TeamConnect June 2016

Office: 855­968­6372

The Importance of the Patient Perspective by Kasaan Hammon, June 1, 2016

In an age of WebMD and Google, patients come to a doctor’s visit more often than notwith preconceptions about what their symptoms mean, a list of multiple concerns whichthey want to address in one visit, and often a history of treatment for chronic illnesswhich may or may not have been effective. In other words, they are loaded up withinformation, experience, and expectations. What is the doctor’s role then? How candoctors meet patients’ expectations and involve them actively and effectively in their owncare while still maintaining their authority as medical professionals? The key may be inappropriately factoring in the patient perspective.

Dr. Gurpreet Dhaliwal, an associate professor of clinical medicine at the University ofCalifornia San Francisco and a staff physician at the San Francisco VA Medical Center,puts it this way: “Doctors can improve their communication by seeking to understand theperspective of the patient. This critical duty can be simplified by always asking patientsthree simple questions (I.C.E.): Idea—What is your idea about what is going on?Concerns—What are you most worried about? Expectations—What are you expectingthat I can do? When the doctor understands what the patient believes, fears and wants,they can both ‘get down to business’—the business of healing the body and themind.”(1)

This involves empathy, but there is a distinct difference between clinical empathy andemotional empathy. Clinical empathy is understanding a patient’s emotions, as opposedto emotional empathy (or sympathy), which is sharing a patient's emotions. Sympathycan hinder objective diagnoses and effective treatment. Dr. Helen Riess, founder ofEmpathetics, explains: “Sympathy often leads to prosocial behavior, but it can also leadto misguided decisions. In contrast, cognitive (clinical) empathy is understanding whatthe person feels and thinks, regardless of whether you have been in the exact samesituation or whether you feel the person’s emotions. Our role as physicians is to getunder the patient’s skin and see the world from their point of view, but also to get backout so that we can be objective and make the best rational decision.”(2)

Research has shown that many patients prefer a shared decision­making model whichincludes their perspective.(3) Integrating the patient perspective has the potential toincrease the patient’s satisfaction with the consultation, lead to better adherence tomedications, lower the likelihood of mistakes, and result in fewer malpractice cases. Iteven affects patient health outcomes; a review of research concluded that effectivephysician­patient communication improves patients’ emotional health, symptoms,physiologic responses and pain levels.(4)

However, hearing the patient’s perspective involves time, and the looming pressure oftime constraints are a key issue in today’s consultations. Doctors are often guilty ofinterrupting a patient to control the length of the visit. A study found that in 7 out of 10office appointments, doctors interrupted before patients could finish explaining theirhealth concerns.(5) The pressure is on doctors to come up with diagnoses andtreatment plans quickly, while a patient’s satisfaction with the visit is dependent uponfeeling heard.

The solution to this conundrum may just be a matter of keeping the “effective” incommunication. With no additional time spent, effective listening and tuning in to non­verbal cues can vastly improve the quality of communication. UCLA research has shownthat only 7% of communication is based on the actual words we say; 38% comes fromtone of voice; and the remaining 55% comes from body language.(6)

Dr. Travis Bradberry gives eight tricks for reading body language: 1. Crossed arms andlegs signal resistance to your ideas; 2. Real smiles crinkle the eyes; 3. Someone copyingyour body language is a good thing; it means they feel a bond or are on the same pagewith you; 4. Maintaining good posture commands respect and promotes engagement; 5.People who are lying may overcompensate and hold eye contact to the point that it feelsuncomfortable; 6. Raised eyebrows signal discomfort and feelings of surprise, worry orfear; 7. Exaggerated nodding signals anxiety about approval; and 8. A clenched jawsignals stress. “What can be most important to read is when words and body languagedon’t match,” says Dr. Bradberry.(7)

Patients feel more understood when doctors practice active listening. This includessmiling and nodding the head, eye contact, leaning slightly forward or tilting the headsideways while listening, automatic (not forced) reflection or mirroring of any facialexpressions used by the speaker, and avoiding distraction. When exercising verbalreflection, casual and frequent use of words and phrases such as ‘very good,’ ‘yes’ or‘indeed’ can become irritating to the speaker. It is usually better to elaborate and explainwhy you are agreeing with a certain point.(8)

