precision Posted August 21, 2011 Report Share Posted August 21, 2011 How much sympathy/comfort does the average doctor present to their patients? If a patient is in severe pain, does the doctor usually show a "worried" impression in their face or do they not show anything at all? From my experience, the doctors I've visited did not express any emotions. I feel that when I volunteer at places where there are ill people, I always look concerned, like someone who really cares about the person, someone who feels their pain or someone who wishes they could do something about it. Is this too much? Similarly, is it okay to just not make any facial expressions when someone for instance scrapes their hand on the ground in a park and bleeds and you go and help them out? Link to comment Share on other sites More sharing options...
ellorie Posted August 21, 2011 Report Share Posted August 21, 2011 I think it depends on the doctor and the patient - how long the doctor has known the patient, what the patient's condition is at the time, what specialty the doctor is in, whether the doctor is a huge jerk, what mood the doctor is in/how much time they have, etc. etc. When I'm helping people, I generally go with "mild concern" + a bit of mirroring. If you look TOO worried, it can be upsetting, but if you don't look worried enough - also upsetting. I shoot for somewhere in the middle. The good family docs and psychiatrists I've had have always given me concern and comfort. This is embarrassing, but when I was a teenager, I was rather afraid of needles, and if I had to have one, my family doctor would always give me comfort - he would put his hand on my shoulder for a minute, or touch my arm. And he always looked very empathetic. Psychiatrists in my experience have mostly been the same. They'll give you the "mild concern and sympathy" look if they don't know you very well, and then if they have been following you for a long time, they'll be more overtly comforting. I guess everyone develops their own style. Link to comment Share on other sites More sharing options...
Lactic Folly Posted August 21, 2011 Report Share Posted August 21, 2011 There are more ways of expressing caring than facial expression. Similarly, different people feel comforted by different things. From your post, it sounds like outward expression of emotion is important to you, and that's ok. For me, while it is nice to have this, it is more important that they demonstrate caring through active listening and acting promptly and responsibly on my behalf. I think ellorie makes a good point that patients also look for reassurance, so looking too worried can be counterproductive. I suggest this book for further reading - it's really quite interesting: http://books.google.com/books/about/Health_care_communication_using_personal.html?id=wjkUi0_XcXcC Basically, everyone's personality is different, meaning that the types of interactions we desire as patients (e.g. get to the point vs cushion my feelings) and what we tend to deliver as health care professionals will vary. But if we are considerate, we can stay attuned to where the other party is coming from, and try to communicate in a way that is suited to them. Link to comment Share on other sites More sharing options...
Let'sGo1990 Posted August 21, 2011 Report Share Posted August 21, 2011 As bad as it sounds, I think doctors get used to bad things happening to their patients over time. How much it affects the doctor depends on how well he/she knows that particular patient. Link to comment Share on other sites More sharing options...
ellorie Posted August 21, 2011 Report Share Posted August 21, 2011 As bad as it sounds' date=' I think doctors get used to bad things happening to their patients over time. How much it affects the doctor depends on how well he/she knows that particular patient.[/quote'] I won't argue that, but there's a difference between what you feel and what you show. I would argue that even if you are not hugely emotionally affected, you still have to project concern and empathy, hopefully in a way that is acceptable and comforting to that patient. Link to comment Share on other sites More sharing options...
Lactic Folly Posted August 21, 2011 Report Share Posted August 21, 2011 Agreed, and you also don't want to be emotionally involved to the point that you can no longer think clearly about the situation - which is one of the arguments for not treating one's own family members. Link to comment Share on other sites More sharing options...
