Experts from the Office of Patient Experience at Mayo Clinic discuss interpersonal communication challenges with patients and families in the COVID-19 pandemic and how health care professionals can enhance their communications strategies and skills.
Moderator: Heather R. Preston, M.S., senior advisor, Patient and Visitor Policy Support Program
Featured expert: Benjamin J. Houge, M.S., senior advisor, Patient Experience Training, Education and Coaching
Featured expert: Jennifer S. Packard, M.A., senior advisor, Patient Experience Training, Education and Coaching
Mustaqeem A. Siddiqui, M.D., M.B.A., member, Patient Experience Leadership Committee; consultant, Hematology; assistant professor of medicine; instructor in hematology Featured expert: Sheila K. Stevens, administrator, Quality; instructor in medicine
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welcome on behalf of the Mayo Clinic School of Continuous Professional Development. I'd like to welcome you to may Go Clinic co vid 19 Webinar Siri's My name is Karen Gilliland and I will be your host for today's Webinar on challenging conversations. This webinar is accredited by the A M A. For one credit. There are no relevant disclosures for today's discussion, and we'd like to thank Pfizer for their support of this educational activity before we get started will cover a few points. The first is how to claim credit. If you'd like to claim credit after the Webinar, please visit c e dot mayo dot e d u slash co vid 1118 You'll need to log into the site. If it's your first time visiting, you may need to create an account. After you've done this and logged in, you'll see an access code box. You'll want to type in today's code, which is co vid 1118 This will allow you to access the course completed short evaluation and then you'll have the ability to download or save your certificate. 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Today's learning objectives include one determined best practices in discussing Covad 19 guidelines to identify communication challenges with the covert 19 Pandemic three Utilize effective empathic communication techniques. When communicating today, we'd like to introduce our panel moderator Heather Preston, senior adviser, patient experience, training, education and coaching. Good morning, everyone, and thank you for being here. I'm excited to introduce our panel today. Our team of colleagues here on today's Webinar are from the Office of Mayo Clinic, Experience, training, Education and Coaching team. Our teams focused is to help employees across the organization to have a more effective conversations specifically around challenging conversations with patients, their families and with each other as colleagues. I myself have a strong partnership with the Department of Nursing. Here at Male Clinic, I training coach providers on communication and health care and facilitate leadership training and coaching. I'd like to introduce my colleague Ben Hoagie. He leads our production of our digital products and supervises male clinics. Patient and Visitor Conduct Program. Jennifer Packard is a certified coach and educator and focuses attention on developing communication skills, off desk scheduling and administrative staff of male clinic. She has a particular interest in ensuring that are written communications. The letters we sent to our patients, the portal messages we send to our patients and our social media posts express empathy and reflect the patient's point of view. Sheila Stevens is our quality administrator, so she partners with Dr Siddiqui to provide oversight and strategic direction to our experience training, education and coaching team. And Dr Siddiqui is the Enterprise Medical director of our group. He provides medical leadership alongside of Sheila in communicating, training, education and coaching. Dr. Siddiqui is also a Huma Atallah Gist oncologist specializing the treatment of blood cancers. So this has certainly been a tough year with Cove it and everything that has come along with it. And it's required health care organizations across the country to have to shift quickly, given the stress that comes with rapid change. Our team and patient experience, training, education and coaching has worked with our practice, our colleagues, in their practice to ensure that we don't lose lose sight of the most important thing, which is human connection. I'm now going to turn it over to my colleague Ben Hogan, who will share more about this. Then go ahead. Thank you, Heather. Thanks everybody for joining us today. I'm excited to spend just a few minutes with you prior to our Q and a session session, talking about challenging conversations we've had around Kobe 19 and continue tohave as we move forward. I want Thio emphasized the Q and A feature again and say, as I'm talking through some of the things that we're doing at Mayo Clinic, I challenge you to use that Q and A and get those questions entered so that when we get to the Q and a session, we can answer them properly. Alright, next slide, please. So before we get into what we've done it Mayo Clinic around communication around covert 19, I want to remind everybody the types of questions that will be answering this panel. Here. We'll be talking about how to communicate about Kobe. 19. We won't be discussing specific Kobe 19 guidelines or offering medical advice related to Cove in 19. If you have questions about those guidelines or you're seeking medical advice, please go to Mayo Clinic or G'kar, Safe care and visitor guidelines, as well as trusted coronavirus information. Next slide, please. Like many health care institutions across the world, we've experienced significant uncertainty and challenges here in Mayo Clinic. From our patients, our visitors and our staff is wealthy communities that we go home to every night. We're all feeling the fatigue and around restrictions, that the difficulty that we're having around the questions that we have about coronavirus and when this will end So all these emotions are piling up in creating some communication challenges here at Mayo Clinic around restrictions and the fatigue that we're all experiencing. We're having to deliver bad news from a distance. We're having to re communicate, masking and distancing guidelines to our patients, our visitors and our staff. We're also having to invest in website manner as our telehealth