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Judgment and Disrespect

Do physicians lack empathy with their obese patients?  How does that effect the outcome for the patient?  A small study at John Hopkins noted that physician behavior was significantly different when comparing interactions with normal weight versus obese patients. The patients in the study were being treated for hypertension, not obesity.

Empathetic Relationship

An empathetic relationship is necessary for medical recommendations and behavior-change counseling to work.  It is essential in helping overweight and obese patients overcome obesity and it’s comorbidities.  Other studies have shown physicians hold negative attitudes toward obese patients. They feel judgmental and disrespectful, that often coming across during patient encounters.

Same Time, Different Message

The study noted that there was no difference in time spent in patient encounters.  The difference was in the display of concern, reassurance and recognition of feelings.  Interactions with patients of normal weight were much more positive and reassuring.  That was clear in the words and phrases chosen.

Emotional Support is Needed

The study suggests that emotional support is very important and that doctors may unintentionally sabotage their patients efforts to get healthier by their lack of empathy.

Comments?

--Dave

Kimberly A. Gudzune, Mary Catherine Beach, Debra L. Roter, Lisa A. Cooper. Physicians build less rapport with obese patients. Obesity, 2013.

Photo by Dr. Brook Noland, www.nolanddental.com

 
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Self Delusion

Are we willing to be objective regarding ourselves?  Can we be truly authentic?
Truth about one’s self can be derived by disinterested self observation through self reflection and meditation.  Knowing the truth allows better, more authentic interaction with the world.  The common inclination of humans is self delusion and judgement for the sake of expediency and decreased anxiety.  

1. We are wrong far more often than we believe.
    We can go to extremes to avoid internal inconsistencies. 
    Even embracing falsehood.

2. We are much less objective with evidence than we believe.  
    Few people escape bias and the strong tendency to rationalize
    dearly held  beliefs.

3. We deflect responsibility for being wrong.  
    We are highly motivated to protect our self image.

4. Our expectations are not objective and are unrealistic.  
    We suffer from optimism bias.

5. We are going to die.  
    It is the most certain and the least believed.

6. Conflicts with two people or groups are more often issues of values than arguments of what is absolute truth.

7. Our beliefs are determined by our wishes, not truth.  We believe in things that we want to be true even if there is evidence to the contrary or absence of evidence.

8. Our desire to resolve anxiety caused by uncertainty causes a leap to conclusions that are unsupported.  The need to avoid anxiety can exceed the consequence of a negative outcome.

9. Enormous energy is expended with the single goal of reducing anxiety.

Derived from the work of Alex Lickerman, MD.  
Read more in
The Undefeated Mind:  On the Science of Constructing an Indestructible Self

Photo by Dave Hutt, www.dmddigitalphoto.com

 
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Perfect Life

“Perfect? One hundred percent perfect is difficult,” said the Dalai Lama. “But I think I can say, among 7 billion human beings, everyone has the potential for good quality. This is the most precious thing. If you keep affection, a sense of concern for others’ well being, that’s the ultimate source of satisfaction. That brings peace of mind."


Be Happy

“There is a Tibetan saying: ‘When things are difficult, then let yourself be happy.’ Otherwise, if happiness is relying on others or the environment or your surroundings, it’s not possible. Like an ocean, the waves always go like that but underneath, it always remains calm. So we have the ability as well. On an intellectual level, we may see things as desperate, difficult. But underneath, at the emotional level, you can keep calm.”

Excerpt from ABC news interview

Photo by Dave Hutt, www.dmddigitalphoto.com


 
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Recently I was with a dying patient and her family. 
Spiritual care is one of my roles.

The nurses told me that she was perhaps a few hours from death.  It is striking how much benefit there is in being a comforting, compassionate presence.  She was so gracious, thanking me for being there.  We all prayed and I gave everyone communion.  Then she asked, “Do you know what is coming for me?.”  I smiled and said, “No one really knows.”  She told me,”That’s alright.”  and she smiled back at me.  She went on to thank the family members who were there for being part of her life.  I went back to the office to arrange for a priest.  What really hit home is that at this most vulnerable stage of her life, she had empathy for everyone around her.  She was the comforting, compassionate presence.

--Dave

Photo by Dave Hutt, www.dmddigitalphoto.com

 
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I recently was reading some excerpts from Dr. Brene Brown’s work.  It reminds me of the Dalai Lama's words and what I have heard from my friend, Geshla Tashi.  These thoughts are condensed and as succinct as I can make them right now.

Barriers to Love
Everyone wants to be loved.  We make it complicated by putting barriers up for ourselves. The belief in unworthiness to be loved is shame and that creates a need for protection from vulnerability.  Dropping these shame barriers creates vulnerability by being authentic. Connections can be created as a result of vulnerability.   A willingness, a courage to acknowledge imperfection is needed by having compassion for self and others. Instead, oft times vulnerability is numbed.  By numbing possible bad feelings, all feelings can be numbed. (Consider that we are the most indebted, obese, and addicted generation in history) Joy, gratitude, and happiness are lost.  In both politics and religion, because mystery and faith is too vulnerable, certainty is embraced.  Ambiguity and compromise is vulnerable and is extinguished.  Instead, to breach the barrier, there must be a belief that you are good enough to be loved.  Decide to be self revelatory without guarantee, and to practice joy, gratitude, and happiness.  Don’t be tied to some imagined outcome but to the truth of your life.

The Courage to be Vulnerable
“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly.”--Theodore Roosevelt, 1910 speech

--Dave

Photo by Dave Hutt, www.dmddigitalphoto.com