Curi0user Posted August 21, 2011 Report Share Posted August 21, 2011 It's good to remain neutral though. Sympathy is good but do you seriously want your doctor to master a "worried" face? I'd HATE it, the last thing you want to do is undergo surgery with your doctor looking worried, or sitting in his office when your doctor looks worried about a condition you have. When your health isn't doing so great, neither are you (most of the time) and somebody needs to convince you that it's going to be okay. And I like that the doctors don't react, it leaves you room to judge the seriousness of your illness by yourself. Link to comment Share on other sites More sharing options...
ellorie Posted August 21, 2011 Report Share Posted August 21, 2011 It's good to remain neutral though. Sympathy is good but do you seriously want your doctor to master a "worried" face? I'd HATE it, the last thing you want to do is undergo surgery with your doctor looking worried, or sitting in his office when your doctor looks worried about a condition you have. When your health isn't doing so great, neither are you (most of the time) and somebody needs to convince you that it's going to be okay. And I like that the doctors don't react, it leaves you room to judge the seriousness of your illness by yourself. I think that's a personal preference. If I'm worried, I damn sure want my doctor to be worried, because that's how I know she's taking me seriously. And if I'm ill, I'm worried. The times I've been really ill and my doctor has looked straight at me and said "Ellorie, I'm worried about you" I've felt very comforted, because I know she's going to do something. But chronic psychiatric illness is a bit of a different ballgame, I guess. I always KNOW I'm damn sick, the problem is getting someone to help. Link to comment Share on other sites More sharing options...
Lactic Folly Posted August 21, 2011 Report Share Posted August 21, 2011 I think the above posts are a good example that patients may interpret the "worried" expression in different ways - they may feel better that the doctor appreciates how unwell they are and is concerned enough to help, or they may feel worse if they think that the doctor doesn't think the prognosis will be good, or that the doctor is unsure about how to handle the situation. Link to comment Share on other sites More sharing options...
Curi0user Posted August 21, 2011 Report Share Posted August 21, 2011 I think that's a personal preference. If I'm worried, I damn sure want my doctor to be worried, because that's how I know she's taking me seriously. And if I'm ill, I'm worried. The times I've been really ill and my doctor has looked straight at me and said "Ellorie, I'm worried about you" I've felt very comforted, because I know she's going to do something. But chronic psychiatric illness is a bit of a different ballgame, I guess. I always KNOW I'm damn sick, the problem is getting someone to help. I guess it definitely is a personal preference. I want the attention that I deserve and I'd love if my doctor said they're going to do everything they can and actually showed me this, but being worried doesn't help me in any way and it's not going to help build me the confidence I need to fight whatever may be going on. In fact it'll only ruin me. IMO, It's kind of like those situations paramedics are told not to react when they find a victim in a really tragic situation because if they panic - so will the patient. And I guess I'm a perfect example of that too. Link to comment Share on other sites More sharing options...
aaronjw Posted August 22, 2011 Report Share Posted August 22, 2011 I dont want a Doctor to act or look worried or even show empathy. I want them to help me. If i want support of comfort i'll turm to friends and family. I think too many people expect more emotional involvement from their Doctors and i dont actually think that's a good thing. Now, maybe my position will change as i move through the system in something other than a patient. Link to comment Share on other sites More sharing options...
precision Posted August 22, 2011 Author Report Share Posted August 22, 2011 Thanks for the link. I'll explore those books. What I've gathered so far from the above posters is that a doctor may or may not present emotions as it depends on the situation (the doctors relationship to the patient, the condition of the patient etc.) There are more ways of expressing caring than facial expression. Similarly, different people feel comforted by different things. From your post, it sounds like outward expression of emotion is important to you, and that's ok. For me, while it is nice to have this, it is more important that they demonstrate caring through active listening and acting promptly and responsibly on my behalf. I think ellorie makes a good point that patients also look for reassurance, so looking too worried can be counterproductive. I suggest this book for further reading - it's really quite interesting: http://books.google.com/books/about/Health_care_communication_using_personal.html?id=wjkUi0_XcXcC Basically, everyone's personality is different, meaning that the types of interactions we desire as patients (e.g. get to the point vs cushion my feelings) and what we tend to deliver as health care professionals will vary. But if we are considerate, we can stay attuned to where the other party is coming from, and try to communicate in a way that is suited to them. Link to comment Share on other sites More sharing options...
