “Please post your response to the readings on Medical Communication/Narrative Medicine here”
Narrative medicine, getting the patients story, respecting their autonomy, realizing the effect of both the clinician and patient’s emotions: these are very powerful concepts. These reading met me very personally. As many of you know I am a nurse in the Baystate Emergency Department in Springfield, a recent study identifying us as one of the busing ERs in the country in terms of patient acuity and volume.
One of my favorite authors, an emergency physician Scott Weingart explains that in a true emergency patients loose their humanity, and it is required for health care workers to view them that way in order to actually give them the care that may save their life. You give as much respect to their body as possible, but medicine comes first in the crashing patient. Only through “distancing mechanisms” can you actually break a rib cage in attempts to restart a heart without breaking down into tears. Despite this truth most people we see day to day are not actively dying in front of us. So many practitioners get caught in one side of this required dichotomy. Health care providers must be able to switch from seeing people as bodies to be healed to whole people with a myriad of contributing factors and effects from their disease.
A great point that Dasgupta makes is how very little clinicians care for their personal physical and mental well-being as they see themselves as simply medical minds. The actual amount of emotional and physical trauma health care providers are exposed to is generally ignored. Out of my friends, who has watched people die? Had a man with a gun threaten to shoot up your workplace? Held hands with a women whose cancer had come back from remission with a vengeance? Been there to tell a woman her mom as passed and there was nothing we could do as she screams at you? Each and every provider has so many stories they could share with you, yet the obvious is never dealt with. Who is caring for those that care for everyone else? How are we offering mental health to these people?
This week’s readings on narrative medicine and the physician-patient relationship made me reflect on my own interactions with my primary care physician. I have been lucky enough to have had the same family practitioner my entire life- he even sees both of my parents as patients too. He has always asked me about school and things outside of my physical health. I’ve always felt that he listens to what I say and if something isn’t working, he makes an adjustment. Unfortunately, I know this isn’t everyone’s reality and for many their thoughts and opinions are ignored, discounted, or not even asked for.
The first reading mentioned the history of physician-patient relationships over time; how originally medicine was very narrative based since much of it was qualitative analysis then shifted away with the biomedical model of pathology, but now appears that it may be making a shift back to narrative medicine. To me, it just seems like common sense to listen to a patient’s story because they are the authority on their life and experiences. By taking the time to get to know your patient you will be able to get important information that can guide recommended treatments or even help determine appropriate diagnostic tests. The third reading even echoes this- “more fertile and clinically salient information we derive about patients comes from them talking about their illnesses.†Because of the social determinants of health, we know that health is impacted beyond health care, so it is important for physicians to take the time learn about patients’ lives. Better and more comprehensive care can be provided.
Lastly, while not the main point or takeaway of the article, one thing that stuck out to me in the second reading was that only female medical students, albeit a small group, chose to sign up for the class on women’s illness narratives. There is a problem across the medical community in which women’s pain is not taken seriously- for example, they wait an average of 16 minutes longer than men to get pain medication in the ER. The fact that no male medical students chose to take a class that could teach them empathy for their female patients says a lot about how we are not taking enough action to remedy this issue. Though I will note both male and male medical professionals (doctors and nurses) are perpetrators of this issue so in general more application of empathy across the board would be key to improvement.
Rachel’s story is so powerful, and definitely generated a lot of feelings. Thank you so much for sharing. The failure of both the doctor’s and nurses assessments and evaluation is astounding. When you deal with people with pain on a daily basis it becomes very difficult to keep your empathy. Going from one person in intense pain to another you just get exhausted feeling for these people. Part of me wants to make excuses for the providers and nurses and part of me feels there is no justification for missing key clues that would at least raise the question of torsion.
The three readings this week focused on physician-patient relationships. I found these readings to be particularly relevant to my future work as a clinician. In the first reading, I learned about effective communication between physician and patient and both verbal and nonverbal communication. I found the section of the reading about emotion to be the most interesting.
According to Roter and Hall, patients are more satisfied when they sense more emotional expression from their physicians. This reminds me of something a professor in one of my audiology courses told us about counseling. He said that in his head, when he is going to speak to a patient, he doesn’t think about himself as stepping into a “doctor†role – instead, he performs his job but stays genuine and just approaches the situation as himself. I think this certainly intertwines with the emotional piece of the clinician/patient relationship, and allows patients to feel like they are speaking to a real, genuine person and not a lofty doctor.
As I was reading the second and third readings, I began to think a lot about the sort of elevated role that our society often gives to people in medicine. It’s almost as though people see doctors as other-worldly or godlike. According to the third reading, “a doctor whose body becomes relevant may risk losing his or her identity as a physician†(p. 352). This leads to doctors and medical students making choices that are disadvantageous to their health in favor of their role as physician. What good does this do? How does elevating people in medicine help patients?
Based on my own thoughts and my reading, I’ve decided that this sort of dehumanization of doctors does not help anyone. A doctor who is aware and respectful of their own limitations as a human being is, to me, the best kind of doctor. It’s only after someone is able to understand their own experience that they can relate to the experiences of others. I hope that I can achieve this in my role as a clinician one day, and try to make sure that my patients don’t see me as “above†them. Rather, I hope they see me as an equal and a confidant, and as someone who they can trust with their stories.
