Read Part I first

Reprinted from the April-June, 2006 BASIS

The most important component of effective connection is effective communication. Some researchers have identified many behaviors that interfere with effective patient communication.

• Appearing busy, i.e., watching the clock
• Reading case notes while interviewing patients
• One-way communication — never asking if a patient understands
• Asking patients specific closed-ended questions
• Cutting off or interrupting patients’ talk
• Ignoring questions or saying you will get back to them but don’t
• Not allowing patients to tell their stories in their own words
• Failure to take into account patients’ concerns and fears
• Treating the disease instead of the patient
• Omitting clear-cut explanations of diagnoses and causes of illness
• Ignoring opportunities to give feedback
• Failing to solicit feedback from patients
• Abruptly terminating sessions
• Providing little support

Obviously, the solution is for physicians to learn how to reframe their message of concern and caring. Physicians are not less committed to the well-being of their patients than practitioners of Alternative medicine. Somehow, the message has gotten lost in the quest to provide the best medical care. The following guidelines may be useful for enhancing relationships with patients.

Importance of the relationship

Rogerian psychology emphasized the quality of the relationship between psychotherapist and client. Psychologists developed a concept they called the “Therapeutic Triad.” All well-trained psychologists use these foundational skills as contextual tools for whatever type of therapy they provide for their clients. One part of the Triad that is called “Accurate Empathy” refers to the ability to put oneself in “another’s shoes.” Responding to a patient in this way captures the essence of the patient’s feelings at the moment.

Openness, honesty, and sincerity characterize “Genuineness” (sometimes called congruence). Empathy is about listening to the patient, genuineness is about listening to oneself. Being genuine means being oneself freely without any facade or phoniness.

“Non-possessive Warmth” (also called unconditional positive regard) is a type of respect that is not dependent on the behavior of the patient. In other words, the physician regards the patient as a person, not as a collection of ailments. This does not mean not seeing flaws and contradictions in a patient’s behavior. The physician does not condone all behaviors. It means accepting these human foibles in a nonjudgmental way that excludes ridicule, depreciation or criticism while retaining one’s own sense of values or personal ethics.

Effective communication skills

Physicians must always tell patients what to do whether it involves lifestyle changes or medication management. Treatment compliance will be more probable if the physician gives the information as a connective request.

An antithetical example would be, “What you are to do is . . .” A better response would sound like, “This is what I am asking you to do . . .” However, the best response would be connective and collaborative: “As I understand it, you will . . .”

Good communication tells the patient that you are treating him as a person rather than as the disease that he has. Instead of asking the patient what the problem is, it is better to ask him “How are you?” Actively listening to the answer is to follow. Good body language needs to accompany the listening.

People who are suffering physically or emotionally find relief in telling their stories. This often seems wasteful and time consuming to the busy clinician. Yet, storytelling is how we connect with people. We call a patient’s story their explanatory model. By using open-ended questions to elicit their story, the physician can establish a human connection quickly and effectively.

Another important communication is something called communication compatibility. It strives to move beyond mere competence and compassion to emotional collaboration with the patient. By listening carefully to the language symbols and metaphors used by the patient, the physician can use the same style of language when responding to the patient. An engineer might describe her symptoms and concerns using the language of mathematics and science. A school teacher might tell his story by words such as plans, goals, and lessons learned. Responding to each of these patients within their own context enriches the personal connection. This in turn helps the patient to be more satisfied with the medical experience.

It is also important to adapt to the patient’s expectations. Most patients want to know if they are going to be all right. They are often concerned with the reason for the illness and what they might have done to get sick. Physicians can speak to these worries and concerns by helping the patients to express themselves. Most patients are relieved to have the physician directly ask them as to what their worries are. Female physicians are more generally inclined to ask these probing questions; male physicians often think their patients would find it intrusive and would become resentful.

The Therapeutic Alliance

The therapeutic alliance —or working alliance—attempts to encourage patients to share responsibility for the progress of their personal health. Medical therapy becomes treatment with mutual participation. Research has shown that a strong working alliance may positively affect treatment outcome. In psychotherapy, for example, the therapyeutic alliance accounts for 21 percent of the variance in treatment outcomes — as opposed to 1 percent variance for the specific treatment modality. In medicine, the therapeutic alliance has a positive influence in treatment adherence.

The therapeutic alliance depends on the patient’s affective relationship to the physician. The alliance is established by making certain that the patient is purposefully an active part of treatment. Additionally, the physician must have an empathic understanding and involvement with the patient. This will then lead to a patient/physician agreement on the goals and tasks of treatment.

Asking patients for feedback can show compassion and respect. Giving patients simple and quick exit interviews about their reactions to the session allow them to see the clinician as more caring. Some evidence exists showing that assessing patient satisfaction is valuable for patient well-being.

Conclusions

Alternative medicine is highly attractive to people who are suffering and have lost hope. The hope of a cure is more powerful than the cure. The trappings of the healer are the stock-in-trade of these peddlers. Promises, compassion, and emotional connectedness speak convincingly to our desires and fears.

Despite continuing advances in traditional medicine, many people find the relationship with their traditional healers lacking. One method that medicine can use to combat alternative medicine is to bring these human elements to the doctor-patient relationship. Doing this would benefit not only the patient, but their families, the health care providers, and society as a whole.