ellorie Posted August 22, 2011 Report Share Posted August 22, 2011 And yet, some patients don't have supportive friends and family around them. Not everyone has that kind of support system. And even if there are people around, they aren't always able to empathize or even understand what the patient is going though, because they know nothing about the disease in question. Link to comment Share on other sites More sharing options...
aaronjw Posted August 22, 2011 Report Share Posted August 22, 2011 And yet, some patients don't have supportive friends and family around them. Not everyone has that kind of support system. And even if there are people around, they aren't always able to empathize or even understand what the patient is going though, because they know nothing about the disease in question. A Doctor isnt part of a support system. They get paid to do a job. Link to comment Share on other sites More sharing options...
ellorie Posted August 22, 2011 Report Share Posted August 22, 2011 A Doctor isnt part of a support system. They get paid to do a job. Lots of people get paid to do a job. Psychotherapists get paid, but nobody could argue that they don't provide support to their patients. And while a doctor may not be a PART of a support system, I believe that there are times when a doctor should augment a support system which may be inadequate for the patient's needs, while, of course, pointing out other sources of potential support, or when a doctor should provide a particular flavour of support based in understanding of the experience of an illness and its treatment options. An integral part of the job is caring for the patient's emotional and psychological well-being, in my opinion. And if that means providing some support and reassurance, I don't see why that's a problem. I would never, never stay with a doctor who didn't express concern for me as a person or provide me with support and encouragement when I am ill. It would be a total non-starter. Link to comment Share on other sites More sharing options...
aaronjw Posted August 22, 2011 Report Share Posted August 22, 2011 Lots of people get paid to do a job. Psychotherapists get paid, but nobody could argue that they don't provide support to their patients. And while a doctor may not be a PART of a support system, I believe that there are times when a doctor should augment a support system which may be inadequate for the patient's needs, while, of course, pointing out other sources of potential support, or when a doctor should provide a particular flavour of support based in understanding of the experience of an illness and its treatment options. An integral part of the job is caring for the patient's emotional and psychological well-being, in my opinion. And if that means providing some support and reassurance, I don't see why that's a problem. Psych, in my opinion, is a completely different ballgame than other Doctors. By virtue of their profession they're emotionally committed. Link to comment Share on other sites More sharing options...
aaronjw Posted August 22, 2011 Report Share Posted August 22, 2011 . I would never, never stay with a doctor who didn't express concern for me as a person or provide me with support and encouragement when I am ill. It would be a total non-starter. wouldnt you say the fact they are treating you and wanting you to get better is expressing concern? Link to comment Share on other sites More sharing options...
ellorie Posted August 22, 2011 Report Share Posted August 22, 2011 wouldnt you say the fact they are treating you and wanting you to get better is expressing concern? Interesting question. I think that if they were to express to me that they wanted me to get better, that would certainly help matters. I suppose it might be different for me since my experience has mainly been with psychiatrists who also have functioned as my psychotherapists, so there may have been some conflation of roles in that respect. Perhaps if I had a doctor who was just responsible for doling out my medication, I wouldn't have such high standards I think mental illness may be a somewhat different boat, given the level of stigma and the generally shoddy support networks that a lot of MI folks tend to have. If I think about simply medical illness, like if I have bronchitis or something, and I'm just swinging by for some antibiotics, I suppose that a simple expression of wanting me to get better would be enough. Certainly don't start putting your hand on my shoulder and crying with me if I just have a bad cold! At that point I certainly don't want to talk about my feelings, I want to GTFO and get on with my life! Of course, if I had a very serious or chronic illness, or if I was very scared or emotionally distraught, I might then expect a little more involvement again. I guess there really isn't a one size fits all approach. Some patients need more than others, and giving either too much or too little can make things get weird. I guess it's a balancing act. The doctor at the urgent care clinic, I'll settle for a decent smile and an expression of mild concern. The more chronic, long term stuff, I'll hold out for a bit more closeness and touchy-feely stuff. And with psychiatry, you'd damn well better hold my hand while I cry, or I will take myself elsewhere (and we will both be glad!) Link to comment Share on other sites More sharing options...
