Conversations with patients <i class="etl etl-heart" style="color: rgb(20,175,180); padding-left: 10px; font-size: 23px;"></i>

Empathy and mindfulness

Conversations with patients

Illness, frustration, anxiety, suffering - exercises for medical personnel

Exercise 1. Repeat aloud after the voice-over the key phrases and expressions that directly relate to patient support. By saying individual sentences out loud, the learning process is many times more effective than if you were only reading or thinking what you could or should say. By repeating individual words, you considerably increase the likelihood of their use in real-life situations. The exercise is like learning a new language; its logic and mindset will change your conversations with patients. It will help you listen, understand and deal with frustration, fear, pain and suffering of the people you are assisting.


Welcome and establish contact

 „Hello, how can I help you, sir/madam?” „Do come in, what seems to be the problem?”, „Please, come in, how can I help you?”

If possible, be the first to say good day. Keep a natural eye contact, i.e. look into the other person’s eyes for about 60% of the time. 100% eye contact happens most often in case of strong conflicts and quarrels. The complete lack of eye contact may be interpreted as a sign of embarrassment, uncertainty or disregard. Adjust your tone of voice and speech rate to the tone of voice and speech rate of the person you are talking to; avoid speaking too slowly, too quickly or using an abnormally low- or high-pitched voice. Avoid any highly mannered style (dragged y’s, a’s, o’s, etc.). Pay attention to the gestures and behaviour that cause anxiety or sense of disregard, i.e. do not touch patient’s body without prior conversation about the purpose and scope of the examination or treatment; do not yawn; do not tap your finger on the table; do not play with your phone or pen; do not play with medical tools; and, above all, do not look at the computer display or write on the computer without first informing the person you are talking to that you are doing it for him/her. During the first 20 seconds of the contact, every new patient will determine whether you are person worthy of his/her trust or not. If he/she thinks that you are not reliable, he/she will question whatever you say or do. At this stage, your experience and competencies will be meaningless. If the patient has not choice, you will be the necessary evil for him/her (and, after a while, also for yourself).


Questions or remaining silent for the patient to be able to tell you of the specific purpose of his/her visit

Leave a moment of silence for the patient to be able to tell you of the specific purpose of his/her visit – this is especially important if you cannot or will not ask detailed questions about patient’s condition (registration, medical procedure):

„A referral to… (silence) I understand… (silence) do you mean?… (pause)…”, „The referral says that… I understand that this is about…”, „Please, tell me what happened? When and what did you specifically notice, sir/madam?”, „Please, describe exactly where it hurts, sir/madam Can you tell me the kind of the pain? How often does it appear?”, „Please, tell me how long you have observed these symptoms, sir/madam?”, „Please, tell me how this injury happened, sir/madam?”, „Please, tell me about the current course of the disease, sir/madam. How did it start? What medications have you taken and what treatments have already been carried out in connection with this condition, sir/madam?”, „Please, tell me more about… What exactly happened then?”, „You mentioned earlier, sir/madam, that… Please, tell me what else you have noticed?”

Watch out for auxiliary verbs, such as „Do” – if you use them too much, you will only confirm your speculations and guesses; the patient will not tell you about non-specific symptoms of the disease because you will not give him/her a chance to talk about them. Ask questions starting with „What”, „Where”, „When”, „How/Which”. Keep questions starting with „do” for the end of the conversation only to clarify what you have heard.

Do not ask why?, e.g. Why have you not come earlier with your problem? Why have you not taken the medication as ordered, sir/madam? There are only two possible and reasonable answers to such a question: I am guilty; I am unreasonable. Usually, after hearing those questions, we feel negatively judged and we switch on the defensive attitude: this is not me – it is the circumstances; it is the others. The person who asks such questions is perceived as unfriendly and lacking empathy.

If you are in a public place, avoid talking aloud about diseases and conditions that may evoke shame or guild in the patient.


Paraphrasing what the patient has said

Repeat, with your own words, what you have just heard from the patient. If the person you are talking to is experiencing feelings associated with fear, pain or suffering, name them and ensure you remember about those feelings and respect them while performing a treatment or examination or when suggesting a solution. The lack of paraphrasing is the most common mistake in communication with the patient, whereas there will be endless queues in front of medical rooms of the medical professionals who are able to paraphrase.

„I understand that this situation is very difficult for you – what I can do now is…”, „I can see that you are very worried because of the result, sir/madam – I suggest that…”, „I can see that it hurts very much – in this case, I suggest that you immediately…”, „I understand that you did not expect that, sir/madam,… I see that you are in great pain… in this case, the best solution would be to…”, „I understand that this is a new situation for you, sir/madam, that it is very difficult to come to terms with the news… eyes fill with tears… I understand… in this case, I have three specific suggestions for you, sir/madam…”, „I see that you are worried about your health. I understand that you lack information… in this situation, I suggest that…”, „I see that you are very upset, I understand that. What I can do for you in this situation is… like I said, I can also…”, „I see that you are tired and exhausted; you have slept only for a few hours – this must be quite difficult for you… therefore, I suggest that…” (to a child) „Your mum says that you did not sleep; you did not feel well; your nose was blocked; you could not sleep, had a fever, did not have the strength to play… I understand, now I have to… I know that you are afraid, so I will be very careful”, „I know it hurts a lot and that is why I will be very careful” (to a child) „I know that you are afraid and worried what will happen during this examination/treatment. Let us agree that before I touch you, I will tell you exactly what I am going to do… I understand that it hurts – I will be very gentle”

When paraphrasing what the patient has said, never use „but” e.g. „I know that you are afraid, but I will have to…”, „I know that you are worried, but”. „But” eliminates the sentence that comes before the” but” in emotional terms; the person you are talking to feels you are questioning his/her feelings; that you do not hear what he/she wants to tell us; that you do not respect what he/she is experiencing; and that you will be careless, insensitive and inattentive.

