Crossroads #1 Video Transcript

 

Interpersonal Communication And Relationship Enhancement (I*CARE)
Crossroads
Crossroads #1
Time: 6:40

Robert A. Buckman, M.D., Ph.D.
Adjunct professor, Behavioral Science
The University of Texas M. D. Anderson Cancer Center

 

Dr. Buckman:
Now in this segment we're going to go through part of the interview again, but this time we're going to stop at the first crossroad. And we're going to look at the different options available for your responses. And we're going to see how they might have affected the interview.

 

Doctor:
Maybe it's best if I just tell you what the bone scan showed

Mrs. Simpson:
Yes. Please.

Doctor:
Is, is that okay?

Mrs. Simpson:
Well that's what I'm here for.

Doctor:
Of course you are. The, the bone scan unfortunately shows that the breast cancer has come back; it's recurred.

Mrs. Simpson:
What?

Doctor:
Mrs. Simpson, I'm, I'm sorry to say that. It's come back. It's metastasized, spread.

Mrs. Simpson:
What are you saying?

Doctor:
I'm, I'm saying that that's the cause of your back pain. That's why your back was hurting, because the breast cancer's come back into the bone.

Mrs. Simpson:
It's come back? Are you sure?

 

Dr. Buckman:
Okay, so the patient clearly makes a very strong statement, big emotion. Let's look at how things might have gone if you made a response directed solely to the factual content of what she said. The direct response, in other words, could be in the form of a reassurance, or a, a, fix-it response.

[ music ]

Mrs. Simpson:
It's come back? Are you sure?

Doctor:
Yes, yes I am sure. I mean there can be no doubt about that. But it actually isn't so bad, because, because you<.../p>

Mrs. Simpson:
Wait! It isn't so bad?

Doctor:
Well it, it's, it's not really so bad.

Mrs. Simpson:
What?

Doctor:
Because, it's come back after many years. And with a hormone receptor cancer that means it will respond to hormone therapy, you see?

Mrs. Simpson:
Yes, but, but for how long will it respond to this therapy?

Doctor:
Well, well, well. Good point. I mean it might respond for, for, for several years.

Mrs. Simpson:
Several years?

Doctor:
Yes.

Mrs. Simpson:
Several years? That's 3 years! I'm only 55! What am I supposed to do after that?

 

Dr. Buckman:
You see how that direct response to the factual content of what the patient said, and in, in, in this case, it was a reassurance, which is actually the most common form of direct response. But ignoring the patient's feelings entirely made her feel more and more anxious. And then when she said, "But I'm 55!" it was actually very difficult to know how to respond to that. Actually, it was almost impossible. Now let's have a look at something even less productive, an escalationary response.

[ music ]

Mrs. Simpson:
It's come back?

Doctor:
Yeah.

Mrs. Simpson:
Are you sure?

Doctor:
Yes. Well yes, of course I'm sure. I mean the, the bone scan shows that areas not just in the spine, but in the ribs, and the shoulder blade.

Mrs. Simpson:
Are you sure we don't need to do another bone scan?

Doctor:
We do not need to do another bone scan. There is absolutely no doubt about it.

Mrs. Simpson:
Come back?

Doctor:
I'm afraid so.

Mrs. Simpson:
Are you sure?

Doctor:
Yeah, I am absolutely sure. Please try not to get too over emotional.

Mrs. Simpson:
Overly emotional?

Doctor:
Yes.

Mrs. Simpson:
Don't tell me that I'm overly emotional!

Doctor:
Please, please try and help me help you. Please calm down.

Mrs. Simpson:
I don't want to calm down! I don't have to calm down! Okay!!

 

Dr. Buckman:
Well, that clearly wasn't a good outcome. And in this case she might well file a complaint with the patient advocate or she probably would start a legal action. But even if she didn't do that, that was a really unproductive interaction. And it left both parties feeling very far from good. So now let's look at using an exploratory response. An open question in this one to explore a bit further what is going on in, in her mind. In other words, a question that can be answered in any way that the patient wants.

[ music ]

Mrs. Simpson:
It's come back? Are you sure?

Doctor:
Why don't you tell me what's going through your mind right now?

Mrs. Simpson:
Well, I mean this is exactly what happened to my grandmother.

Doctor:
Can you tell me a bit more about your grandmother?

Mrs. Simpson:
She died from breast cancer. And when the recurrence started she was, she was in this tremendous amount of pain. And it went on and on and on.

Doctor:
So the pain and your grandmother's experience must have made this shock much worse for you?

Mrs. Simpson:
Yes. It's a shock!

Doctor:
I realize that.

 

Dr. Buckman:
So you see how an exploratory response, in this case an open-ended question, might well help a patient define more accurately what she's feeling. And so help you to understand more about her reaction, so you can then follow up with a specific empathic response. Actually, you know, it's almost worth taking that as a general rule. If you're pretty sure what the patient is feeling, right, go ahead make an empathic response. If you're not really sure and when you need some more exploration, ask an open question. And then when you've got the focus, follow that up with an empathic response. Okay, so now here's how a straight empathic response without an open question would work.

[ music ]

Mrs. Simpson:
It's come back? Are you sure?

Doctor:
I realize this is a really big shock.

Mrs. Simpson:
Oh, my God! I, I, I mean, are you sure?

Doctor:
I, I, I wish I wasn't. But it, and I, I realize this is very overwhelming for you at this, this particular moment. It's a, it's a big shock.

Mrs. Simpson:
Yes. It is.

Doctor:
Perhaps it'd be best if I actually go ahead and tell you how we're going to treat this, the, the plan of treatment. Would that be a good thing for you?

 

Dr. Buckman:
As you were watching that response, I hope that you were thinking yeah, that, that's no big deal. And if so, you were right. It really is no big deal. Acknowledging the emotion need not be a major effort. Very often it's relatively simply, relatively straight forward. But it does make a big difference. By a somewhat benign analogy, it's like chewing with your mouth closed at dinner. It's not difficult, but it makes a huge difference to the impression that you create.

 

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