Consultation skills

This week we had another round of consultation skills. We have it about three times a semester I think, and we've been building up our history taking etc. gradually. This weeks' title was "dealing with emotions and feelings in the structured consultation" or something like that.

Woopee I thought. After the last dire 4hour session, I was NOT looking forward to this. But, I was hoping that it would be useful in dealing with patients, as there had been a few sessions in Primary Care where we had sensed that there were emotional issues under the surface, but too afraid of a meltdown to go near them.

What I was not expecting was the harrowing, draining barrel of emotional turmoil (tears n'all!) that we got. And I mean from us, not the "patient".

For our consultation skills classes we have our PBL group, one or two tutors and an actor who plays out the role of different patients.

We had had a lecture earlier in the week on dealing with emotions. Here they stressed to us the importance of being empathetic, but not necessarily sympathetic. Now I do understand the difference, and I do know why it is important. One of the tutors gave us a nice little picture to illustrate it. She said "imagine you are at the top of a cliff and there is someone stuck at the bottom in great distress. Sympathy is climbing down to comfort them, but not bringing anything with you to get you both back out. Empathy is recognising the problem and the distress, and going off to get a rope to pull them up with." which I though was pretty neat. But my issue is this: is it really possible, as a feeling human being, to deeply empathise with someone and feel nothing? Is it just a question of time and experience that will teach us to see pain but distance ourselves from it? Another thing that confused me was that they said it is possible to learn to be empathetic, that you can know what to say and do with someone to appear empathetic, but not to fake empathy because the patient will always know! Now what's the difference between using formulaic empathy and faking empathy? Not much as I see it. Anyway, there wasn't much problem with a lack of empathy in our class, but probably an excess of sympathy....

The scenarios that the actor played out were all very sad. The kind of awful upsetting things that happen every day, and that you as a doctor, or anyone, can do nothing about. I know that they say just turning an ear can be enough, but don't you hate that feeling of desperately wanting to make it better, to do something, to fix the pain, and not being able to? And for some reason it all felt completely real. Initially I thought I was just being "sensitive", but when I talked to the group a lot of others felt the same. I wasn't the only one who welled up.

The other thing that was a little distressing was that 2 of the scenarios played out almost exactly what had happened to 2 people in our group. It wasn't something I expected, but it made it extremely difficult to be "professional" and distance yourself emotionally when what the patient is saying keeps giving you flashes of your own past. But strangely enough, I found it was easier to be in the position of "Dr." and directly involved in the consultation than it was to watch someone else. I guess the latter was a little bit like a sad film.

Afterwards, I felt drained, flattened, worn out the the way you do when you have cried until your eyes are raw. But I was glad we had done it, because I now feel much more able to deal with any emotional situations that might arise in consultations. Before there was a terrible fear of the unknown; of being unprofessional, of saying the wrong thing, letting the patient down. I guess its one of those "fear of the unknown" things; its never as bad as you imagine it.

Man alive, what am I going to be like when we do our "breaking bad news" class?????