<abstract> Posted August 22, 2011 Report Share Posted August 22, 2011 Interesting question. I think that if they were to express to me that they wanted me to get better, that would certainly help matters. I suppose it might be different for me since my experience has mainly been with psychiatrists who also have functioned as my psychotherapists, so there may have been some conflation of roles in that respect. Perhaps if I had a doctor who was just responsible for doling out my medication, I wouldn't have such high standards I think mental illness may be a somewhat different boat, given the level of stigma and the generally shoddy support networks that a lot of MI folks tend to have. If I think about simply medical illness, like if I have bronchitis or something, and I'm just swinging by for some antibiotics, I suppose that a simple expression of wanting me to get better would be enough. Certainly don't start putting your hand on my shoulder and crying with me if I just have a bad cold! At that point I certainly don't want to talk about my feelings, I want to GTFO and get on with my life! Of course, if I had a very serious or chronic illness, or if I was very scared or emotionally distraught, I might then expect a little more involvement again. I guess there really isn't a one size fits all approach. Some patients need more than others, and giving either too much or too little can make things get weird. I guess it's a balancing act. The doctor at the urgent care clinic, I'll settle for a decent smile and an expression of mild concern. The more chronic, long term stuff, I'll hold out for a bit more closeness and touchy-feely stuff. And with psychiatry, you'd damn well better hold my hand while I cry, or I will take myself elsewhere (and we will both be glad!) The doctor patient relationship will always be different for every situation and circumstance. As a patient, I do not expect a doctor to sit and cry with me if I were just diagnosed with a terrible illness. I expect them to conduct themselves in a professional manner and to give emotional support in terms of telling me the truth and hoping and working for the best possible outcome. I think a doctor is there to show support and empathy in a manner that fits the circumstance. From a personal perspective, seeing my cardiologist with a grave look on her face did not spell confidence in term of my outcome and frightenned me. Cheers, ABS Link to comment Share on other sites More sharing options...
future_doc Posted August 22, 2011 Report Share Posted August 22, 2011 As an EMS medic, I believe the last thing a trauma patient wants to see on the face of first rfepsonders is a worried expression, rather what they rerquire is professionalism and a timely and appropriate response to the emergency. Similarly, when having dealt with the chronic elderly who needed to improve their motor dsyfunctions and were crying or shouting at me, they needed encouragement, to know they were capable of improvement, a calm demeanour and a professional response. Appearing worried definitely would have been inappropriate in every patient situation that I have encountered so far. To reflect the feelings of a patient, thereby showing understanding and compassion is one thing, to inadvertantly instill instill a lack of confidence in the patient by appearing worried and overly concerned is something else that should be avoided. The patient is already aware that there is a problem and does not need to feel unnecessarily insecure. A trained professional is part of the solution and should never become part of the problem by word or body language. Link to comment Share on other sites More sharing options...
thehockeykid Posted August 26, 2011 Report Share Posted August 26, 2011 what is a doctor supposed to do when he tells someone that they have cancer? Link to comment Share on other sites More sharing options...
Lactic Folly Posted August 27, 2011 Report Share Posted August 27, 2011 http://www.communityoncology.net/journal/articles/0202138.pdf Link to comment Share on other sites More sharing options...
HopeToBeGreen Posted August 27, 2011 Report Share Posted August 27, 2011 http://www.communityoncology.net/journal/articles/0202138.pdf Great article! Thanks for posting. Link to comment Share on other sites More sharing options...
future_doc Posted August 27, 2011 Report Share Posted August 27, 2011 http://www.communityoncology.net/journal/articles/0202138.pdf Thank you for this marvelous resource. Link to comment Share on other sites More sharing options...
rmorelan Posted August 27, 2011 Report Share Posted August 27, 2011 http://www.communityoncology.net/journal/articles/0202138.pdf This approach is actually what is taught at Western and probably other schools as well. Of course like any system it feels formulaic in some ways initially I think, but it covers all the basics! Link to comment Share on other sites More sharing options...
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