Communication Skills in Clinical Practice, Part 2 – Dealing with Feelings By Dr.Robert Buckman

perhaps there is one theme that runs through all of the scenarios that you're about to see and that is this when the atmosphere becomes emotionally charged because of an issue it's often helpful to address the emotion first and the issue second in other words instead of trying to as it were settle the issue immediately with a statement of fact or direct response to that issue it often helps to act knowledge the emotional content of what the patient is saying first that way the patient feels appropriately that he or she has been listened to and heard and that's an important component of support then when you later come to address the issue you're on the same side so to speak as the patient so let's see how that works in a few examples to start with let's look at a situation that makes most of us feel uncomfortable and that is when the patient cries of course crying is really a symptom of the extent of an emotion it usually signals distress or pain but it can of course signal anger and on certain occasions even laughter or happiness the important thing is to explore it and acknowledge it not ignore it and that is where an empathic response is so useful have a look at a couple of these examples and see what you think is most helpful would you like a Kleenex miss Thank You mr. Thomson here you go I'll take take a moment I think let us both get our breath back eh yes um I think I have to be honest about this mrs. even that sadly after a second bleed that there really isn't a chance you can't do surgery strings John do you want em I'm sorry to be telling you as mrs. Li so there are some basic practical helpful hints when it comes to dealing with crying always offer a tissue or ask the patient if she or he has a handkerchief and if not get a tissue move closer and if you feel comfortable if the patient does also and you can touch the patient on the hand or arm give the patient some time use an empathic response or ask the patient an open-ended question if you are not sure what precipitated the tears now here's another situation that may actually be more common but it's still quite awkward for most of us and rather uncomfortable that is when the patient is feeling angry in this scenario the patient is angry but when the patient comes into the room the doctor has no idea of what started the anger off during this scenario you're going to see how each time it's used an empathic response stops the interview escalating turning into a shouting match and how it is possible to use an empathic response instead of a direct factual response to the patient's criticisms not necessarily easy to resist the temptation to try and shout the patient down but it does pay off in the end coming mr. Davis why didn't you tell me about this procedure before it took place oh it's obviously a very upset yes I'm very upset okay tell me what procedure you're talking about and what I want the barium enema that you so kindly prescribed for me do you remember that yes I do tell me what happened it sounds it was very painful it was very humiliating you think I enjoy going into a clinic where there's an x-ray room where I have things shoved up my ass you got Pleasant I do not and I hear it was very very unpleasantly obviously you're obviously really upset come and sit down and tell me exactly what happened and how awful it was come and sit yourself down take me into this x-ray room in a clinic yeah and do this procedure without my knowledge that this was going to take place why didn't you tell me that this was going to take place well well I had no idea of the pain that was going to be involved in this procedure and I've been aware of that I obviously would have tried to explore other ways of doing this yes okay so it hurts a lot absolutely and did you have no idea that this procedure causes people pain it doesn't usually cause a lot of pain it's always I'm always uncomfortable but obviously some people are much much greater sort of pain I just might happen to be one of those people my tongue of course of course of course um did the pain last just while the procedure was happening no it continued quite some time which when the procedure was over yes so this was a quite act we're gonna realize bottles oh yeah okay I'm sorry to Anna you're sorry to hear that yes I am yeah well I'm sorry you didn't experience it yourself so you know exactly what I was talking about I understand what you're saying I mean I I guess a standard piece of information that they give you at the radiology department says it's going to be uncomfortable and it's only occasionally that somebody's foul as it were is so sensitive that it really really hurts a lot there's no way of predicting who is going to have a rotten time of elegance that's why they call it practice isn't it I take your point I take your point I think it's about now even though mr. Davis it was a horrible experience I want to separate that from the result of the Berryman er because the result is important now although it was a nasty experience I was worried when I ordered that I was worried that your symptoms might have been related to something really serious I was actually worried that you might have had a cancer in the bow I think we discussed that briefly now separating the trauma of the experience from the result of the barium enema I'm really glad to tell you that actually there was no cancer in the bowel you're clear you there's no problem what you have and those symptoms the symptoms are what we call irritable bowel syndrome and I'll talk more about that in a moment or two but even though well I am glad the news turned out that way as well but had I been a little more prepared this wouldn't be happening at this point in time I understand you I understand you to this extent if ever we need another procedure whatever you may be Berryman or a gastroscopy or anything in the future you must reminder and I'll remind myself our market in the chart I'll give you some pills which you take the night before and on the morning of the procedure which will make you sort of almost like a mild anesthetic kind of thing so that would have been very helpful I guess if we don't know we do now but if we know then that it was going to cause this amount of trauma we we would have given you those those pants not my way to treat people in your profession this way but I'm and this is this is not acceptable I understand entirely and I also understand that you don't normally behave like this you're not normally that cross and what I thought is something really bad must have happened to make you well I thought it was pretty bad yes so I'm glad that it was that awful experience led to the results that it did no cancer well I'm glad of that as well and if anything any procedure is needed in the future I'll give you some pills all right all right don't you so there are a few useful ways of approaching the patient who is angry now let's talk about a problem that is more common but which is still not easy to deal with them you


  1. How would you respond had the results from the barium enema come back and the patient was found to have cancer? I imagine that double whammy of bowel pain and the bad news of cancer might really set the patient off.

  2. Absolutely fantastic. I hope one day I get to that point of confidence and expertise to handle the emotions of patients. This doctor is a genius!

  3. Thank you Dr.Buckman. I wish I could handle an angry patient the way you did.I often loose the agenda when a patient becomes angry or cries.I simply feel helpless.Your post will definitely help. 

  4. There is a very medically skilled  opthalmologist here that is very rude and condescending with most of her patients.

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