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Upsetting reminder

Dr Melanie Wynne-Jones on the dangers of empathising too strongly with a patient

'I know just how you feel'

is something we've all said at one time or another to show support and empathy to family, friends or even patients. What we usually mean is that we can imagine how they are feeling; unfortunately we often get it wrong because we can't know all the facts, and our personalities/ life experiences are different.

This is why communication skills include asking directly how someone feels, and checking we have got it right by using phrases such as 'it sounds as if....'. We can also facilitate the consultation by deliberately (not cynically) using particular words or body language to demonstrate empathy, while remaining professionally detached.

But sooner or later we will encounter a patient with whom we truly empathise ­ whose situation reminds us of something distressing we have experienced ourselves or are still dealing with. This can occur without warning in the middle of a consultation, and one needs to be careful that one behaves appropriately.

On the positive side, our experience may give us additional insight into patients' problems and help us to suggest a wider range of options. We may feel particularly qualified to help, and find this professionally rewarding; the patient may feel uniquely understood. We may even learn something that helps us in our own situation.

But this can be risky. There is a danger that we could extrapolate from our own experience and impose our own ideas, concerns and expectations on the patient instead of eliciting theirs. We may inadvertently make the patient feel their coping skills are inferior to our own, or unduly influence their decision-making.

It's important to be self-aware in this situation, and if we suspect our reactions may not be completely objective, it may be in the patient's best interests to suggest they consult another doctor in the practice (this needs to be tactfully handled).

A more common scenario is that the patient touches a raw nerve; for example, if we have been recently bereaved, have unresolved grief issues, are ill ourselves or have a relative with cancer, dementia, alcohol dependence or another serious diagnosis. A patient's miscarriage, difficulty in conceiving, impotence, history of abuse or bullying may be too close to home; we can suddenly feel acute personal distress.

Getting choked up during, say, a discussion about the death of a child, is sometimes acceptable in some consultations, but we must not burden patients with our personal feelings. The last thing they need is for us to fall apart with them.

If we are becoming truly overwhelmed by emotion we have a duty to compose ourselves; we may even need to leave the room. Unfortunately this could signal to the patient that their emotions are unacceptable to us, so we (or someone else) must reassure them that this is not the case, and ensure that their needs are met.

A more likely outcome is that we manage to contain our emotions and get through the consultation. Now is the time to do an emotional stock-take, even if we are running late. We must not carry our personal distress on to the next consultation; the unsuspecting patient may pick up on it, or we may fail to concentrate and miss something important.

Options include going for a coffee break, offloading on a colleague, using relaxation techniques or deliberately putting feelings to one side until we have time to deal with them properly. If none of these work, then in extreme circumstances it may be wiser to ask someone else to finish our surgery.

Something as upsetting as this needs dealing with. We need to reflect, with a colleague, friend, family member or even our own GP, on why we became so upset, whether we have unresolved personal issues and how we might handle a similar situation in the future. If we are trying to work through major life events we may need to take some holiday or sick leave or see a counsellor.

We have a duty to look after ourselves so that we can provide proper care to our patients. On the plus side, we are likely to become better, more truly empathic doctors by learning from our own life experiences.

Melanie Wynne-Jones is a GP in Marple, Cheshire

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