Communication is an important tool people utilize every day. People want to be seen and heard, and when they are not, they often become frustrated. This can be found in all settings, and it is not surprising to see they have done tests with physicians regarding communication. The most interesting one that Roter and Hall mentioned was the study where the physicians rated their respect for a patient, and then the patient guessed what the physician had rated. It was found that for the most part, the patients were able to accurately perceive how much respect their physician has for them. This showcases that even if a physician is not explicitly verbally disrespecting or disregarding a patient, it still comes through in their body language. Over the summer, I did some research at my internship regarding the new HHS conscience ruling. The new ruling specifically targets women and the LGBTQ community, and the ruling would allow a doctor to refuse services based on the doctor’s own moral beliefs. Patients in the LGBTQ community, especially in the transgender community, have a difficult time finding a physician they trust. The study on respect shows that even if they are able to find a physician that is willing to see them, it does not mean that they respect them, and the patient will know this. The doctor-patient relationship will be hurt because the patient will not feel their concerns are being heard and therefore, are likely to share less.
In the second reading by Rita Charon, I thought it was great to hear the perspective from a doctor who is trying to implement change in her own way of practice. For each new patient, she gives them her full attention to tell her about their health. Of course, what they choose to disclose is going to be what they feel is most important, and it will be things they want their doctor to understand. Even if she has a detailed medical history of the patient, the medical records alone are not enough to know her patients and their backgrounds. In community health class, we had to conduct a needs assessment and asset map. Through research, you can learn a lot, but you are still limited. The members of the community are the experts of their own community, so unless you talk to people within the community, you will only have a piece of the puzzle. It’s the same with the doctor-patient relationship. If you are only glancing at medical records, you will only have a small understanding of your patient. Through talking with them and figuring out what is going on in their lives, you can learn so much that has been overlooked, some which could be important pieces to getting their health back.
The readings touch on the schooling that doctors go through, showing it is more focused on the patient as a body they must work to heal, rather than a human they should listen to with empathy. The problem is, as is mentioned in the third reading by DasGupta and Charon, it is very difficult to teach empathy. They use personal illness narratives as a means to learn empathy, which is similar to what we are doing, except ours will be a digital narrative, and it does not have to focus on an illness. Personally, I know I will struggle with this writing because I find it difficult to write about myself.
The readings this week were very easy to relate to and I found them really important as someone who will be a medical professional in the future. One thing that stood out to me in the first reading was what a difference positive talk can make in comparison to negative talk, in terms of patient success. It made me realize that the way medical professionals communicate with their patients can make a big difference on how likely patients are to come to follow-up appointments and trust the information they are being given. This is really important to keep in mind as a future professional because it will remind me to consider my nonverbal behaviors and how I am talking when I am giving information to patients. However, the reading also mentioned that the patient/physician relationship has a lot of emotion behind it and sometimes these emotions are difficult to hide. For example, patients might be paying attention to how concerned the physician’s voice is when giving a diagnosis to determine how severe the diagnosis is. On the other hand, physicians might be watching the patient’s nonverbal behaviors to tell how they take the information being given to them to reveal underlying emotions even if they verbally say they are fine. This is another point that is important to remember as a future professional because even when we think we are hiding our emotions, they can come out in ways we would not immediately think about like blushing or eye contact. One final point that stuck out to me from the first reading was how the internet has many pros and cons when it comes to patients accessing health information. The section about emailing really struck me as important because many of us use email on a daily basis and it is such a routine part of our lives but as the reading mentioned, it can take away that human interaction that we sometimes really need. I thought this was especially interesting for future medical professionals because technology is becoming more and more apparent in healthcare and by the time we are professionals in the field, it may be even more accepted and apparent.
The second reading was interesting to me because I never really thought about the ways studying literature could help doctors. The reading mentioned that literature could help med students see things through multiple points of view, use metaphors and be transported through stories. I thought this was so interesting because originally I thought students could only learn these things through interacting with people or workshops but it makes a lot of sense that these ideas could be taught through reading and writing. This made me realize that there are many different ways to spread the same message, which can relate back to communicating with patients because there are many ways to get your message across to a patient. Whether it is verbally or nonverbal, there are various ways to express emotion and concern.
One point from the last reading that stood out to me was how physicians tend to be defined by their minds and patients are defined by their bodies. I found this so interesting because it is so accurate but I never think about it like that. As a patient, I always expect my doctor to be readily available if something comes up for me or if I have a question but I rarely ever consider what is going on in her life at the time. I really liked one of the statements that suggested that it takes a whole doctor to hear a patient. Doctors must be acknowledging and incorporating their own experiences in their care.
A quote that really stood out for me from the Charon reading was, “Narrative medicine becomes, in the end, a heady, brainy, compassionate, corporeal practice that can heal the patient and nourish the doctor at the same time — by virtue of talk”. This stood out to me because I believe that narrative medicine is something that benefits everyone and can easily be done by communicating and listening to each other. Often times, people think that letting the patient talk is only beneficial for the patient but it actually makes it easier for physicians to better understand who and what they are dealing with and how the issue may have manifested. Someone’s story is very important and it has a lot to do with who they are and their journey. Personally, I have felt more comfortable and like I was receiving better care when physicians asked me questions about my life and not so much the generic yes or no questions. I remember the first time this happened, I almost felt uncomfortable and like I was oversharing information the doctor did not want to know, but at the end he was able to better help me with my situation and we both left feeling like we had better grasp of the issue.
