Giving language to empathy: lessons from palliative care [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

“The value of empathy in medicine is seldom debated. Just as the art of medicine is taught as the balance of knowledge and application, so has empathy been recognized as both a value to be fostered and a skill to be learned. Medical curricula have reflected this, and while didactics are increasingly filled with various conversational frameworks and behaviors that convey empathy, rarely do they include specific language to convey it.”

Varsha Venkatakrishna is a medical student.

She shares her story and discusses her KevinMD article, “Giving language to empathy: lessons from palliative care.”

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RATE AND REVIEW → https://kevinmd.com/rate

FOLLOW ON INSTAGRAM → https://www.instagram.com/kevinphomd

FOLLOW ON TIKTOK → https://www.tiktok.com/@kevinphomd

GET CME FOR THIS EPISODE → https://earnc.me/U3isEX

Powered by CMEfy – a seamless way for busy clinician learners to discover Internet Point-of-Care Learning opportunities that reward AMA PRA Category 1 Credit(s)™. Learn more at about.cmefy.com/cme-info

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at kevinmd.com/rate. Subscribe at kevinmd.com/podcast. Today on the show we have Varsha Venkat. She’s a medical student, and her KevinMD article, which we’ll talk about today, is titled “Giving language to empathy: lessons from palliative care.” Varsha, welcome to the show.

Varsha Venkatakrishna: Thank you.

Kevin Pho: So we’ll get into the article in a little bit. First off, briefly share your story and journey to where you are today.

Varsha Venkatakrishna: Yes. I’m a fourth-year medical student currently applying to internal medicine residency, so in that sense, my story is just getting started. I grew up in Indiana, then I completed undergrad in Chicago, and now I’m here doing medical school in New York City. I’ve always had a variety of interests that were pretty diverse. In undergrad, I studied biology as well as political science, and now I think it takes the form of doing medical school and also getting involved with various advocacy efforts.

Kevin Pho: So tell me about that role of advocacy as a medical student.

Varsha Venkatakrishna: It’s been two things. One has been trying to get into more LGBTQ care. I have volunteered with Queer Care, which provides postoperative care to those just undergoing gender-affirming surgeries, which has been a very fulfilling experience. It’s been great. And also, especially through the COVID-19 pandemic, at the height of it, I did a lot of work with the PPE shortage crisis, trying to get PPE to those in need and doing a lot of lobbying for policies that would improve the supply chain.

Kevin Pho: So a lot of medical students say sometimes there’s no point to advocacy because we don’t have much of a voice. So give us a concrete example where your advocacy has measurably moved the needle.

Varsha Venkatakrishna: Yeah, so I would say two things. One, from the PPE efforts, I joined an organization called Get Us PPE, as well as Med Supply Drive. And Get Us PPE was part of a larger body, a very large national organization, and by volunteering and getting emails or drafting pages on policies, and by contacting senators, I was able to contribute meaningfully to this larger advocacy effort. I think doing things alone can be very daunting, especially as a medical student, when you’re still in the early parts, well before you’ve even started your career proper. So for me, it was teaming up with other people who are doing good work and having it be more of a collaborative effort in order to actually get stuff done.

Kevin Pho: All right, so let’s transition into your KevinMD article that you wrote. It’s titled “Giving language to empathy: lessons from palliative care.” And before summarizing the article, give me some background. What got you interested in this area?

Varsha Venkatakrishna: Yeah, I think from medical school, I learned about empathy in a very robotic way. It was a lot of conversational frameworks, a lot of specific behaviors, like sitting down, making eye contact, and listening to the patient, which are all very good, and specific phrases like “I’m sorry you’ve had to go through that” or “That sounds very hard.” And while these are very helpful in setting a framework for students, it really left me unprepared for a lot of the wild scenarios that you end up seeing in clinical practice. When somebody asked me, “So, Doc, do I have five more years to live?” I was racking my brain: How do I empathetically respond to this? It was something that I wasn’t prepared for.

And a lot of that can be helped through mentorship, through who you’re rounding with in your clinical years and beyond, but that can also be variable. It is the luck of the draw, depending on who you’re paired with. So I specifically chose to rotate with palliative care in an effort to learn from those who are, on a daily basis, having very difficult empathetic conversations. And I learned a lot. I learned a lot of specific, versatile language that could be used in a lot of scenarios, in a way that can align with the patient but also give good news as well as bad news.

And one of the biggest takeaways that I learned was how to provide reassurance while also delivering bad news. I think that was something that I struggled with prior to my palliative care rotation, so I wrote this article in hopes that it could give a template that’s useful to other people who are learning as well.

Kevin Pho: All right, so give us some of those specific lessons that you could outline for my audience.

