Thursday, March 30, 2017

Thursday, March 30, 2017

Tonight's picture was taken in June of 2009. This was at Mattie's second party held for him in honor of his seventh and LAST birthday with us. Mattie had his official party on his birthday in the child life playroom at the hospital. But between treatments, my friend Christine planned this wonderful bug party for Mattie and his friends in her backyard. Reptiles Alive, a company which introduces children to live animals came to entertain the kids. The animals they selected were all up Mattie's alley, but they creeped me out, which he just loved observing. How do you like this birthday cake in the shape of a roach? Christine found a baker who would do this and her husband, James, even came out dressed as a giant size roach (a really good sport, no?). Look at Mattie's face! He absolutely loved it!!!



Quote of the day: One path to educating empathic physicians is by encouraging trainees to maintain their natural curiosity about their patients' lives. Doctors learn to suppress curiosity in order to take rapid, standardized histories. ~ Brody (1992)



This morning I headed to my doctor's office to visit with her nurse practitioner. Since I leave tomorrow for Florida, I wanted to make sure I did not have bronchitis or a sinus infection. While talking to the nurse, she asked me.... WHY ARE YOU GOING TO FLORIDA? Is it for vacation? Well I could have answered that simply with a yes, or a no, or made something up. But in this particular instance, I told the truth. I explained that Mattie's birthday is on April 4th, and it is too hard to be home for yet another milestone without Mattie. As an aside (which I did not tell her), with each year that goes by, more and more people forget about Mattie's birthday, and I have learned to remove myself from feeling hurt and angry is the best way to cope. 


So to recap, I just told the nurse my child died from cancer, that his birthday is coming up, and that is why I am leaving town. How do you think she responded? She had NO response. NOTHING. As if she did not even hear what I said. Instead she wished me a nice trip. Now I realize she isn't a therapist, but she is human no?! I have grown accustomed to these out of touch, insensitive, and clueless reactions and responses. You would think I would be used to it by now. Why does it bother me so much? Sure a part of it is that I am a mom who lost a child, and would appreciate those I receive care from to be empathetic, but I think the reason why this troubles me so much as I look at this as an educational failure (given my former life was teaching students the art of becoming an effective therapist). Something is very wrong with the way doctors and nurses are being trained today. They are programmed not to have their own or react to others' feelings. Great if working in a vacuum and with a robot. NOT great when dealing with humans, as our feelings and emotions heavily influence our physical state! 

Honestly if a patient of mine came in and shared with me that a pending milestone of a loss is about to occur and one feels forgotten at times, and therefore has to go out of town because of it.... my immediate reaction would be.... no wonder you aren't feeling well. That is a lot of stress, pain, and grief to be carrying around year after year. But today I got NOTHING. It should be no surprise that my therapeutic theoretical mentor was Carl Rogers. The psychotherapist who coined the term, therapeutic empathy. Rogers understood the power of the human connection and the healing power of having this connection and being understood by another person. In fact, Rogers' would say that..... accurate empathic understanding means that the therapist is completely at home in the universe of the patient. It is a moment-to-moment sensitivity that is in the “here and now,” the immediate present. It is a sensing of the client’s inner world of private personal meanings “as if” it were the therapist’s own, but without ever losing the “as if” quality. 

Clearly Rogers' definition of empathy is not practiced in the world of medicine. Instead in medicine, empathy is an experiential way of grasping another's emotional states. However, empathy is a “perceptual” activity that operates alongside logical inquiry. So long as physicians continue to exercise their skills of objective reasoning to investigate their empathic intuitions, empathy should enhance medical diagnosis rather than detract from it. So what this means is that empathy is not necessarily expressed or shown, but instead is a perceptive skill that doctors use to give them further data points into a medical problem. This is a very important difference here. Because a doctor or nurse maybe absorbing the feelings being expressed by the patient, but the only one benefiting from this airing of information is the provider. He/she is getting more data points, but the patient is left feeling exposed emotionally and wondering...... DID YOU HEAR ME?! It helps to understand this philosophical difference of how empathy is executed in the medical world, but again I ask why? 

I came across this article today, What is Clinical Empathy by Jodi Halpern
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494899/). I wanted to learn more about this issue from the lens of a medical doctor. In her article, she cites three barriers to empathy in the medical profession (I list them below, as the content came directly from her article). The second barrier really resonates with me, because it is the whole reason the Mattie Miracle Cancer Foundation was created... to spread awareness about the importance of psychosocial issues and how they directly affect our physical health. Integrating health care and psychosocial support together is not just a priority for CANCER treatment, but for all medical care. Yet it is an uphill battle as the majority of medicine still compartmentalizes the physical from the psychological. 

The first barrier which interferes with empathy is anxiety. Time pressure is invoked as a concrete barrier to listening to patients, but probably functions more as a psychological barrier, making physicians anxious. This can be addressed in part by showing physicians that listening can make care more efficient. For example, it usually takes less than ninety seconds for a patient to speak without interruption at the beginning of an interview, and this helps set the tone for trust and disclosure. More generally, to address the anxieties that accompany doctoring, the culture of detachment needs to shift, encouraging physicians to acknowledge and seek support for their own emotional needs.

A second barrier to empathy is that many physicians still do not see patients' emotional needs as a core aspect of illness and care. Research shows that doctors who regularly include the psychosocial dimensions of care communicate better overall. Physicians can be educated to perceive psychosocial needs as important.

A third barrier to empathy comes from the negative emotions that arise when there are tensions between patients and physicians. Physicians who feel angry with patients and yet find such feelings unacceptable face barriers to thinking about the patient's perspective. All physicians could be taught to tolerate and learn from their own negative feelings in the way psychiatry residents are taught to pay attention to counter-transference.