infrastructure is being scaled up. Additionally, we're seeing misinformation on having to to grapple with that as we're communicating with patients we're seeing, our patients are better educated than ever before, coming to us with information that is often accurate but sometimes not as accurate. And it's important that we honor their beliefs at the same time that we also share with them our evidence based approaches to managing this pandemic. Next slide, please. So important component that you'll hear over and over again during our talk today is the importance of equipping staff to manage these challenging conversations with grace and compassion. And one way we do that is just by sharing back the perspective of the other person, the experience that they've had. So the statement on your screen here, this has been overwhelming for you. You just want this to be over. That's an empathic statement that we train our staff to use that statement and many like it. Additionally, we have other communication strategies that we use. We use hope. Worry statements sometimes say things like It's evidence. How evident how much you care for your mom. My hope is that our treatments will help her. My worry is that the virus has greater impact on those with the underlying health conditions that your mom has on the right side of the screen, you can see one way in which we're training staff were delivering micro learning experiences for them, and I'll talk more about that in a little bit. But how we communicate to staff, how we train them on how to have these conversations is important. Next question or next slide, please. We're also seeing that those empathic statements or utterances of praise those elements of the medical encounter that are essential to keeping the human touch and health care are actually less present in the video setting or over the phone. So we're have thio. We're having to approach these conversations with intention and purpose. We're acknowledging the distance and thanking people for bringing us into their home. So that first statement there I wanna thank you for welcoming, welcoming, welcoming me into your home today to talk about your mom's condition, acknowledging that they're not able to be in the hospital with her potentially not being here with her has been really challenging for you and then using other statements like given how things have progressed. This is a time where we have to refocus from treatment, the planning end of life care. We're having to invest in specifically speaking to the challenges that our staff are facing around communicating with our patients. Next slide, please, as we're supporting this rapid shift towards telehealth and we're trying to re emphasize the importance of a human touch, as I mentioned previously, those things that make health care special. Our offer is often that human touch. It's interpersonal effectiveness, and we know that that suffers when we moved to a digital platform, whether it be zoom or we're talking to folks via phone. Additionally, our staff with the Cove in 19 Pandemic are exceptionally stressed, so we are having to deploy small micro learning experiences so they can take and take those in and have pragmatic solutions relevant to the conversations they're having right Now, with patients, visitors on their families, we're putting an emphasis in particular emphasis on interpersonal effectiveness. So we have a different group that manages the technical side of connecting with our patients virtually and their families. Our focus is really on. Okay, one of the things that we really need to dio to make sure that they feel that human connection when we're connecting with them on the right side of your screen and you'll see this website manner. Org. We call it a quick reference guide, and these air designed to be consumed in a minute or less and again, we focus on solutions, things that our staff can actually say in the moment that will make those experiences a bit better for both patients, their family as well as our employees. Ex slide, please. Additionally, we are embedding empathy and perspective taking and optimism into how we communicate policies both with our staff, our visitors, patients as well as the communities around us. So some of the statements on the screen here emphasize how we might respond to a patient who has questions about one of our policies, like no visitor policy for hospitals. We might respond by saying something like It sounds like you and your husband are great support system for each other. Goal is to keep everyone safe, including you and your husband. He is in the very best of hands. You really wish that you could be here for him in the hospital. Then we might go into actually offering explanation around that policy. But before we do that, we have to honor the impact that that is being experienced by our patients by not having loved ones there in the hospital at the bedside. Aziz Well, as their family members who are at home, we're having to connect with them via Zoomer via phone and not able to support them the way that they once were on the right side of the screen. You could see just a sample of the numerous products that we've produced around responding to questions about our covert 19 policies masking and distancing things like that. A zwelling, as we've additionally put empathic language into your communications to the public into our employees just to acknowledge that this has been a trying time and it continues to be a trying time for everyone involved. So really, in summary theme. The empathic communication or sharing back the perspective or the experience of that other person really is the key, we believe to effective communication. Next slide, please. Currently, there is. There's misinformation that that our patients are bringing with them, sometimes into into the exam room. And we've developed a collaborative approach for our physicians and our staff to use one. Information is brought in. We assume it's under the best of intentions, but sometimes it doesn't quite align with what we know to be evidence based practices for preventing infection and things like that. And so we're really equipping our staff to use validation again that empathic communication and offering choice tow our patients. We want to honor their beliefs and their perspectives. At the same time, we want to make sure that we're presenting the factual