In the third reading on personal illness narratives, I found it very interesting reading how most physicians detach themselves from their own body when working. I feel like in society we often make people choose their identities and switch on and off. For example, traditionally a patient is seen as a patient needing help before they seen as a person with a whole history and journey and for doctors they are seen as their profession before they are as a human. It is necessary to see everyone as a human with a story and past first and foremost. It makes us more empathetic and compassionate. A interesting part of the reading that was relatable was when people answered question 6. They said that being able to reflect on their own experiences and interactions with personal illness made it easier for them to relate and care for their patient. My mother has diabetes and her diet is different from the American diet. She eats foods that are heavily influenced by our southeast asian culture. A nurse practitioner she had met at a health center actually was from the same country and talked about her mother also having diabetes. Her experiences and background allowed her to better care for my mom and address things that others could not, like how to substitute soy sauce and msg in our traditional food. The physician being able to acknowledge her own background and experiences and relate them to my mother’s made it beneficial for my mom to handle her diet and care for her diabetes.
This week’s readings were focused on patient-provider interactions and the use of narrative to improve interactions and quality of care. In the Roter and Hall reading, I was particularly fascinated with the information about how physician’s feelings towards patients impact patient outcomes. For example, one study by Milmoe, Rosenthal, Blanee, Chafetz & Wolf found that the amount of hostility in a physician’s tone of voice when discussing an alcoholic patient was predictive of the patient’s failure to follow through on alcohol treatment center referrals. This reminded me of many conversations I have had with my peers about being honest with their doctors. I have heard multiple times from friends that are scared to tell their doctors about their use of alcohol and drugs or their sexual habits because they are afraid of judgement. These things may be crucial to the diagnosis or treatment of an issue, but are being left out of the conversation. Physicians must learn to communicate with patients without expressing judgement or becoming patronizing.
On a positive note, I was excited by the method of collecting narratives described by Charon in “The self telling body.” In public health, we constantly talk about the Social Ecological Model of health, and how an individual’s health is the result of interactions between personal and environmental factors. Information about a patient’s relationships, culture, built environment, and so on cannot be determined by a physical examination. I love that Charon takes notes on patient narratives, and provides the patients with folders containing those notes so they can review them. I imagine that not only does this help her learn more about her patients, but it shows that she truly cares for the patient and helps to create positive rapport. I feel like a practice like this could have been useful in my own life, when I spent months trying to find a diagnosis for the painful gastrointestinal symptoms I had been experiencing. I was sent to specialists, given ultrasounds, and had complicated diets recommended to me. It took months for a doctor to piece together that my symptoms were being caused by an undiagnosed anxiety disorder. If I had been given the space to express my personal narrative, rather than a list of symptoms, that diagnosis may have been found much earlier.
In this week’s reading Roter and Hall discuss how medical interaction shapes and reflects physician-patient relationship. Within the last two decades there has been a shift and now the approach is to have focused attention on the centrality of patient-centered communication to the safe delivery of quality medical care and the practice of ethical medicine†(Roter & Hall). I first heard of patient centered care when I worked at Boston Children’s Hospital: Division of Endocrinology. Patient centered care is being “respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.†(IOM 2001). Basically, this means keeping the patient’s best interest but respecting their emotions and feelings and focusing through their perspective. You would think that this should be common sense but in a society where listening and compassion isn’t people’s strengths it is necessary to learn these skills especially when someone’s life is in your hands. I think it is important for medical schools to include empathy and patient focused training because many studies show how female patients or patients of color are often overlooked or dismissed. Especially if the patient is a woman of color, the chances of your provider downplaying your symptoms or illness is even greater. Growing up, especially during my teenage years, I felt like my pediatrician didn’t listen to me closely. It always felt like she was only scratching the surface and didn’t really care. The only reason I can say that is because my current PCP is amazing. Her quality of care and communication and attention to detail makes me feel like I am being taken care of. Although I am older, I am able to advocate for myself better but working in a hospital definitely shows how to navigate through the system. However, patient centered care should be easy regardless of one’s sex, racial background, education level, or occupation.
The readings from this week focused on doctor/patient relationships and the communication that takes place between them. They emphasize the importance of verbal and non-verbal interactions, and how both play significant roles in health communication. We learn that it is absolutely necessary for doctors to communicate with their patients clearly and directly, but to also be able to pick up on those non-verbal cues and actions.
One of the readings also talks about the benefits and drawbacks of health care and the internet. The way we experience health care has shifted so much in the last decade. Patients are now able to schedule appointments, send messages (and pictures!) to their providers, and gain access to parts of their health records online. Working in a pediatrician’s office has given me the opportunity to see the strengths and weaknesses of this. Although it is convenient and increases a patient’s accessibility to their provider, it is not always the most convenient method for everyone, and more importantly, it diminishes that face-to-face interaction that you get when you are actually in the room with your own doctor.
All three readings this week focused on the importance of patient/provider relationships and especially on the responsibility the provider has to foster positive relationships. In the first reading Roter and Hall stress the importance of patient-centered communication. I had heard about patient-centered communication previously from a club I was a part of in undergrad. The club was The Institute of Healthcare Improvement and their mission is to improve health through person centered care and patient safety, among other things. Patient-centered care and communication has been linked to better health outcomes, which seems a little bit obvious but often not taught to medical professionals. Positive relationships and interactions will make a patient more receptive to the information and treatment plan given to them. A big part of patient-centered communication is the use of nonverbal communication. Nonverbal communication can sometimes carry more weight than the actual words exchanged and often gives more meanings to the spoken words. Emotional awareness and shared emotional experiences between the provider and patient are also key elements to patient-centered communication. Relating to a patient as a human through emotion will help create that positive relationship. I found it interesting that they found that females were better at describing their emotions toward an interaction with patients than males. This makes sense though because females are taught to talk about their feelings and males are often told to suppress those emotions and deal with them on their own.