(Part 1 of this article appeared in the last issue of BASIS)

Dr. Sandbek, the auther of The Deadly Diet, is a licensed clinical psychologist, licensed marriage and family therapist, and a credentialed school psychologist.


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Wiccan Footnote

by Yves Barbero

Reprinted from the April-June, 2006 BASIS

(An update follows this article) .

“There is no memorial for Sgt. Patrick D. Stewart,” wrote Alan Cooperman of the Washington Post last July 4th, “at the Veterans Memorial Cemetery in the small town of Fernley, Nevada.

“That's because Stewart was a Wiccan, and the U.S. Department of Veterans Affairs has refused to allow a symbol of the Wicca religion -- a five-pointed star within a circle, called a pentacle -- to be inscribed on U.S. military memorials or grave markers.”

Cooperman went on to explain that the VA allows 38 other symbols, including one for atheists.

Retired Army Chaplain William Chrystal, who was chaplain of Stewart's National Guard unit, is reported to have said, "It's such a clear First Amendment issue, I can't even conceive of why they are not granting it, except for political reasons. I think the powers that be are afraid they'll alienate conservative Christians if they approve a symbol that connotes witches and warlocks casting spells and brewing potions."

But they allow atheists. Why not Wiccans? The answer is that they don’t fear atheists. Atheists have a clear non-belief in a monotheistic god, therefore recognizing that the concept has a validity, even if only in the negative. In addition, atheism is a “faith” since there is no practical physical way of proving or disproving the existence of a deity.

The real danger to conservative Christians is from offering a concept that suggests that monotheism is not necessary to living a fulfilling life. Some polytheist religions, such as Hinduism, have to be recognized because they are a world religion with a powerful country behind them, and anyway, they don’t come out of the West.

But the Wiccans are estimated to number less than 200,000 in the U.S., and despite their claims of an ancient history, there is no unbroken line with the primitive animistic religions that pre-dated Christianity in Europe. They are, as an organization, modern. Politically weak, they can be picked on.

Those of us committed to the scientific method, are much more powerful, even if social conservatives see us as a threat to their view of how the universe is organized. We produce things that make us comfortable, prolonging our lives in the process, and help keep America’s enemies at bay. They can rant against us, but they can’t deny us. Instead, they try to control our influence on the young. But like the Wiccans, we present a threat by suggesting that a fulfilling life can be achieved without them. And like the Wiccans, our modern roots are in the West.

I have a great admiration for the Veterans Administration. They prolonged my father’s life when he was dying of cancer. A World War II veteran, he lies honorably in one of their cemeteries. And they are presently prolonging my own life. VA staffers are committed, ethical and first rate. The VA is, however, a government department, and subject to political pressures.

It should also be pointed out that the VA is not a single-minded entity. One doctor offered an explanation, in evolutionary terms, as to why I should follow a particular course of behavior. But he first asked me if I would accept such an explanation without being offended. He had, apparently, run into patients who did object. As a doctor, he will pursue whatever strategy is necessary to get his patients to modify their behavior and live longer. That’s his job. In telling him that I accepted evolution as the best explanation of how things stand, he cut to the chase and told me what I must do to survive.

Within the VA bureaucracy, however, are folks with stealth agendas. They are in a position of power and exercise it to advance their political and/or religious ends whenever they think they can get away with it. Or, as Chaplain Chrystal believes, it may not be all that conspiratorial. It may be simply a case of watching out for their collective behinds, hoping that the courts or a future administration will correct the situation. That tactic has been used in government before.

Sgt. Patrick D. Stewart, 34, was killed when his helicopter was shot down in Afghanistan in September, 2005. He was posthumously awarded a Purple Heart and a Bronze Star. His wife, Roberta, is fighting to get the symbol he wanted on his marker. The entire congressional delegation of Nevada, regardless of political party, is behind her.

Stewart, thought to be the first Wiccan killed in combat, remains a hero to us all.

---

Veterans Administration Relents (April 24, 2007 Update)

The VA, which had refused to recognize the five pointed star in a circle of the Wiccan religion as a grave marker, has relented, according to the New York Times of April 24, 2007.

"Though it has many forms, Wicca is a type of pre-Christian belief that reveres nature and its cycles," the article by Neela Banerjee said. "To settle a lawsuit, the Department of Veterans Affairs has agreed to add the Wiccan pentacle to a list of approved religious symbols that it will engrave on veterans’ headstones.

"The settlement, which was reached on Friday, was announced on Monday by Americans United for the Separation of Church and State, which represented the plaintiffs in the case."

A Washington Post article by Alan Cooperman had this to say on April 24th, "During his first campaign for president, then-Texas Gov. George W. Bush told ABC's 'Good Morning America' in 1999 that he was opposed to Wiccan soldiers practicing their faith at Fort Hood, Tex. 'I don't think witchcraft is a religion, and I wish the military would take another look at this and decide against it,' he said.

"[Barry W.] Lynn, of Americans United, said references to Bush's remarks appeared in memos and e-mails within the VA." Lynn was quoted the previous day in the Post as saying, "This settlement has forced the Bush Administration into acknowledging that there are no second class religions in America, including among our nation's veterans."

There is all sorts of information on Sgt. Stewart on the net. Search “Wiccans VA”

The Veteran’s Administration’s officially accepted available markers can be found at www.cem.va.gov/cem/hm/hmemb.asp.


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