information that we have in a way that is appropriate for them to hear. So we've done that in a couple of different ways. One is, we've developed a continuing medical education module for for our staff that's also available on ce de mayo dot e d u. The general public to consume. Next slide, please, and I'll turn it back over to my colleague Heather Preston on, We'll get the Q and I kicked off. Thank you so much, Ben. Um, I want to start by Just the first question that we received is what's the secret sauce? So what makes our approach here at Mayo Clinic different on DSHEA? Sheila, I'll turn that over to you to answer that question. Thanks, Heather. I think that, uh, we communicate all day every day, and we believe that communication skills are is important to surgical skills and health care. You know, even if we disagree with patients or give them bad news or we responded their service value, er there's evidence that if patients feel heard and understood, they have higher compliance rates to treatment, higher satisfaction and overall enhanced experience. So we hear all the time from providers, clinicians and people that Mayo clinic how empathic they are and we know they are. But being empathic is different than communicating that you are. So we have specific skills. So you ask about a secret sauce. It's really a specific skill. When I say skill, it's different than a strategy, right? So strategy is something that you can check off the list. I shook their hand firmly. I had nice eye contact, those air strategies. But the secret sauce is really skill building, which any skill takes practice in time. And so there's many, many parts to our communication model that we utilize thio communicate on all different things every day, but during cold that it was extremely important because emotions were so high. And I think one of the secret sauce is is what Ben referred to is those empathic reflection back sharing back what you hear, people say. And it's not simply, oh, I understand. You know, you're you're frustrated. It's really mindfully listening and practicing that Skrill skills so that we can utilize perspective taking and sharing back approach. Thank you so much, Sheila. The next question is around body language. So we talk about the importance of using empathic statements. What's important about body language? Jen, do you want to take that one for us? You so much other. I'd be happy. Thio, This is part of this. This is part of the secret sauce. The special sauce, um, empathy and empathic communication is brought to life. It's brought to the patient in a way that they can really feel it through that that I contact through the leaning in through that, making the patient feel like they're the Onley person that matters. And right now during this covert 19 pandemic, I think it's particularly important to consider that in our video visits we're good at that face to face. We're good at that in the office, off bringing that patient into our bubble of attention through our body language. And I think it's very worth considering how we do that through these zoom video visits. How do we continue to ensure that patients feel that warmth and understanding through that body language? So, Jen, our presence with the patients is almost as important, if not more important, sometimes than the words that were saying to them. It's something that you can feel through. Uh, patients will say in sometimes through channels in our, uh, in our surveys, things like, I felt like I was the only person that mattered. And body language is one way we can do that right, turning away from technology, having a clean desk, having no distractions, not looking at your phone, uh, and giving all of your attention physical and emotional to the patient when they're there with you and sharing your space. Thank you so much, Jen. Um, a Mayo Clinic. We've had Thio limit the number of visitors that our patients see during this time of co vid. So, Ben, I'm gonna ask you, Can you give guidance on how to deal with family members that aren't allowed to be in the hospital to be a support person to their family member during this time? And what if they become aggressive during that that moment? Yeah, excellent question. And first, I think, you know, we need Thio. Validate Why? They're why they're so upset right on bits, Because they're being prevented from being at the bedside with with the person that they love, the person that they supported for their entire lives. That's a really big deal. So before we do anything, even if they are upset, maybe even yelling is we need to share back their perspective, that key to effective communication need to acknowledge them and say This has been a huge challenge for you. Your mom. You're not able to be there for her in the hospital. And that's really impacted. You say that Pause see what happens often. Actually, a good percentage of our patients will, even if they're kind of nearing that point of really escalated behavior, will deescalate They're looking for validation. I'm looking for somebody to understand that, and we can both validate and, uh and also kind of stick to our policy and share the reasons for it. But they're going to be in a better position, toe, listen and collaborate with you on how they can connect with their loved one. Once you validated and shared back that experience, I would say when that fails and occasionally does. But again, not most of the time we have other strategies that we employ to set boundaries and expectations around behavior. But again, we don't typically get to that point if we're really validating and being there with the loved one and explaining the reasons for these policies. Thank you, Ben. Dr. Siddiqui, I would love to hear your perspective having you know, working with patients directly on the front lines. What have been some of your experiences with having to communicate with patients, that they aren't able to have their family member there with them or in communicating with the family members when you're talking to them distantly, Yeah, no thanks. It's It's a very important question. I was just on hospital service last week. Um, you know, taking care of patients who have blood cancers that needed to be hospitalized. And we have no visitor policies. So each of these patients is by themselves in in the hospital. Um, they're able to communicate with their family members through