The second reading by Rita Charon talked about why the current focus on narrative medicine has emerged. Up until recently the main focus of the medical world was biomedical advancements, coming up with new treatments, and doing things better than before. There is still research and medical advancements happening, but I think people are beginning to take a step back from all that in order to begin to think about the interpersonal component of medicine. Allowing people to tell their narrative can give the doctor a better picture of their life and the aliments they are dealing with. It breaks the doctors from thinking that patients are just a set of symptoms and makes them but the patient into the context of their world. The third reading by DasGupta and Charon shows how the realization of the need for narrative medicine practice was put into medical school training. After reading about the seminars they offered I found myself wanting to try the reflective writing exercises, we do not often get the opportunity to think about our experiences through different lenses. It is so true that doctors are almost trained in a way that makes them forget about their humanness and it becomes only about the medicine. These seminars showed that their medicine can be improved by reflecting on their personal experiences and giving them points of connection with future patients.
This week’s readings on Medical Communication and Narrative Medicine were ones that I found very relevant to my field of study. As an aspiring clinician, we do learn in classes the importance of being an empathetic medical professional and communicator to our patients, but how do you actually go about teaching empathy? I was under the impression that simply being reminded to be a caring clinician was enough, but upon examining our reading this week, I discovered that it involves a more proactive approach.
I was particularly draw to the “Personal Illness Narrative” article by DasGupta and Charon because it described a method to teach empathy to medical students that seemed to be rather effective. Through a reflective writing course for second-year medical students, DasGupta was able to provoke self-awareness in her students by encouraging them to explore their own personal experiences of illness. I thought it was a fascinating point that medical students and professionals often feel an estrangement from their own bodies as a result of so much emphasis being placed on their minds and having the emphasis of body on their patients. I would have never considered the difficulty medical professionals might face being ill when they are supposed to be a “healer.” I personally think that reflecting on personal illness experiences might be a great way to transform their perspectives to better emphasize with patients.
This reading made me begin to reflect on what challenges I might face in my future as a clinician. Will I experience this sort of “disembodiment” that physicians tend to experience? I think that these early stages of personal reflection that this reading caused me to encounter might be of use when it comes to being self aware when interacting with clients. While a class of self reflection in writing is a great way to teach and encourage empathy, simply being aware is a great first step.
I found the idea of empathetic witnessing very interesting especially from the point of the provider. I think it is important for the provider to help the patient build their narrative by helping them create a positive story regardless of the illness. The connection between empathy and reflection being bidirectional is so important to note because often times I see medical professional as very busy and not really having the time to reflect. Because of this, I think it is important for doctors especially to find time to reflect so that they can truly bring empathy to their work . It was mentioned that reflective clinical practice require self examination and I think that is hard to bring into practice because many medical professionals are trained in a way to believe that they are all knowing and their brains has all the answers but self examination would make them realize that that is not always true and that may be difficult to accept.
I thought the idea of reductionism in The Self Telling Body is very prevalent in society and not just in the medical field. As human beings, we like to fit everything into pristine pretty boxes but that is not how life really goes or how things really fit. The medical system has become very reductionist because we have tried to create uniformity across the board from how we do intake processes to referral patterns and treatment order and so on. As a result many people’s story have become minimized to be fit into forms and charts and medical professionals have seen patients as these forms and charts. The story about how the women had severe abdominal pain and went through several specialists with not a single lead but then the one doctor who listened to the story about her father and being able to pinpoint the problem with that story alone speaks to how important people’s background and stories are and how we must make a constant effort to listen to these as medical providers because they can have the answers that the tests fail to show.
Patient centered communication is essential to healthcare. While I did an internship at the Department of Mental Health for the state of Massachusetts, this was a constant topic of conversation during staff meetings as the department worked to have its staff reflect its client population. Many trainings were done to show how providers could ensure that their practice was patient centered which included language and non verbal communication as the Roter and Hall reading emphasized.
The first reading starts with describing the historical shift from qualitative medical history data to a focus on data collected using a quantitative survey. This shift coincided with the rise in molecular science and more quantitative medical practices. These readings made me reflect on a story I heard recently – I think it was on NPR – about the development of robots able to analyze scans/x-rays to diagnose the patient. This may be moving towards standardization of diagnosis, but represents a shift away from people interpreting the scans. When I heard the story I was thinking that it would be advantageous to switch to a robot interpretation (once optimized) to reduce the chance of human error. However, these readings are reminding me that doctors could look back at the patient narrative to perhaps interpret the results more effectively than a robot in some cases.
I agree with another person who stated that patient-centered care seems like an obvious skill necessary for clinicians to successfully treat a patient. It’s interesting that that skill won’t be officially demanded/assessed in the US until 2020. This is reminding me of a friend I had in undergrad who was pre-med – she said that she worried about ending up a doctor and still not having good communication skills to properly care for her patients. This problem was partly stemming from her personal skills, but also from the inflexibility of the requirements of her degree and pre-med course requirements that did not allow room in her schedule to develop her communication skills. I’m glad to read that there is a shift towards training physicians to be empathetic through their own “personal illness narratives” and listening to their colleagues narratives. It makes sense to train physicians to think about their own emotional experiences and how to process them as a way to learn how to process patient’s stories.
