Annals Graphic Medicine - Progress Notes: Doctoring as Patient
Authors: Michael Natter
Journal: Annals of Internal Medicine (2020)

Web Exclusives21 April 2020Annals Graphic Medicine - Progress Notes: Doctoring as PatientFREEMichael Natter, MDMichael Natter, MDNYU School of Medicine, New York, New York (M.N.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/G20-0016 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Download figure Download PowerPoint Comments0 CommentsSign In to Submit A Comment Alain Braillon MD, PhD and Françoise Taiebi MPsyuniversity hospital. 80000 Amiens. France23 April 2020 Reflective listening: the cornestone for cognitive empathy, the capacity to understand patient’s concerns The “Annals Graphic Medicine” titled “Doctoring as Patient” deserved questions.(1)Firstly, does doctoring mean “falsifying or distorting information” as in an article about “manipulated figures in science.”?(2) Secondly, must we be recruited from our personal experience of diseases? Certainly, empathy is a key for effectiveness: no compliance to treatments if no shared decision making. Empathy (Ancient Greek "physical affection or passion") combines both understanding (cognitive process) and feeling (emotional process) what another person can experience from within his frame of reference. Cognitive empathy matters: fMRI showed nurses provided more help, with less personal distress, to those suffering than did control participants.(3) Emotions are not understanding and can preclude adequate responses. Emotional empathy, or compassion (Latin “together”+“suffer”), is a slippery slope to tearful thoughtfulness, whose results are only professional burn-out.We prefer: a) interactions with expert patients,(4) as Evidence Based Medicine is about objective records from large series not a subjective case report; b) new technologies. E.g. professionals participating in "In Their Shoes", a program about inflammatory bowel diseases, receive on their smartphone daily recurring messages such as "You have ten minutes to go to the toilet" which require sending a photo of a lavatory door within few minutes.(https://www.takeda.com/newsroom/featured-topics/intheirshoes-what-its-like-to-be-an-ibd-patient--how-weve-approached-it3/) Further, empathy can be taught. The cornerstone for empathy is reflective listening, the key element of Carl Rogers’ “client-centred therapy”.(5) Rogers coined this term in 1951, then after hijacked into “patient-centered care” may be to restore a dominance of the doctor on the patient and to avoid the concept of the service to be provided. Reflective listening is a specific but simple technique allowing to understand a speaker's idea by offering the idea back. Simply summarize what the patient said by using his own words rather than paraphrasing and without digressing to other subjects. This reinforces patient’s own expressions of problems, recognition of concerns, complaints and, values. It reveals potential misunderstanding of patient’s concerns. However, there is a denial: Pubmed only retrieved 66 hits for “reflective listening “, none in core medical journals. The cartoon 5th case “I do” is the opposite of reflective listening. Last, time, a prerequisite for communication, is a scarce resource: overbooked care providers must face bureaucrats’ greed for systematic and exhaustive Electronic Health Records for billing with the big computer on the first cartoon case.(1) Empathy is not about tricks, e.g. shaking hands in the concluding carton case, even more when no hydro-alcoholic bottle visible.(1) 1 Natter M. Annals Graphic Medicine . Progress Notes: Doctoring as Patient. Ann Intern Med 2020;172:W93-W94.2 Editorial. Image doctoring must be halted. Nature 2017;546:575. 3 Swift TL, Dieppe PA. Using expert patients' narratives as an educational resource. Patient Educ Couns 2005;57:115–21.4 Coll MP, Grégoire M, Eugène F, Jackson PL.. Neural correlates of prosocial behavior towards persons in pain in healthcare providers. Biol Psychol 2017:128;1-10.5 Kyle A. Behind the Mirror: Reflective Listening and its tain in the work of Carl Rogers. The Humanistic Psychologist 2014:42:354–69. Author, Article, and Disclosure InformationAffiliations: NYU School of Medicine, New York, New York (M.N.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=G19-0002.Author/Illustrator Information: Michael Natter, MD, is a current internal medicine resident at NYU School of Medicine and a graduate of Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia. His artwork is inspired by his medical training, patient encounters, and the human condition. A type 1 diabetic, Dr. Natter views himself as a patient as well as a doctor and plans to pursue a fellowship in endocrinology to help others who also share his disease. You can find more of his illustrations, stories, and comics on Instagram (www.instagram.com/mike.natter) and Twitter (@mike_natter).About Progress Notes: Progress Notes explores the everyday emotional, clinical, humorous, and ethical challenges of the medical residency training process. As implied by the title of the series, these pieces act as a visual bildungsroman, graphically dissecting the subtext of what it means to be a young doctor in today's medical world. Progress Notes appears monthly in Annals Graphic Medicine at Annals.org. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 21 April 2020Volume 172, Issue 8Page: W93-W94KeywordsConflicts of interestDisclosureEmotionsEndocrinologyFellowshipsGraduate medical educationResidency ePublished: 21 April 2020 Issue Published: 21 April 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...