Every day thousands of people have conversations with healthcare providers (HCPs) about their medical condition. Such meetings can be profoundly comforting or extremely distressing to the patient and caregiver. This medical encounter by Carla and her mother-in-law illustrates the latter.
When Carla accompanied her shy mother-in-law Jean for a follow-up visit after treatment for ovarian cancer, she expected kind, considerate, and clear communication. Jean had suffered through her chemotherapy, which actually made her feel worse than her cancer. However, what she saw was a distracted doctor, standing at the computer, hurriedly going over tests, using medical jargon, and making little effort to connect with and listen to Jean. Carla watched patiently hoping for a sign of empathic concern from the doctor. When she tried to clarify something the doctor said, her question was disregarded. The meeting included hopeful information. However, it was delivered in a way that left Jean feeling informed but not cared for. They both left the meeting disappointed even though the news she received was good, as the treatment was effective and Jean’s cancer had not progressed.
In this example of a disappointing medical appointment, the basic elements of a healing conversation, listening carefully and responding honestly and thoughtfully, were missing, even though the information imparted was good news. The outcome went beyond the meeting itself and resulted in a damaged relationship between Carla, Jean, and her doctor.
Healing conversation: definition and basic elements
A healing conversation (HC) is one in which the patient feels cared for, heard and where suffering is addressed. It can be a positive emotional experience at a time when the patient may have physical symptoms that cannot be completely eradicated or a chronic illness that can be managed but not cured. It is an encounter where the patient experiences relief of suffering due to the care, prescription, and information provided by the HCP. For example, in cancer medicine, fatigue may be caused by the treatment itself rather than disease progression. Patients who learn their fatigue is secondary to chemotherapy and not cancer will likely receive some relief from that information alone since the meaning of the symptom has changed. Of course, treatment that solves the problem of debilitating, nagging fatigue will also help. In fact, almost all medical encounters involve a problem-solving component. However, it is the empathic concern of their provider, the key to healing conversation that can make all the difference. These conversations can be simple when medical problems are easily identified and cured, such as an ear infection requiring medication. However, the more complex conversations involving a life-threatening or chronic illness exposing a patient’s vulnerability require and benefit from deep listening and a trusting relationship.
Two elements in good communication form the foundation in HC. The first is active, deep listening where the listener makes an effort to hear the words, the feelings expressed, and their meaning. Yet, it is not sufficient to hear the patient; the hearing must be communicated to and felt by the patient. One method of demonstrating this is to reflect empathically the content and emotional tone of the patient. This is done with words as well as physical and emotional presence. In order to listen carefully, the HCP needs to be in the moment with the patient, to make the “click of contact” by looking and seeing the patient. It is likely that Jean felt overlooked when her HCP spent so much time focused on the computer. Among other good outcomes, when the HCP is a good listener and communicator, patients are more likely to listen to what is said. Not only does thoughtful communication heal emotionally, it has the potential to facilitate physical healing as well. The type of HC emphasized here reduces patient suffering.
The second element is responding thoughtfully and honestly. This may be the more challenging element in HC as honesty often requires giving information that is alarming, such as news that the patient’s illness has not responded to treatment. The manner in which this distressing information is given reflects the training and thoughtfulness of the clinician. In academic medical centers, communication-training programs have been developed to enhance relationship and provider skills (see the Academy of Communication in Healthcare’s Communication Rx, for example). One physician uses the phrase “I am afraid the news is not good” rather than “I have bad news for you”. Choosing words carefully is part of the thoughtfulness as well because words can hurt or heal. How words are given to patients can make all the difference in the world. Words well spoken can help balance realism and hope in any medical encounter. While the facts of the matter (the treatment is not working as well as hoped) may not be altered by the method of the delivery, how patients experience such information can be tinctured with the hope that comes from future possibility, even when that means what was originally hoped for (cure) must now change to managing a chronic condition.
A skilled HCP alone cannot create healing conversation. Any conversation is created by its participants. Therefore, the possibility of healing in such encounters depends not only on a perceptive professional provider but on patients as well and their ability and interest in dialogue where honesty and kindness meet the reality of the situation. Difficult medical conversations can also be healing conversations, even when they hurt.
Encounters in the doctor’s office do not always result in healing dialogue. However, careful listening combined with honest and thoughtful responding in a trusting relationship improve the likelihood that patients can experience even difficult encounters as healing. If a majority of these appointments could be informed by deep listening and the quality and skill of empathy, imagine the reduction in suffering that could occur in a busy medical practice every day.