Varsha Venkatakrishna: Yeah, so one of the lessons would be to really focus on your language and try to get as many ideas as you can from those around you. One of the ones that I got was the power of “I wish” statements: “I wish I had better news.” “I wish that the treatment had worked.” “I wish there was an option that was less troublesome.” It’s actually better than “I’m sorry” at trying to provide reassurance to a patient when things aren’t going in an ideal fashion.

Another takeaway that I learned was really how to validate patients and how to really listen to them, and how it doesn’t necessarily need to take a lot of time. One way to provide validation to a patient is just to name the emotion that you see they’re feeling. For example, “I noticed that you seem a little sad today, or a little tense today. What’s going on?” Things like that, which I wrote about in my article, are ways that you can effectively make the patient feel heard and give them the permission to speak more, because they feel more comfortable with you and they know that you as a physician are attuned to how they feel.

Previously, I thought that the only way to provide that validation was to let the patient speak for extended periods of time, which is lovely for you to do as a patient. Unfortunately, due to time constraints and the realities of medicine, it’s not always possible.

Kevin Pho: One of the other points that you wrote about is prioritizing prognostication. So tell us more about that.

Varsha Venkatakrishna: Yeah, so I think a lot of times prognosis is missed in informing the patient and in patient education. This means making sure that you talk about future side effects of a medication. It could mean what the disease course or illness course will look like. It also means what might happen if you don’t take this treatment, or what may happen during the natural progression of this illness that you have to be prepared for.

One of the patient experiences that I had was a gentleman who had repeated COPD exacerbations and had multiple hospitalizations, and at this time, when he came to the hospital, he had to be intubated. And so the family members were very used to the COPD exacerbations and having him come in and all of that rigmarole, but they had no idea that intubation was something that could potentially happen and what that could mean.

So that kind of information is very important, because it allows patients, and families as well, to be more involved with their care, be more compliant, and just have a framework to manage their expectations and to understand the realities of what might be going on. People are pretty bad in crises. They don’t make the best decisions, because adrenaline is rushing and they’re very distressed. So preparing them as much as possible when they’re not in a state of crisis or distress is very important.

Kevin Pho: So can you give us a case study, a scenario, or something that you’ve observed, a patient interaction that you’ve seen or your preceptors have seen, that incorporates some of the ideas that you just mentioned?

Varsha Venkatakrishna: One of the experiences that I had was having a difficult conversation with health care proxies, who were the family of a gentleman who had just had a stroke, and we were discussing the potential for hospice and comfort care. The family was understandably very upset. There was a lot of anger in the room, as well as sadness, and also this feeling of, “I have to do my due diligence here.” And perhaps some of that due diligence means not fully trusting the provider and challenging the provider, “so I know that my family member is going to be taken care of in the best way.”

So a lot of the feelings that were going on in the moment were in large part due to the family members’ fear: “At some point, I might regret the decision that I made, or I might have done the wrong thing. It’ll keep me up at night. I need the reassurance that my family member is going to be best taken care of with comfort care instead of pursuing more treatment.”

So a lot of the language that was used when talking to this patient was, “I wish that I could tell you differently, but your brother’s body, from a medical standpoint, is shutting down. And even if treatments were to be pursued, he will be unlikely to be able to return and have the same quality of life as he did prior to the stroke. What we can do with comfort care is to provide at least the best comfort, so that he is not experiencing any pain, and we can manage him as best as we can moving forward.”

So in that scenario, there was also a lot of asking the patient more about why they were feeling the way that they were, to get more of an understanding of perhaps the family dynamics that were in play that were contributing to their response.

Kevin Pho: We’re talking to Varsha Venkat. She is a medical student. Her KevinMD article is titled “Giving language to empathy: lessons from palliative care.” Varsha, anything that you’ve seen not work, just from your observations as a medical student? What are some things that clinicians should not do when trying to be empathetic?

Varsha Venkatakrishna: They should not ignore the emotions, the feelings, or the concerns that the patient is providing. Ignoring the patient’s emotional response is a way to signal to the patient that you as a provider are uncomfortable with responding to emotions and uncomfortable with difficult situations, and it probably won’t foster the most trust in the patient that they can honestly voice their concerns. So resorting to a certain repertoire of short phrases, like “Oh, I’m sorry to hear that,” and then moving on to take the history is something that I would advise avoiding. Instead, work on responding to emotions. It doesn’t have to be very long in order to build patient trust.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Varsha Venkatakrishna: Yeah, I want to leave with an exercise that one of the palliative care physicians left to me, which is a challenge to validate the emotions of each patient at least once in your patient encounter. So with every patient, name the emotion that you see in the room. Tell them. You can use understanding: “I understand that you feel that way.” You can ask more about how they’re feeling, some of the things that I listed in the article, and try to notice how the patient reacts to that and see how that impacts your patient experience in the clinic.

Kevin Pho: Varsha, thank you so much for sharing your time and insight. Thanks again for being on the show.

Varsha Venkatakrishna: Thank you for having me.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes