Emotions and COVID-19

Emotions and COVID-19: GIVE to connect, understand, and support

Patient’s mother: I can’t believe I can’t come see my daughter. I need to speak to your supervisor.

Doctor: I’m really sorry but it’s hospital policy. You can speak to my supervisor but it won’t change anything.


Patient’s son: I’m scared.

Doctor: His vent settings are stable since yesterday.


Patient’s wife: You guys are leaving him totally alone. He needs company. And I wait all day for phone calls.

Doctor: He is not alone. The entire ICU team is in and out all day. 


Intensivist 1: I’ve lost three patients in the last two days. I don’t know how much more of this I can take.

Intensivist 2: Maybe you need a break. Let me cover your overnight shift.


These examples illustrate that even with the best of intentions clinicians’ default responses to emotion-laden questions or expressions of frustration are often data, reassurance, and problem-solving.  Understandably, we retreat to our comfort zone of communicating information, often missing or actively avoiding the silence, listening, and reflection that allow for empathy. We are quick to reassure when we encounter discomfort.  Frankly, we do this not just with our patients, but also with the people we love most. Here is a mundane example of typical ways I might not truly listen and respond to an important emotion:

“Mom, I’m not going to school today, I have no friends.”

  • “Of course you have friends.” (Invalidating reassurance, not listening)
  • “Sally just invited you to her birthday party” (Answering feelings with facts)
  • “Here’s what you have to do:  say hello to 3 new classmates during recess today.” (Task-oriented listening, problem-solving)

When we “answer feelings with facts,” or offer kind reassurance, or rush to offering solutions, we miss an opportunity to connect and to understand the values and concerns underlying the emotion. This goes for the feelings of our patients and their loved ones, and the feelings we all carry. The simple emotion response tool, GIVE, reminds us to respond to emotions with empathy, acknowledgement, curiosity, and simply our presence:

  • Get its emotion. Give your presence. Drop your agenda or your urge to “fix” and just listen. Respond with connection, not information. 
  • Identify what you hear or see and name it, if that feels appropriate.
  • Validate by acknowledging feelings.
  • Explore to better understand the emotion, or to inquire whether the other person wants to share more.

Responding to the emotion in the above examples using GIVE

Patient’s mother: I can’t believe I can’t come see my daughter. I need to speak to your supervisor.

Get that emotion is almost always present now.

Identify: I can hear how devastating this is. 

Validate: I wish so badly you could be with her. I think it is critically important to have your family with you. 

Explore: Since you can’t be together right now, would it be okay if we talk about what we can do?


Patient’s son: I’m scared.

Get that data alone will not help this person feel heard or supported.

Identify: This is so hard and I hear you’re scared.

Validate: Anyone would be scared right now.

Explore: Would it help to talk about it? What’s scaring you the most?


Patient’s wife: You guys are leaving him totally alone. He needs company. And I wait all day for phone calls.

Get it’s emotion: What is making her feel frustrated and accusatory?

Identify: It sounds like you feel abandoned and ignored

Validate: This is so hard on you. I can’t imagine the agony of not being able to visit- and waiting for hours for phone calls.

Explore: How can we help? What can I do to support you right now?


Intensivist: I’ve lost three patients in the last two days. I don’t know how much more of this I can take.

Getting this emotion is really important and this colleague may need help.

Intensivist 2: That’s a lot. Even doing this for twenty years, it’s unprecedented what we’re dealing with. It sounds like it’s taking a toll on you. I’m so glad you told me. This is so hard. Do you feel like talking more about how it’s affecting you?


Using GIVE to respond to emotion does not require using each of the suggested steps. It may be enough to simply give your silent presence and patience by resisting the urge to problem solve, explain or reassure. Recognizing the emotion as a chance to listen and help the other person feel truly heard may go a long way to strengthening the kind of community we need among healthcare teams to offer genuine peer support by building relationships through kind receptiveness. Offering this to the terrified and excluded family members of our patients may make it easier to collaborate and make our communication more efficient and effective. These steps may help us feel more connected and empowered when there is so much potential to feel isolated and helpless.


References

  1. Rock LK. Don’t answer feelings with facts. BMJ Opinion. 13 April 2020. [Accessed 4 July 2020]. Available at URL: https://blogs.bmj.com/bmj/2020/04/13/laura-k-rock-dont-answer-feelings-with-facts/
  2. October TW, Dizon ZB, Arnold RM, Rosenberg AR. Characteristics of physician empathetic statements during pediatric Intensive Care conferences with family members: a qualitative study. JAMA Netw Open.2018;1(3):e180351-e180351. doi:10.1001/jamanetworkopen.2018.0351.
  3. Gross JJ. Emotion regulation: affective, cognitive, and social consequences. Psychophysiology.2002;39(3):281-291. doi: 10.1017.S0048577201393198
  4. Lieberman MD, Eisenberger NI, Crockett MJ, Tom SM, Pfeifer JH, Way BM. Putting feelings into words. Psychol Sci.2007;18(5):421-428. doi:10.1111/j.1467-9280.2007.01916.x.
  5. Lerner JS, Li Y, Valdesolo P, Kassam KS. Emotion and decision making. Annu Rev Psychol.2015;66(1):799-823. doi:10.1146/annurev-psych-010213-115043.
  6. Halpern J. From idealized clinical empathy to empathic communication in medical care. Med Health Care Philos.2014;17(2):301-311. doi:10.1007/s11019-013-9510-4.
  7. Stewart M. Patient recall and comprehension after the medical visit. In: Lipkin MJ, Putnam SM, Lazare A, editors. The Medical Interview. New York, NY: Springer-Verlag; 1995. p. 525-529. doi:10.1007/978-1-4612-2488-4.
  8. Kelley JM, Kraft-Todd G, Schapira L, Kossowsky J, Riess H. The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials. PLoS ONE. 2014;9(4):e94207. doi:10.1371/journal.pone.0094207.
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Dr. Laura K. Rock is a Pulmonologist and Critical Care Physician at the Beth Israel Deaconess Medical Center in Boston, Massachusetts and Assistant Professor at Harvard Medical School. She is faculty for the Center for Medical Simulation and a VitalTalk instructor. She believes the human connection is the pith to a functioning team, patient safety, and what brings the fun into our daily work. Laura strives for curiosity, respect and the spiciness of a great debrief to encourage difficult conversations and promote learning. She conducts research on interprofessional team debriefing and patient safety and runs training programs for effective and empathic communication; unit culture and how it affects teamwork, the patient experience, and clinician well-being; managing conflict at the bedside; and providing feedback that improves performance. Her most pressing personal challenge is implementing family debriefs to promote sanity and cohesion during COVID-19.

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