Dr Brené Brown has made a wonderful video about empathy. While this video is not specifically designed for medical providers, it is nonetheless a wonderful teaching tool.

As medical providers, we have the privilege and responsibility of being with patients during very difficult times.  And sometimes, we are the ones having to deliver terrible news.  It is therefore critical to learn how to effectively interact with our patients during their time of need.  This involves shifting from our ‘provider self’ who is always thinking in terms of ‘how can I fix this’ and into our ‘human self’ and trying to really connect with our patient.  There’s a big difference between an empathic response and a response that means well, but only serves to try to sugar coat the pain (or per Dr Brown’s expression: ‘silver lining it’).  In my mind this video is a must watch for everyone, particularly for those in medical fields.   please watch

I have a small quibble with this otherwise insightful video (hence the curmudgeon part of the blog title). It centers on the sandwich-eating antelope.  In the video, the antelope who is ‘silver-lining it’, does so in a flip way.  While the use of caricature takes away the pain of seeing a truth about yourself that you don’t want to see, I’m afraid it can lead someone to think, ‘that’s not me’, ‘I don’t act like this’.  As I’m confident that most medical providers are sincerely trying to be helpful and caring when ‘silver lining it’ in hopes of lessening the pain of our patients/families, I worry that medical folks won’t think Dr. Brown’s video is aimed at them- BUT IT IS!!!

VR, a 9yr old little girl had been diagnosed with acute leukemia several years ago.  Once a uniformly fatal disease, children are now surviving and being cured of this disease.  But sometimes, for whatever reason be it cell type or other genetic reasons we don’t yet understand, some children do not achieve long-term remission and cure.  Their disease relapses; and soon thereafter they die.

VR had been through 3 difficult treatment regimens, each with only a very short remission period, and now the leukemia had transformed into a particularly aggressive type, one with no effective treatments- not even to slow down the disease progression.  Her family knew she was not doing well, and they expected bad news when they met with the pediatric oncologist.  And in fact- that’s what they got.  Although the doctor told the family this news as gently as possible, there’s no way to soften this blow.   Her parents were devastated.

This is a particularly challenging conversation (and there will be more about breaking bad news in future posts).  After breaking the news about the change in their daughter’s disease, the doctor also told them there were ‘no effective treatments’.  But as the parents again and again asked about other potential options, pleaded ‘isn’t there anything else you can do?’, the doctor started to give in to the normal desire we medical providers have to ‘fix it’ because he wanted to do something to ease their pain.  And although he had explored all potential avenues for treatment prior to talking with VR’s parents- and knew there was nothing, the doctor started mentioning ‘talking to doctors at other cancer centers’, or ‘looking into phase I clinical trials’- which did help her parents start to feel better.

What the well-meaning doctor is doing is trying to sugar-coat it, the equivalent of Dr Brown’s ‘silver lining it’.

The problem is that the oncologist has not only added false hope, but also stopped the important process of the parents starting to come to terms with their new reality. And although his attempt to lessen the pain was truly heartfelt, it is not any more beneficial than the response offered by our friendly antelope, i.e., platitudes, and a sandwich.

Think about it.  At this time, when there are no cures or obvious good choices or outcomes available, there is still care to be given- to ensure symptoms are controlled, to ensure relief of suffering.  What your patient/family needs from you is your empathy:   to offer them your presence, and your assurance that you will be there with them and they will not have to face this alone.