Find the story at: http://hospiceandnursinghomes.blogspot.com/2010/10/hospice-volunteers-with-no...
Great job, Frances......as usual.
Sunday, October 31, 2010
The emotional state of doctors can affect patient care
by Jeffrey Knuppel, MD
Great doctors listen to their patients.
They start out by asking open-ended questions, and unless patients get too far off-track, they don’t typically interrupt them. Despite having limited time for appointments, they have an unhurried manner. They make eye contact with their patients and do not bury their heads in charts and computer screens. Their patients leave their appointments feeling respected and heard.
Of course no doctor is likely to be able to do all of these things all of the time, but some come closer to this ideal more consistently than others.
But great doctors additionally have a “sixth sense.” They can “read between the lines.”
It’s vital that physicians listen to their patients, but human beings are complicated and sometimes do not say what they mean or mean what they say. Or, they may not even know for sure how they feel. Therefore, listening to a patient’s words alone is not enough.
Exceptional physicians have honed the skill of reading non-verbal cues as well as easily-missed subtleties of spoken language that help them to interpret their patients’ histories with greater accuracy. Ultimately, since they are able to connect with and truly understand their patients better, they have the potential to provide superior care.
But, wait. There’s an invaluable clinical pearl that physicians can borrow from the world of psychotherapy to help them to better hone this “sixth sense.”
I’ll explain.
Have you ever been around a negative, depressed person for too long? Or too many negative, depressed people in a short period of time?
How did you feel?
Let me guess–you probably felt depressed or “blah” yourself.
What about someone who was in a very happy and joking mood?
Did you want to smile and maybe laugh?
And that’s the “secret”–it’s actually quite simple: The feelings that others elicit in you are often reflections of their own internal mood states. So, how you feel in the presence of someone very well might be similar to what they are feeling.
I’ve seen this occur from being around people experiencing other emotional states as well.
An anxious, obsessive, fearful person often creates a sense of anxiety, tension, and unease in those around him.
An untrusting or even paranoid person often causes others to feel suspicious.
The list of possibilities goes on and on.
And while this “window” into a patient’s emotional state is not always reliable, it often is. It’s potentially important “information” that shouldn’t be ignored, regardless of a doctor’s specialty.
In addition to providing a clue about the patient’s own feelings, there is another reason that I believe it’s helpful for doctors to be tuned into our own emotions. Our emotional state can impact patient care.
As physician blogger, Rob Lamberts, points out, the doctor-patient interaction involves two humans. He states:
Patients forget that doctors have bad days, get depressed, are sometimes sick, and can be as irrational as patients. We are forgetful at times, don’t always think of things that may be obvious, and even get distracted at times. Sometimes our kids annoy us, sometimes our marriages are bad, some of us have our own past trauma, and sometimes the patient immediately before your appointment was very difficult.
With regard to being “irrational,” that’s exactly what can happen when we have strong emotional reactions to our patients: We doctors can easily lose our objectivity. Making diagnostic and treatment decisions when in an overly emotional state can jeopardize good patient care.
So, what can physicians do?
We can try to pay more attention to how we feel when we’re with our patients. If we notice ourselves having strong emotional reactions, whatever they may be, we should remind ourselves that they may mirror our patients’ mood states. By simply getting ourselves in the habit of being more mindful of our emotions, I believe we’re less likely to allow them to inappropriately sway our clinical judgment.
Jeffrey Knuppel is a psychiatrist who blogs at Lockup Doc, where this post originally appeared.
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Tagged as: Patient, Primary care
via kevinmd.com
Very interesting article - the doctor's mirror of emotions can impact patient care.
Grieving online - LancasterOnline.com Lifestyle
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In a day when everything is virtual, it is no surprise that people are utilizing the Internet to help them grieve.
Online tributes to those who have passed are inundating the Web with memories of loved ones being posted on Facebook, MySpace, Internet memorial sites and funeral home pages.
Word of someone's death now spreads quickly and a network of support can appear within minutes online.
"I call it e-mourning," said Patti Anewalt, director of Hospice of Lancaster County's PATHways Center for Grief & Loss. "The bottom line to this is that the Internet provides a way for people to connect with each other and they can grieve anytime, day or night."
Websites are modern versions of traditional grieving techniques including talk therapy and writing in a journal, according to an article at www.cnnhealth.com. By sharing grief over the Internet, people feel as if they're being listened to and feel that they're not alone.