Narrative medicine, getting the patients story, respecting their autonomy, realizing the effect of both the clinician and patient’s emotions: these are very powerful concepts. These reading met me very personally. As many of you know I am a nurse in the Baystate Emergency Department in Springfield, a recent study identifying us as one of the busing ERs in the country in terms of patient acuity and volume.
One of my favorite authors, an emergency physician Scott Weingart explains that in a true emergency patients loose their humanity, and it is required for health care workers to view them that way in order to actually give them the care that may save their life. You give as much respect to their body as possible, but medicine comes first in the crashing patient. Only through “distancing mechanisms” can you actually break a rib cage in attempts to restart a heart without breaking down into tears. Despite this truth most people we see day to day are not actively dying in front of us. So many practitioners get caught in one side of this required dichotomy. Health care providers must be able to switch from seeing people as bodies to be healed to whole people with a myriad of contributing factors and effects from their disease.
A great point that Dasgupta makes is how very little clinicians care for their personal physical and mental well-being as they see themselves as simply medical minds. The actual amount of emotional and physical trauma health care providers are exposed to is generally ignored. Out of my friends, who has watched people die? Had a man with a gun threaten to shoot up your workplace? Held hands with a women whose cancer had come back from remission with a vengeance? Been there to tell a woman her mom as passed and there was nothing we could do as she screams at you? Each and every provider has so many stories they could share with you, yet the obvious is never dealt with. Who is caring for those that care for everyone else? How are we offering mental health to these people?
This week’s readings on narrative medicine and the physician-patient relationship made me reflect on my own interactions with my primary care physician. I have been lucky enough to have had the same family practitioner my entire life- he even sees both of my parents as patients too. He has always asked me about school and things outside of my physical health. I’ve always felt that he listens to what I say and if something isn’t working, he makes an adjustment. Unfortunately, I know this isn’t everyone’s reality and for many their thoughts and opinions are ignored, discounted, or not even asked for.
The first reading mentioned the history of physician-patient relationships over time; how originally medicine was very narrative based since much of it was qualitative analysis then shifted away with the biomedical model of pathology, but now appears that it may be making a shift back to narrative medicine. To me, it just seems like common sense to listen to a patient’s story because they are the authority on their life and experiences. By taking the time to get to know your patient you will be able to get important information that can guide recommended treatments or even help determine appropriate diagnostic tests. The third reading even echoes this- “more fertile and clinically salient information we derive about patients comes from them talking about their illnesses.†Because of the social determinants of health, we know that health is impacted beyond health care, so it is important for physicians to take the time learn about patients’ lives. Better and more comprehensive care can be provided.
Lastly, while not the main point or takeaway of the article, one thing that stuck out to me in the second reading was that only female medical students, albeit a small group, chose to sign up for the class on women’s illness narratives. There is a problem across the medical community in which women’s pain is not taken seriously- for example, they wait an average of 16 minutes longer than men to get pain medication in the ER. The fact that no male medical students chose to take a class that could teach them empathy for their female patients says a lot about how we are not taking enough action to remedy this issue. Though I will note both male and male medical professionals (doctors and nurses) are perpetrators of this issue so in general more application of empathy across the board would be key to improvement.
Here’s an article that highlighted a case study (and also where I got the 16 minutes longer stat): https://www.theatlantic.com/health/archive/2015/10/emergency-room-wait-times-sexism/410515/
Rachel’s story is so powerful, and definitely generated a lot of feelings. Thank you so much for sharing. The failure of both the doctor’s and nurses assessments and evaluation is astounding. When you deal with people with pain on a daily basis it becomes very difficult to keep your empathy. Going from one person in intense pain to another you just get exhausted feeling for these people. Part of me wants to make excuses for the providers and nurses and part of me feels there is no justification for missing key clues that would at least raise the question of torsion.
The three readings this week focused on physician-patient relationships. I found these readings to be particularly relevant to my future work as a clinician. In the first reading, I learned about effective communication between physician and patient and both verbal and nonverbal communication. I found the section of the reading about emotion to be the most interesting.
According to Roter and Hall, patients are more satisfied when they sense more emotional expression from their physicians. This reminds me of something a professor in one of my audiology courses told us about counseling. He said that in his head, when he is going to speak to a patient, he doesn’t think about himself as stepping into a “doctor†role – instead, he performs his job but stays genuine and just approaches the situation as himself. I think this certainly intertwines with the emotional piece of the clinician/patient relationship, and allows patients to feel like they are speaking to a real, genuine person and not a lofty doctor.
As I was reading the second and third readings, I began to think a lot about the sort of elevated role that our society often gives to people in medicine. It’s almost as though people see doctors as other-worldly or godlike. According to the third reading, “a doctor whose body becomes relevant may risk losing his or her identity as a physician†(p. 352). This leads to doctors and medical students making choices that are disadvantageous to their health in favor of their role as physician. What good does this do? How does elevating people in medicine help patients?
Based on my own thoughts and my reading, I’ve decided that this sort of dehumanization of doctors does not help anyone. A doctor who is aware and respectful of their own limitations as a human being is, to me, the best kind of doctor. It’s only after someone is able to understand their own experience that they can relate to the experiences of others. I hope that I can achieve this in my role as a clinician one day, and try to make sure that my patients don’t see me as “above†them. Rather, I hope they see me as an equal and a confidant, and as someone who they can trust with their stories.
