Last year at an American conference on patient/clinician communication, Holland Bloorview family support specialist Lorraine Thomas participated in a simulation.
An actor playing the part of a patient was lying in a hospital bed in his robe. He had a number of scripts for clinical interactions and randomly picked people in Lorraine’s group—including doctors and nurses—to role play the part of the health professional.
“With me he started by saying ‘My mother had this disease and now I have it too,’” she recalls. “I said ‘I’m sorry to hear that’ and he came back immediately with ‘But it’s not fair. Why did it happen to me?’ He was there to push our buttons and take us out of our comfort zone. Then he said: “I saw my mother die of this disease and it was awful. I promised myself I would never let myself go this way. I looked after myself and had regular checkups and it still happened to me.’ Then he started sobbing.”
Lorraine says she was so concerned about appearing “professional” in the eyes of the clinicians watching, that she panicked. “When the actor started sobbing, it was a little too real. I got flustered, wondering whether I should hold his hand or pat him on the back. But I was aware that the other health workers might think that wasn’t professional. I said ‘I know it isn’t fair, but sometimes that’s how life is.’ The actor and the group groaned and said ‘You can’t say that.’”
Lorraine had “overthought it,” the group told her. “I needed to respond to the emotions behind the patient’s words. So it would have been better if I made a physical gesture—like patting his back or holding his hand silently. Or even saying “‘I'm so sorry, this is very hard for you.’
“The actor said the way I responded made him feel like I wasn’t really listening to him. That I was glossing over things by making them abstract. He said ‘I don’t care about “that’s life.” This is happening to me, and this is personal.’”
At the conference Lorraine learned about “deep listening”—described as a whole body experience meaning “I give you my ears, my eyes, my undivided attention and my heart.”
Instead of jumping in to resolve or fix the client’s or parent’s problem, she says, “we need to look beyond the words at what is the emotion under it. We need to acknowledge that emotion, whether it’s sadness or anger or fear: ‘I understand that you’re afraid or very worried. I hear you.’”
Often clients and parents aren’t looking for an answer, or to be given a list of “action items” to resolve the problem. In many cases, they have problems that can’t be resolved in a logical way.
“The group felt I was trying so hard to be professional that I was holding back on my emotions and I didn’t trust my response. Sometimes briefly squeezing a person’s hand or a neutral touch on the back or shoulder can physically ground people. It’s a way of saying: ‘I’m here okay? I’m here and you’re here.’”
Lorraine says the most important thing in difficult clinical conversations “is to be present and in the moment. The person in front of you needs to be the only thing on your mind. Don’t start thinking ‘I’m going to make this observation’ or ‘I’m going to ask this question.’ Just be present in the moment.”