"We've talked about pain, pain management and how pain is treated. Now we turn toward our relationships and interactions with patients," said Dr. Marc Rothman, Kindred's Chief Medical Officer, in his introduction to the next presentation during the 2016 Clinical Impact Symposium.
Rothman then introduced Dr. VJ (Vicente) Velez - MD, FACP, FHM, Internal Medicine Hospitalist at the Cleveland Clinic and Institute Experience Officer for the Department of Medicine Institute.
First, Velez got the audience warmed up by getting everyone in the room acquainted with each other. By show of standing and/or raising hands he used the audience as a tool to illustrate that we are all here for the same reasons-because we care, because we want to learn, and because we want to share what we've learned about caring.
Velez then told audience members to split into smaller groups for a THINK-PAIR-SHARE activity where duos or trios could communicate with each other and practice reflective listening about encounters they had with patients with chronic pain management. He called upon different tables to find out what was effective in these interactions and what was challenging.
Several important observations were made by the clinicians in the audience. Specifically, by focusing on redirection, setting boundaries and working on a multidisciplinary approach, challenges with chronic pain patients are often better managed.
The next activity Velez had the audience engage in was ANGER TRANSLATIONS. In this drill, one partner ranted as if a patient may, and the other, translated that rant as a clinician could- into something that can be beneficial to both parties. For example, a patient rants about faux syrup and cardboard eggs, which the clinician is able to translate into the patient taking his dietary health seriously and having concerns about meal plans designed to improve patient health and satisfaction.
Through these exercises, it was realized that the patient was being heard, and the situations were being de-escalated simply by modeling active listening behaviors. An audience member also noted that the clinicians are no longer taking the comments personally, but instead acknowledging the pain or suffering of the patient.
Velez continued by asking the partners to talk about their favorite desserts by only using statements that begin with, "yes, but..." People felt ignored. Immediately following, he asked them to do the same with the topic of favorite cities. But instead of "yes, but..." statements, they began with "no, and..." statements. People felt embattled. Finally, he had participants cover the topic of favorite music, with all statements beginning with, "yes, and..." People felt acknowledged and productive.
This simulated the difference that one word can make. One audience member said, "In the field, we need to drop the 'but' and drop the 'no.'" Adding that those statements don't help move the conversation because the patient feels powerless.
Four volunteers then joined Velez on stage to participate in a model discussion and skills practice between chronic pain patients and caregivers regarding the Symposium's fictitious patient, Lorraine and Ralph.
Lorraine and Ralph both listed their myriad ailments and pain concerns. At this point in their CIS continuum journey, both patients are entering home health care. Nurse Nancy, described as a single mother continuing her education, is introduced as one of the home care clinicians. Our therapist, Stacy, also a single mother, is along for this home visit as well. We learn that it is not only important to acknowledge the personal lives of the patients, but for clinicians to share what's going on in their lives as well.
"Relationships are not a one-sided event," Dr. Rothman added. "We receive something from them, and they receive more than medicine and results from us."
Throughout the introduction of the role-playing exercise, Nancy validated Lorraine's emotions and concerns, and Stacy was able to validate her feelings. Because of these empathetic actions, Lorraine felt supported by her plan, and the visiting clinicians were able to see Lorraine relax as her anger dissipated. The audience were also reminded that empathy isn't a check-off box that ends once you have performed empathetic expectations.
Nurse Nancy listened to the patient's perspective and asked reflective questions to elicit important information. This helped her to develop an idea for a treatment plan encompassing a pain management regimen and better scheduling that involves Lorraine's husband and daughter and also supports her needs. Therapist Stacy followed by setting expectations with Lorraine and her husband Ralph by reflecting on their concerns.
Additional interpersonal tips were also provided by Velez regarding setting healthy expectations and boundaries. He recommended that the clinicians set functional goals rather than analgesic goals, and to use specific end points.
Ultimately, the name of the game when it comes to building relationships with our patients is empathy-from the time that you first speak or meet until the treatment is complete. Your empathy has the ability to improve patient pain and satisfaction, but also improves your own experience and job satisfaction. When you get to know the person instead of the patient, you are able to treat them wholly and the outcomes improve for all involved.
Please continue to follow the Clinical Impact Symposium 2016 on the Kindred Continuum and on Twitter @KindredHealth.
*Each year the Kindred Clinical Impact Symposium focuses on a topic to enhance clinical practice in the post-acute continuum and to maintain Kindred as a leader in clinical excellence. This eighth symposium focuses on pain management across the continuum. At this week's symposium, held in Louisville, Kentucky, national speakers discuss these topics broadly, while internal speakers bring it home to Kindred attendees from across the country.