While empathy courses are not currently required in medical training, interest in them isgrowing.(9) Columbia University School of Medicine has pioneered a program in“narrative medicine,” which emphasizes the importance of understanding a patient’s lifestory and value system when providing compassionate care. A range of “medicalhumanities” courses incorporate philosophy, film, art, and literature to enhance

healthcare workers’ reflective practice and observational skills.(10)

At the end of the day, patients are looking for empathy, engagement, and shareddecision­making. Researcher Zanini writes, “In the age of information, patients form theirviews outside the medical consultation, and these views can facilitate or hinder anycollaboration with doctors. For patient informed care to take place, doctors need toidentify and address the patient perspective.”

(1) Gurpreet Dhaliwal; “Ask Patients These Three Simple Questions;” Wall Street Journal, April 2013; (2) KasleyKillam; “Building Empathy in Healthcare;” syndicated from Greater Good, January 2015; (3) Claudia Zanini;“Doctors’ Insights into the Patient Perspective: A Qualitative Study in the Field of Chronic Pain;” BioMed ResearchInternational, May 2014; (4) Stewart MA; “Effective physician­patient communication and health outcomes: areview.,” CMAJ, May 1995; (5) Beckman MD and Frankel PhD; “The Effect of Physician Behavior on the Collectionof Data;” Academia and the Profession, November 1984; (6) A. Mehrabian; “Silent messages: Implicitcommunication of emotions and attitudes;” Wadsworth, 1981; (7) Bradberry MD; “8 Great Tricks for Reading BodyLanguage;” Huffington Post, May 2016; (8) “SkillsYouNeed.com”; (9) Sandra Boodman; “How to Teach DoctorsEmpathy;” The Atlantic, March 2015; (10) Eric J. Hall; “Why We Need the Humanities to Improve Health Care;”Huffington Post, July 2014.

Share Share

Erich's Message: Expand YourPerspective

If you have ever flown in a window seat ofan aircraft, you may have watched theground ‘fall away’ beneath you. As theaircraft climbed, the airport complex,roads and buildings all became moredistant. Within minutes, what was onceyour view of the terminal building quicklybecame a view of the entire city beneathyou. Eventually, you may have even seenthe curvature of the earth. The truth is, theground beneath you didn’t change; it wasyour perspective of the world thatchanged.

In a similar way, your perspective on medicine will change over time based on theexperiences you have and the knowledge you gain. The greater your perspective, thegreater your ability to solve problems will be. I encourage you to seize as manyopportunities as you can to expand your perspective on medicine and healthcare ingeneral. Educate yourself on everything from disease processes to healthcarelegislation. Waste no opportunity to increase your understanding and vary yourperspective in this field.

At ScribeConnect, we strongly encourage and foster a culture of excellence ineverything we do. We know that by investing in you, you will be able to better serve yourproviders and strengthen your foundation in medicine. One way we do this is throughour scholarship that helps financially assist with ‘expanding your knowledge of medicine’.Check out the “Continuing Education Scholarship” below for more information.

Erich Rempel CEO ScribeConnect

Quality of the Month: Perspective

“We can complain because rose busheshave thorns, or rejoice because thornbushes have roses.” ­Abraham Lincoln

“What we see depends mainly on what welook for. In the same field the farmer willnotice the crop, the geologists the fossils,botanists the flowers, artists the coloring,sportmen the cover for the game. Thoughwe may all look at the same things, it doesnot all follow that we should see them.” ­John Lubbock

“Some people see the glass half full.Others see it half empty. I see a glassthat's twice as big as it needs to be.” ­George Carlin

SC Spotlight: Sasha Mozelewski Regional Manager, Southern Illinois

Sasha has been part of our Southern Illinois team since2013. Since being promoted to Regional Manager in2014, she has been a proven leader in ScribeConnect’sculture of excellence. Sasha is known for being first toarrive and last to leave. She is also known for heradaptability to different circumstances and compassion.Sasha says about her job, “I love working in the ER, thephysicians we work with, and the clinical judgment andknowledge I have gained. Also, I love being able todevelop the mindset of a physician. I get a front seat towhat it’s truly like to be a physician, including all the goodand bad aspects.”