Communication is an important tool people utilize every day. People want to be seen and heard, and when they are not, they often become frustrated. This can be found in all settings, and it is not surprising to see they have done tests with physicians regarding communication. The most interesting one that Roter and Hall mentioned was the study where the physicians rated their respect for a patient, and then the patient guessed what the physician had rated. It was found that for the most part, the patients were able to accurately perceive how much respect their physician has for them. This showcases that even if a physician is not explicitly verbally disrespecting or disregarding a patient, it still comes through in their body language. Over the summer, I did some research at my internship regarding the new HHS conscience ruling. The new ruling specifically targets women and the LGBTQ community, and the ruling would allow a doctor to refuse services based on the doctor’s own moral beliefs. Patients in the LGBTQ community, especially in the transgender community, have a difficult time finding a physician they trust. The study on respect shows that even if they are able to find a physician that is willing to see them, it does not mean that they respect them, and the patient will know this. The doctor-patient relationship will be hurt because the patient will not feel their concerns are being heard and therefore, are likely to share less.
In the second reading by Rita Charon, I thought it was great to hear the perspective from a doctor who is trying to implement change in her own way of practice. For each new patient, she gives them her full attention to tell her about their health. Of course, what they choose to disclose is going to be what they feel is most important, and it will be things they want their doctor to understand. Even if she has a detailed medical history of the patient, the medical records alone are not enough to know her patients and their backgrounds. In community health class, we had to conduct a needs assessment and asset map. Through research, you can learn a lot, but you are still limited. The members of the community are the experts of their own community, so unless you talk to people within the community, you will only have a piece of the puzzle. It’s the same with the doctor-patient relationship. If you are only glancing at medical records, you will only have a small understanding of your patient. Through talking with them and figuring out what is going on in their lives, you can learn so much that has been overlooked, some which could be important pieces to getting their health back.
The readings touch on the schooling that doctors go through, showing it is more focused on the patient as a body they must work to heal, rather than a human they should listen to with empathy. The problem is, as is mentioned in the third reading by DasGupta and Charon, it is very difficult to teach empathy. They use personal illness narratives as a means to learn empathy, which is similar to what we are doing, except ours will be a digital narrative, and it does not have to focus on an illness. Personally, I know I will struggle with this writing because I find it difficult to write about myself.
The readings this week were very easy to relate to and I found them really important as someone who will be a medical professional in the future. One thing that stood out to me in the first reading was what a difference positive talk can make in comparison to negative talk, in terms of patient success. It made me realize that the way medical professionals communicate with their patients can make a big difference on how likely patients are to come to follow-up appointments and trust the information they are being given. This is really important to keep in mind as a future professional because it will remind me to consider my nonverbal behaviors and how I am talking when I am giving information to patients. However, the reading also mentioned that the patient/physician relationship has a lot of emotion behind it and sometimes these emotions are difficult to hide. For example, patients might be paying attention to how concerned the physician’s voice is when giving a diagnosis to determine how severe the diagnosis is. On the other hand, physicians might be watching the patient’s nonverbal behaviors to tell how they take the information being given to them to reveal underlying emotions even if they verbally say they are fine. This is another point that is important to remember as a future professional because even when we think we are hiding our emotions, they can come out in ways we would not immediately think about like blushing or eye contact. One final point that stuck out to me from the first reading was how the internet has many pros and cons when it comes to patients accessing health information. The section about emailing really struck me as important because many of us use email on a daily basis and it is such a routine part of our lives but as the reading mentioned, it can take away that human interaction that we sometimes really need. I thought this was especially interesting for future medical professionals because technology is becoming more and more apparent in healthcare and by the time we are professionals in the field, it may be even more accepted and apparent.
The second reading was interesting to me because I never really thought about the ways studying literature could help doctors. The reading mentioned that literature could help med students see things through multiple points of view, use metaphors and be transported through stories. I thought this was so interesting because originally I thought students could only learn these things through interacting with people or workshops but it makes a lot of sense that these ideas could be taught through reading and writing. This made me realize that there are many different ways to spread the same message, which can relate back to communicating with patients because there are many ways to get your message across to a patient. Whether it is verbally or nonverbal, there are various ways to express emotion and concern.
One point from the last reading that stood out to me was how physicians tend to be defined by their minds and patients are defined by their bodies. I found this so interesting because it is so accurate but I never think about it like that. As a patient, I always expect my doctor to be readily available if something comes up for me or if I have a question but I rarely ever consider what is going on in her life at the time. I really liked one of the statements that suggested that it takes a whole doctor to hear a patient. Doctors must be acknowledging and incorporating their own experiences in their care.
A quote that really stood out for me from the Charon reading was, “Narrative medicine becomes, in the end, a heady, brainy, compassionate, corporeal practice that can heal the patient and nourish the doctor at the same time — by virtue of talk”. This stood out to me because I believe that narrative medicine is something that benefits everyone and can easily be done by communicating and listening to each other. Often times, people think that letting the patient talk is only beneficial for the patient but it actually makes it easier for physicians to better understand who and what they are dealing with and how the issue may have manifested. Someone’s story is very important and it has a lot to do with who they are and their journey. Personally, I have felt more comfortable and like I was receiving better care when physicians asked me questions about my life and not so much the generic yes or no questions. I remember the first time this happened, I almost felt uncomfortable and like I was oversharing information the doctor did not want to know, but at the end he was able to better help me with my situation and we both left feeling like we had better grasp of the issue.