When repeating what you have heard from the patient, do not go into discussions; do not present any arguments why it is not possible to do what the patient needs. Talk about what you can do (even if you can do very little), what you want to do and what you intend to do. Remember to name feelings. Do not be afraid to talk about them. This will help the patient – and it will help you too. Do not worry you will burn out this way – that empathy is a threat for you. Burn-out originates from ignoring and suppressing patient’s feelings in a situation where the person you are taking to needs so much to name them. This ends in thinking about yourself bad, accusing yourself of the lack of sensitivity, comparing to others to whom patients show commitment, trust and affection.

Remember that your patient may experience:

pain, suffering, anxiety, panic, fear, shame, anger, annoyance, frustration, uncertainty, confusion, exhaustion, fatigue, helplessness, loneliness, resignation, despair, grief, irritation, impatience, sadness; he/she may also feel cold, hot, itchy, numb, tingling, pricking, etc.

Learn how to talk about these feelings – if you do, everything you say and do for the patient will have much more significance and importance.


Inform the patient what the examination or treatment will specifically involve

„This treatment is painless, what I need to do is…”, „First, you will feel cold, then there will be a sensation of distension… it is natural… this way, I can help you and ensure that…”, „The procedure will involve… at the beginning… then… at the end…”, „The examination consists of 3 stages… the first one is … the second one is … finally, the third one… is one that may cause pain – for this reason, I suggest that…”, „I will now have to have a look at…, touch… I know it may be embarrassing… it will only take a moment…”, „Before we start the procedure, I would like to tell you exactly what I will do… during the procedure, you may feel… this is a completely natural… please, let me know if you start to feel tingling or itching.…”, „Before the examination, I will need your cooperation… at the beginning, I will ask you to… then… please, also let me know if the pain increases – I will change then…”, „I will warn you before pricking your skin…”

Avoid silent performance of individual operations and medical procedures. Most of us feel anxiety, fear, shame and sometimes anger in such circumstances.

Try to say all the questions, paraphrases, explanations and instructions while maintaining good eye contact with the patient. When he/she is lying on his/her stomach on a bed and you are standing behind his/her back, it is a lot harder to focus attention and maintain a longer conversation. If you are going to force the patient to do so, he/she will mostly feel disrespected, humiliated and ashamed.


Formulating the solution or performing the procedure

„In this situation, sir/madam, I would suggest…” „The best solution would be to…”, „What I can to in this situation is that…”, „As I have said before, now I will ask you…”, „Watch out… a jab…”, „I understand… it hurts… I am already changing the route of administration of the medication.”, „Please, tell me where exactly it hurts… I need to know to be able to…”, „The possible consequences of this treatment include… the risk does not exceed 10%…  the decision is yours, sir/madam…”

When formulating the solution, name the objective that you want to achieve. This makes it easier for the patient to focus on the future and helps him/her endure the pain and suffering associated with various medical procedures.

„It is all about your health, sir/madam. This procedure will make your arm regain its full range of movement…”, „Your heart needs to rest. It needs time to regenerate and recover – the stay in the rehabilitation centre is necessary in order to…”, „You will be able to walk again – that is the purpose of what I am suggesting to you… the rehabilitation process will take… therefore, I suggest that … 95% of patients recover…”, „This examination will allow us to determine precisely what needs to be done for you to stop feeling the pain…”, „In this situation, to restore your health, you will need to…”, (to a child) „What do you like doing in the playground?… I see – you would like to play ball/throw snowballs/go sledding/cycling… Well… if this is to be possible, now you need to…”, (to a child) „I understand that you really want to be able to go to your friend’s birthday in a week’s time. In this situation, I suggest … I think that if you… you have a very high chance to meet with your friends”, (to a child) „After the treatment, you will be able to… it will be possible for you to… you said to me that your really care about… I know about this and I remember… this will make you…”

Avoid silence or using incomprehensible medical terms. The patient needs to be sure you understand his/her needs, what is important to him/her and what he/she cares about. He/she needs to know and understand that you will do everything that is possible to help him/her restore health to him/her and his/her relatives.


Closing the visits with specific arrangements

At the end of the visit, discuss specific steps of the planned treatment and the decisions taken. Repeat the most important facts, numbers and dates.

„In 7 days, please report for a check-up. On that day, I will be available from 10:00 a.m. in room no. 26. I will write this down for you”, „Registration will begin on 26 October at 7:00 a.m. Please, bring along…”, „Today, we have performed the 4th procedure – there are still ten to go. I suggest that the next one be performed on 10 May. Please, determine the specific time of the visit at the registration desk.”, „Take 2 tablets of this medication every other day for 10 days, i.e. you need to take this medication on Wednesday, Friday, Sunday, Tuesday and Thursday. I am writing this down right now. Please, remember that you will only feel better if you continue to take the medication like I said.”, „Summing up, we agree that on 10 March, then on 18 March,… and finally on 3 April…”, „You will need 5 additional procedures… I suggest that the first one be performed on Tuesday at 10:00 a.m.; please, report to Tom in room no. 34”

Avoid general words and phrases: „As soon as possible” (determine exactly when), „a few, many, several, a lot, a small amount (determine the exact amount).

If possible, write down the most important information on a piece of paper.

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