Sasha studies at Southern Illinois University Carbondale,majoring in Biomedical Sciences and minoring inChemistry. She is currently applying for medical schoolwith a strong interest in integrative and preventive

medicine. Though she tells us, “Through my clinical

medicine. Though she tells us, “Through my clinicalexperience, I have come to love emergency medicine.”

When she has time outside of work and studying, Sashaenjoys hiking, running, outdoor activities, reading, andreligious studies. We asked her what she’s likely to bereading, and she highly recommends anything by AtulGawande, MD. For interesting perspectives on life inmedicine, she recommends reading “Complications” byGawande and “On Call” by Emilie Transue, MD.

SC Spotlight: Lauren Richards Scribe, Southern Illinois

Lauren has been an irreplaceable member of theScribeConnect team since 2013. She is recognized byphysicians for getting pertinent details into patienthistories and anticipating physicians’ needs like havingpast medical history, studies, or labs up and ready forthem to review. She tells us, “I think they reallyappreciate it, and it allows them to focus on patient care.”

Her favorite part of her job is being part of treatmentteams both in the ED and orthopedics. “In orthopedicsespecially, I just love seeing patient outcomes. It is sucha wonderful feeling to see someone who has been inpain for a long time come into clinic with a big smile ontheir face! Being even a small part of that is humblingand rewarding.” When asked what insights her work hasgiven her, Lauren says, “I think that seeing people onwhat could be the very worst day of their life makes youmore cognizant of how impermanent life is, and howimportant it is to try and be present and grateful in eachmoment.”

In the next year, Lauren plans on completing herundergraduate degree in Biological Science and applyingto SIUC's Physician Assistant program. She would like tocontinue in emergency medicine as a mid­level provider.What’s her dream job? “My dream job is to apply with theUS Antarctic Program.” Lauren also loves art. Before shemoved to Southern Illinois, she studied fine art and

moved to Southern Illinois, she studied fine art andillustration and still draws and paints regularly. She alsolikes to backpack, kayak, and trail run. She has two petrats, BF Skinner and Pavlov.

If you’re looking for a great movie about life in the ED,Lauren recommends “The Waiting Room,” adocumentary about the ED waiting room of a publichospital in Oakland, CA. “Even while they are completelyoverwhelmed, the staff in this film treats their patients ­mostly poor, mostly uninsured ­ with absolute dignity andcompassion. I consider it my personal benchmark forhow I treat others.”

Welcome aboard our newest CertifiedScribes! Charnise T., Lauren S., Julie N. (LosAngeles)

Locations are hiring...spread the word. Employment Opportunities

SC's Continuing EducationScholarships

ScribeConnect is committed to investing inthe personal and professionaldevelopment of every employee. In orderto aid employees in pursuit of a career inhealthcare, SC offers ContinuingEducation Scholarships, up to $1,000 perperson, awarded to employees who arecommitted to exceptional customerservice, continuing medical education, andwho have shown dedication to the field ofhealthcare. Scholarships may go towardqualified continuing education sources,including medical mission trips,conferences and symposiums.

Employees can request an application formore details and requirements.

Brain Food BOOK

Still Alice by Lisa Genova

A moving and vivid depiction of life with early­onset Alzheimer's disease.

VIDEO Empathy: The Human Connection to Patient Care

by Cleveland Clinic If you could stand in someone else's shoes, hear what they hear, see what they see, feel what

they feel...Would you treat them differently?

ARTICLE How to Teach Doctors Empathy

Being a good doctor requires an understanding of people, not just science.

What are you reading? Send us your recommendations, and we may include them in anupcoming "Brain Food."

Got any news? Send us news, photos, updates, interesting reads or items youwant to share with TeamConnect: kasaan@scribeconnect.com.