In the third reading on personal illness narratives, I found it very interesting reading how most physicians detach themselves from their own body when working. I feel like in society we often make people choose their identities and switch on and off. For example, traditionally a patient is seen as a patient needing help before they seen as a person with a whole history and journey and for doctors they are seen as their profession before they are as a human. It is necessary to see everyone as a human with a story and past first and foremost. It makes us more empathetic and compassionate. A interesting part of the reading that was relatable was when people answered question 6. They said that being able to reflect on their own experiences and interactions with personal illness made it easier for them to relate and care for their patient. My mother has diabetes and her diet is different from the American diet. She eats foods that are heavily influenced by our southeast asian culture. A nurse practitioner she had met at a health center actually was from the same country and talked about her mother also having diabetes. Her experiences and background allowed her to better care for my mom and address things that others could not, like how to substitute soy sauce and msg in our traditional food. The physician being able to acknowledge her own background and experiences and relate them to my mother’s made it beneficial for my mom to handle her diet and care for her diabetes.
This week’s readings were focused on patient-provider interactions and the use of narrative to improve interactions and quality of care. In the Roter and Hall reading, I was particularly fascinated with the information about how physician’s feelings towards patients impact patient outcomes. For example, one study by Milmoe, Rosenthal, Blanee, Chafetz & Wolf found that the amount of hostility in a physician’s tone of voice when discussing an alcoholic patient was predictive of the patient’s failure to follow through on alcohol treatment center referrals. This reminded me of many conversations I have had with my peers about being honest with their doctors. I have heard multiple times from friends that are scared to tell their doctors about their use of alcohol and drugs or their sexual habits because they are afraid of judgement. These things may be crucial to the diagnosis or treatment of an issue, but are being left out of the conversation. Physicians must learn to communicate with patients without expressing judgement or becoming patronizing.
On a positive note, I was excited by the method of collecting narratives described by Charon in “The self telling body.” In public health, we constantly talk about the Social Ecological Model of health, and how an individual’s health is the result of interactions between personal and environmental factors. Information about a patient’s relationships, culture, built environment, and so on cannot be determined by a physical examination. I love that Charon takes notes on patient narratives, and provides the patients with folders containing those notes so they can review them. I imagine that not only does this help her learn more about her patients, but it shows that she truly cares for the patient and helps to create positive rapport. I feel like a practice like this could have been useful in my own life, when I spent months trying to find a diagnosis for the painful gastrointestinal symptoms I had been experiencing. I was sent to specialists, given ultrasounds, and had complicated diets recommended to me. It took months for a doctor to piece together that my symptoms were being caused by an undiagnosed anxiety disorder. If I had been given the space to express my personal narrative, rather than a list of symptoms, that diagnosis may have been found much earlier.
In this week’s reading Roter and Hall discuss how medical interaction shapes and reflects physician-patient relationship. Within the last two decades there has been a shift and now the approach is to have focused attention on the centrality of patient-centered communication to the safe delivery of quality medical care and the practice of ethical medicine†(Roter & Hall). I first heard of patient centered care when I worked at Boston Children’s Hospital: Division of Endocrinology. Patient centered care is being “respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.†(IOM 2001). Basically, this means keeping the patient’s best interest but respecting their emotions and feelings and focusing through their perspective. You would think that this should be common sense but in a society where listening and compassion isn’t people’s strengths it is necessary to learn these skills especially when someone’s life is in your hands. I think it is important for medical schools to include empathy and patient focused training because many studies show how female patients or patients of color are often overlooked or dismissed. Especially if the patient is a woman of color, the chances of your provider downplaying your symptoms or illness is even greater. Growing up, especially during my teenage years, I felt like my pediatrician didn’t listen to me closely. It always felt like she was only scratching the surface and didn’t really care. The only reason I can say that is because my current PCP is amazing. Her quality of care and communication and attention to detail makes me feel like I am being taken care of. Although I am older, I am able to advocate for myself better but working in a hospital definitely shows how to navigate through the system. However, patient centered care should be easy regardless of one’s sex, racial background, education level, or occupation.
The readings from this week focused on doctor/patient relationships and the communication that takes place between them. They emphasize the importance of verbal and non-verbal interactions, and how both play significant roles in health communication. We learn that it is absolutely necessary for doctors to communicate with their patients clearly and directly, but to also be able to pick up on those non-verbal cues and actions.
One of the readings also talks about the benefits and drawbacks of health care and the internet. The way we experience health care has shifted so much in the last decade. Patients are now able to schedule appointments, send messages (and pictures!) to their providers, and gain access to parts of their health records online. Working in a pediatrician’s office has given me the opportunity to see the strengths and weaknesses of this. Although it is convenient and increases a patient’s accessibility to their provider, it is not always the most convenient method for everyone, and more importantly, it diminishes that face-to-face interaction that you get when you are actually in the room with your own doctor.
All three readings this week focused on the importance of patient/provider relationships and especially on the responsibility the provider has to foster positive relationships. In the first reading Roter and Hall stress the importance of patient-centered communication. I had heard about patient-centered communication previously from a club I was a part of in undergrad. The club was The Institute of Healthcare Improvement and their mission is to improve health through person centered care and patient safety, among other things. Patient-centered care and communication has been linked to better health outcomes, which seems a little bit obvious but often not taught to medical professionals. Positive relationships and interactions will make a patient more receptive to the information and treatment plan given to them. A big part of patient-centered communication is the use of nonverbal communication. Nonverbal communication can sometimes carry more weight than the actual words exchanged and often gives more meanings to the spoken words. Emotional awareness and shared emotional experiences between the provider and patient are also key elements to patient-centered communication. Relating to a patient as a human through emotion will help create that positive relationship. I found it interesting that they found that females were better at describing their emotions toward an interaction with patients than males. This makes sense though because females are taught to talk about their feelings and males are often told to suppress those emotions and deal with them on their own.
