Kris English, PhD

The University of Akron/NOAC

Scenario: Today an audiologist will meet a new patient, Mr. Jones. She asks about his concerns and obtains a comprehensive case history. When the testing is completed, she confirms the patient’s suspicions about his hearing problems. She begins to discuss treatment options, but then realizes her patient has stopped listening.  She pauses, and soon the patient breaks his reverie. He shakes his head, makes eye contact again and says:

The thing is … years ago, I was so impatient with my dad’s hearing problems.  I didn’t even try to understand and just stopped talking to him.  I was pretty awful about the situation. Then after he died, I started to realize how stubborn and selfish I had been.  This man I had loved so much – we had been become strangers.  And now it’s me – and maybe the whole cycle will start again with my kids! That would just … it would just break my heart.”   His voice breaks and he looks away again, sighing deeply.

In less than 30 seconds, several emotions have tumbled out: guilt, regret, self-blame, worry.  The audiologist was mindful of the change in demeanor, and gave the patient the opportunity to express these concerns.  But now that we know what the patient is experiencing, what do we do?  Do we assure the patient that everything will work out and then “get back to the point” of the appointment?  Are we defining “the point” only from our own perspective? And if so, are we ourselves missing an important point?

Portrait of an apprehensive senior man.

What Exactly Is The Point?

In a recent conversation, Tim Cook (webmaster at the Ida Institute) mentioned a concern shared by many Ida seminar participants: When patients get emotional, how do we redirect them back to hearing solutions – that is, get them “back to the point”?   This concern assumes that patient emotions will inherently impede progress — not to imply that the emotions are irrelevant to the patient, just irrelevant to the appointment goals. Emotions are perceived as a problem, a “noisy byproduct” that we need to manage, control, suppress (Stone et al., 2010, p. 13).However, the authors of Difficult Conversations: How to Discuss What Matters Most point out that in fact, at this moment in time, the patient’s emotions actually are the point.  They remind us (and it’s easy to forget) that “we can’t have an effective conversation without talking about the primary issues at stake, and in these conversations feelings are at the heart of what’s wrong” (p. 86). Unfortunately, it tends to be human nature that when emotions are raised, “It’s tempting to jump over feelings. We want to get on with things, to address the problem, to make everything better. We often seek to get feelings out of the way…” (p. 106).

When We Get the Point

When we recognize that, at this moment, patient emotions are the point, we change our response. Rather than ignoring or glossing over emotions, we face them with the patient, for instance with this simple and “acknowledging” response:

That would be hard, to look back with some regrets – and now it applies to you…

And what happens next? Audiologists may worry about conversations spinning out of control, but far more likely one of two very ordinary outcomes occurs:

• The patient shares his concerns and burdens, consequently experiencing some degree of relief and also a sense of safety with us – both necessary conditions for moving forward.
• OR … we learn that the patient’s troubles are more complicated than we are qualified to address, and can suggest a referral to a professional counselor.

It’s important for our own peace of mind to know that listening to a patient’s worries and fears will not be part of every appointment, tends to take only a few minutes when it does occur, and also is correlated to higher patient satisfaction and adherence to recommendations (Stewart, 2003), a good return on investment in a very real sense.

When We Miss the Point

Research indicates that our response to patient emotions affects patient outcomes. For instance, a recent study (Adams et al., 2012) followed the course of events when physicians responded to or ignored patients’ expression of emotions. When physicians responded to emotional statements, their efforts resulted in additional opportunities for patients to complete their train of thought, expand on their concerns, and continue building a positive, therapeutic relationship. On the other hand, when physicians ignored the emotions, subsequent conversations were distant and even antagonistic.  In this study, the latter group of physicians did not see emotional expressions as “the point,” and risked compromising patient success.

These results confirm what we intuitively know. Putting ourselves in our patients’ shoes, we know what would happen if we shared our emotions with a health care provider, only to be ignored. We would not trust this professional in the future with more personal disclosures, and may decide not to trust recommendations for treatment as well.

A Cliché, And Yet …

We say it all the time: patients are more than ears and audiograms. More .. but what does “more” include? Surely it must include the emotional, psychological, and social aspects of patients’ lives. We may have been trained to believe that the appointment is “all about us,” our objectives and our expertise, but it’s never too late to recognize the limits of that approach and respond to the “more” when the occasion arises.  Patients bring their own points, and if we do not honor them, we lose an opportunity to help.

References

Adams K., Cimino, J., Arnold, R., & Anderson, W.  (2012). Why should I talk about emotion? Communication patterns associated with physician discussion of patient expressions of negative emotions in hospital admission encounters. Patient Education and Counseling, 89, 44-50.

Stewart, M. (2003). Questions about patient-centered care: Answers from quantitative research. In M. Stewart, J.B. Brown, and T. Freeman (Eds.), Patient-centered medicine: Transforming the clinical method (2nd ed.)(pp. 263-268). Abingdon, UK: Radcliffe Medical Press.

Stone, D., Patton, B., & Heen, S. (2010). Difficult conversations: How to discuss what matters most. (2010). NY: Penguin Books.