Social networking pages of those who have died are sometimes established by those who remain. Memories, messages and pictures are posted as a way to grieve and allow the friends and family to "connect" with their loved one, Anewalt said.
"We used to think that you get over a loss," Anewalt said. "You don't forget, you continue to remember that person and many people post things as a way to remember them and celebrate them."
The Internet allows people to connect and grieve together, even if they live far apart. In cases where family members may live across the country, social networking pages allow them to continue to work through their grief after the funeral, or allows them to share in the mourning process if they can't make it to services because of distance.
"It allows people to know they are not alone," Anewalt said. "It provides a safe place to mourn."
Wendy Rebman Lefever's 24-year-old son Zach died in an October 2009 accident, and she has found comfort in using a Facebook page as a way to help her mourn.
"I have learned so much about him and what he meant to people," Lefever said. "It's so comforting to be able to be close to him at the click of a mouse and leave thoughts about him on his page. I have shared a lot and so have others."
Although Zach's personal Facebook page is private and only allows those who are "friends" with him to post messages, Lefever created the "In Memory of Zach Lefever" page on Facebook as a daily journal, of sorts, to memorialize her son. The page is filled with messages not only from his mother, but other relatives and friends who post sentimental, and sometimes funny, thoughts to whomever wishes to read the posts.
"It gives me a piece of him that is still here and that I can connect to," Lefever said. "I journal on there for myself, but do not expect any kind of response. The response is amazing, though.
"His friends are a testament to him. They have not forgotten him and the posts they leave touch my heart," Lefever said.
"I am sure I am further along in the grieving process because I was able to write and share my son and thoughts," Lefever added.
Terry Christopher, 27, of Lancaster, has found an online outlet has enabled him to deal with the grief of losing his brother, Kevin, who died unexpectedly last November at age 24. Family and friends use Facebook to memorialize Kevin.
"I have learned a lot about my brother," Christopher said. "When you get that many different perspectives coming together on one page, it allows me to see him the way others saw him and see the memories they have of him."
"It helps me to stay close to him," he said.
However, there may be a downside to online grieving.
"The con is that I might be sitting down at night and reading the posts on Facebook and crying," Christopher said. "The posts may affect me that way.
"I might have been crying that night anyway," he added.
Grieving, which was once a very intimate and private process, is now more public with online grieving.
"Each person grieves differently," Christopher said. "Looking at an online site might be hard for some because it forces you to deal with your grief and think about the person
"I am constantly thinking about him," Christopher said.
Even when a person dies, his or her social networking site can remain active for a long time, unless someone knows the person's password and wishes to delete the person's site.
MySpace handles each incident on a case-by-case basis, according to spokesperson Corrina Pieloch.
"When notified, MySpace will work with families to respect their wishes," Pieloch said in an e-mail. "We often hear from families that a user's profile is a way for friends to celebrate the person's life, giving friends a positive outlet to connect with one another and find comfort during the grieving process."
However, the social networking site does not allow anyone to assume control of a deceased user's profile nor does MySpace delete profiles for inactivity. MySpace will delete a profile at the request of a family member, according to Pieloch.
In light of the growing number of memorial postings, Facebook has made adjustments to its policies, according the the company's site. According to a blog written by Max Kelly, Facebook's director of security, sensitive information such as contact information and status updates are removed after an account is memorialized following the person's passing. Privacy is also set so that only confirmed friends can see the profile. The changes allow family and friends to leave posts on the profile but prevent others from logging on to the page.
Facebook has developed an application called Mournwatch, www.mournwatch.com, an online site designed specifically for posting memories of loved ones, according to www.facebook.com/media. Mournwatch currently has more than 9,500 memorials posted.
Although many people post memorials without thinking and may be deep in their mourning process, there are precautions that should be taken before grieving online.
"People are very lonely and vulnerable while grieving," Anewalt said. "People put themselves out there and are very emotional. It depends on what you are posting and where — it's hard to take back.
"And unfortunately, in the world of technology, there are people out there who will prey on the vulnerable," she added.
Anewalts suggests thinking twice before posting online, checking to make sure it is a credible site, reading the other posts before posting your own and not answering messages from anyone you do not know after you post.
"Do not use the online sites as a substitute, though, for face-to-face support," she added.
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