The second reading by Rita Charon talked about why the current focus on narrative medicine has emerged. Up until recently the main focus of the medical world was biomedical advancements, coming up with new treatments, and doing things better than before. There is still research and medical advancements happening, but I think people are beginning to take a step back from all that in order to begin to think about the interpersonal component of medicine. Allowing people to tell their narrative can give the doctor a better picture of their life and the aliments they are dealing with. It breaks the doctors from thinking that patients are just a set of symptoms and makes them but the patient into the context of their world. The third reading by DasGupta and Charon shows how the realization of the need for narrative medicine practice was put into medical school training. After reading about the seminars they offered I found myself wanting to try the reflective writing exercises, we do not often get the opportunity to think about our experiences through different lenses. It is so true that doctors are almost trained in a way that makes them forget about their humanness and it becomes only about the medicine. These seminars showed that their medicine can be improved by reflecting on their personal experiences and giving them points of connection with future patients.
This week’s readings on Medical Communication and Narrative Medicine were ones that I found very relevant to my field of study. As an aspiring clinician, we do learn in classes the importance of being an empathetic medical professional and communicator to our patients, but how do you actually go about teaching empathy? I was under the impression that simply being reminded to be a caring clinician was enough, but upon examining our reading this week, I discovered that it involves a more proactive approach.
I was particularly draw to the “Personal Illness Narrative” article by DasGupta and Charon because it described a method to teach empathy to medical students that seemed to be rather effective. Through a reflective writing course for second-year medical students, DasGupta was able to provoke self-awareness in her students by encouraging them to explore their own personal experiences of illness. I thought it was a fascinating point that medical students and professionals often feel an estrangement from their own bodies as a result of so much emphasis being placed on their minds and having the emphasis of body on their patients. I would have never considered the difficulty medical professionals might face being ill when they are supposed to be a “healer.” I personally think that reflecting on personal illness experiences might be a great way to transform their perspectives to better emphasize with patients.
This reading made me begin to reflect on what challenges I might face in my future as a clinician. Will I experience this sort of “disembodiment” that physicians tend to experience? I think that these early stages of personal reflection that this reading caused me to encounter might be of use when it comes to being self aware when interacting with clients. While a class of self reflection in writing is a great way to teach and encourage empathy, simply being aware is a great first step.
I found the idea of empathetic witnessing very interesting especially from the point of the provider. I think it is important for the provider to help the patient build their narrative by helping them create a positive story regardless of the illness. The connection between empathy and reflection being bidirectional is so important to note because often times I see medical professional as very busy and not really having the time to reflect. Because of this, I think it is important for doctors especially to find time to reflect so that they can truly bring empathy to their work . It was mentioned that reflective clinical practice require self examination and I think that is hard to bring into practice because many medical professionals are trained in a way to believe that they are all knowing and their brains has all the answers but self examination would make them realize that that is not always true and that may be difficult to accept.
I thought the idea of reductionism in The Self Telling Body is very prevalent in society and not just in the medical field. As human beings, we like to fit everything into pristine pretty boxes but that is not how life really goes or how things really fit. The medical system has become very reductionist because we have tried to create uniformity across the board from how we do intake processes to referral patterns and treatment order and so on. As a result many people’s story have become minimized to be fit into forms and charts and medical professionals have seen patients as these forms and charts. The story about how the women had severe abdominal pain and went through several specialists with not a single lead but then the one doctor who listened to the story about her father and being able to pinpoint the problem with that story alone speaks to how important people’s background and stories are and how we must make a constant effort to listen to these as medical providers because they can have the answers that the tests fail to show.
Patient centered communication is essential to healthcare. While I did an internship at the Department of Mental Health for the state of Massachusetts, this was a constant topic of conversation during staff meetings as the department worked to have its staff reflect its client population. Many trainings were done to show how providers could ensure that their practice was patient centered which included language and non verbal communication as the Roter and Hall reading emphasized.
The first reading starts with describing the historical shift from qualitative medical history data to a focus on data collected using a quantitative survey. This shift coincided with the rise in molecular science and more quantitative medical practices. These readings made me reflect on a story I heard recently – I think it was on NPR – about the development of robots able to analyze scans/x-rays to diagnose the patient. This may be moving towards standardization of diagnosis, but represents a shift away from people interpreting the scans. When I heard the story I was thinking that it would be advantageous to switch to a robot interpretation (once optimized) to reduce the chance of human error. However, these readings are reminding me that doctors could look back at the patient narrative to perhaps interpret the results more effectively than a robot in some cases.
I agree with another person who stated that patient-centered care seems like an obvious skill necessary for clinicians to successfully treat a patient. It’s interesting that that skill won’t be officially demanded/assessed in the US until 2020. This is reminding me of a friend I had in undergrad who was pre-med – she said that she worried about ending up a doctor and still not having good communication skills to properly care for her patients. This problem was partly stemming from her personal skills, but also from the inflexibility of the requirements of her degree and pre-med course requirements that did not allow room in her schedule to develop her communication skills. I’m glad to read that there is a shift towards training physicians to be empathetic through their own “personal illness narratives” and listening to their colleagues narratives. It makes sense to train physicians to think about their own emotional experiences and how to process them as a way to learn how to process patient’s stories.