How to Create a Culture of Caring

Recognizing patient emotions is good for physicians, too, says a doctor who’s seen both sides.

A physician’s brain is filled with facts, science and statistics, thanks to their training. It isn’t always filled with empathy, compassion and understanding. But one doctor is trying to change the culture that surrounds her into one of caring.

“If [doctors] are asked a question, they tend to respond with data,” says Rana Awdish, MD, medical director for care experience at Henry Ford Health System in Detroit. They don’t always see the emotions involved with what is going on around them and the transformation happening in a patient’s life, she says. “It’s not something that we’re implicitly trained in. We’re trained in facts and answers.”

Rana Awdish

Awdish is trying to change that dynamic by offering training to fellow physicians that involves intense role play — simulating difficult conversations, such as delivering bad news and dealing with death. “We want to get better at this every day. That’s all any of us can hope for,” she says.

The Physician Communication and Peer Support curriculum began at Henry Ford in 2013. New hires participate as well as current staff members who want to enhance their skills. Awdish says adult learners won’t learn what they don’t want to learn, but “we made it so attractive and engaging and let it spread organically, there are times we can’t keep up with demand,” she says. “And that’s a good thing.”

Awdish and her team are concentrating on the areas where difficult conversations happen most — pulmonary critical care, hospice and palliative care, oncology and the emergency department.

“We simulate everything else in medicine, but we don’t simulate those conversations,” says Awdish, who specializes in pulmonary hypertension and critical care medicine. “If you get it wrong, that leaves someone scarred forever, and we don’t want that.”

When doctors recognize emotion, it can lead to better patient understanding of a recommended treatment plan. “If a patient is terrified after hearing a diagnosis, they are not listening to what is next,” Awdish says.

Statements of empathy from a doctor, such as “I can’t imagine how scary this must be” and “I can’t imagine how devastated you must feel,” reflects the emotion back to the patient. “It’s the things that make us feel seen and understood, that’s what really adds value,” she says.

That added value can lead to time savings for the physician. “You [otherwise] end up repeating everything again, and probably more importantly, there is an absence of trust,” Awdish says. That lack of trust can lead to nonadherence if a patient feels marginalized. “There are a lot of things that come out of ignoring emotion, none of which are positive,” she says.

Changing the channel from a cognitive one to an emotional one can make a difference. “We all want to get to the treatment, the healing and effecting change, but we can’t do that until we honor the emotion that is in front of us,” she says. “Engaged physicians have better adherence and healthier patients.”

Awdish personally saw the need for change in 2008, when she became a patient and nearly died in her own hospital. She says she received excellent medical care, but something was missing. “I felt as a person, I wasn’t being cared for, but my body was,” she recalls. “They were doing everything my body needed to recover, but I still felt like there was a large part of me that wasn’t being cared for.”

One minute, she was healthy, and the next moment, she was not. “That’s something that deserves discussion,” she says. One surgeon made an emotional connection to what she was feeling and her medical condition, and it made an impact on her. She began to notice what was lacking with some of the other members of her care team. “You don’t know what’s missing,” she says. “You just know it’s not there, [even if] you don’t recognize it right away.”

Recognizing emotions in patients can also help a physician’s longevity and help avoid burnout, Awdish says, adding it’s draining for a physician to provide a plan of care a patient doesn’t follow. “There is improved physician resilience because they feel like they are providing effective change,” she says. “When these conversations are patient-centered, that they are value-guided, that they really take into account the patient, for the physician what it does is create a plan of care that the patient will adhere to.” Healthier patients often make physicians happier with their career, Awdish says.

Making a change to cultivate empathy does not need to be difficult. Awdish’s advice:

Recognize someone’s emotion and reflect it back to them.

Don’t judge. Patients cannot form an emotional relationship with a physician if they feel they are being judged for something, such as failing to see a doctor sooner.

Acknowledge what’s happening. If a doctor sees a patient anxiously taking notes, it’s OK to call attention to the anxiety and offer support.

All of these steps lead toward one goal for Awdish. “It’s to reinsert empathy and show the value in that,” she says. Mission conflict — keeping time schedules, insurance needs, medical record requirements and more — should not interfere with that goal. “We can’t give away relationships we have with our patients. We can’t sacrifice that for the clock, that’s really what it comes down to,” she says. “That’s what creates longevity, resilience and better patient outcomes.”

Tiffani Sherman is a freelance journalist in Florida. This article was originally published by AAPL in February 2017.