phone and face time, but there's no one allowed to be physically present at the bedside. Um, there are some exceptions, and we can talk about those. But to answer your question, it's really challenging. We have these conditions that are life threatening, that require hospitalization that are occurring during a pandemic. And if it weren't difficult enough to be going through treatment for cancer now, the pandemic has added additional layers of complexity, not just for treatment but also for, um, for visitors. So what has happened? Just last week I had a a 70 year old woman who is in for a complication of the treatment who has been with her husband for 50 plus years, and their caregivers to each other, so she takes care of him and he takes care of her, but now she's hospitalized and that 50 year bond is under strain because they can't be with each other. And she was, is so distraught. You know, she said, Listen, I can't stand being here. I've got to be able to see my husband and why can't you let him come and visit? And she immediately broke down crying, and we're having these conversations on a daily basis, but they never get easier and she breaks down crying. And I just took a moment. I took a moment and I said, It sounds like you and your husband have a very special relationship. It sounds like you really care for each other and you're each other's best friend support and rock. And at that moment, she then realized, Yes, somebody gets it. What could I have done? I could have said something like, Oh, well, it's only for the time being will get you out of here soon and, oh, sure, you know it's for your safety as much as your safety of your husband. But those would have all been very dismissive of how she's feeling. We have to take a step back and recognize what she is telling us. Acknowledge it. And then can we plan a course to move forward about how we might get around the issues and her particular situation? We had to get her better to get her out of the hospital. Um, but we have to acknowledge you have to reflect and then make a pivot and say, Would you mind if I shared with you a little bit of background of why you're still in the hospital? Or would you mind if I shared with you a little background of why we're not able? Thio, have you your caregiver at the bedside? Thank you, Dr Siddiqui. Uh, some of you on the call may be thinking, Boy, I don't have time to sit down and have those kind of conversations with my patients. I'm already, you know, having to move through my patients on rounds very quickly. So she'll I'm wondering if you could speak a little bit. Thio, does this take more time or how do we effectively have these conversations so it doesn't take more time? A good point. I think that a lot of people think it takes more time. It actually is a time saver, and the reason being is because people oftentimes repeat or show frustration when they haven't been heard. And a lot of people think if I'm courteous, if I'm nice, uh, that that's what I need to be, and that's important. That's the foundation. But it goes beyond that to this empathic way of showing that we get what they're saying and once we and share back appropriately. You know, it's so important to have your husband here and it feels unfair to you, and we can let them know. Here's what you're going through and I want you to get it. They can. They might not be happy that they can't have what they want, but they feel understood and validated. If we don't get that step and we just go into here's what the visitor policy and we're doing this for your own good, and here's what we can do to help you. If we re bond to the policy and not respond to the patient in a way that we want to connect, they will continue to bring that up. But you don't understand. I don't think I'm going to get well without him. This is different. I need him here. He needs to communicate. They want to keep telling you their story so it oftentimes can take more time than if we simply just be mindful of everything that we're seeing hearing about the patient. What do they value? What's important to them? What's the message here? What's behind the message? What am I hearing? What are they feeling? What's their entire experience? And when I pay attention to that, I can empathetically say, Mrs Jones, you've been through so much. You're alone here. It's so important to you to have your husband by your side. Then I could say, Would you mind if I share the importance of why we're doing this? And then I could even legitimize and say, I know this is not what you want to hear. I know this is not what you expect. Here's the rationale. Oftentimes we jump too quickly to that rationale, and it ends up taking more. Thank you, Sheila, very helpful to understand that perspective and and the time saving that it can actually be when we really are getting to the root of what's causing some of the emotions of our patients and their family members. Jen, I have a question for you. Just curious how patients respond to this type of empathic approach. And when it doesn't go the way, we would anticipate it to go right if it doesn't work, if you will. What air? Some suggestions for fallback communication. Good deal. Great question. Thank you so much, Heather. How to patients respond. Right now, patients are so fearful and so anxious that their shoulders are pinned to their ears and they have tunnel vision and they're not hearing everything that we're saying and they're not perceiving everything that is around them because of that fear and validation of that fear. Empathic, reflective listening statements that build trust. You can see the shoulders start to come down away from the ears. You can see the field of vision open up, and you can feel anxiety. Come down in a way that that patient is able to understand your suggestions and understand your explanations in a way that they couldn't before. It's such a necessary step to validate and empathize, and also ask permission before you share information because you need to build a therapeutic alliance with an individual and also with the public before you share information that is crucial that they take in to get better. And the second part of your question, I think you know, if this fails, what do you do next? Um, the patient's perspective is crucial and continuing to acknowledge the patient's perspective that what I'm sharing with you doesn't seem to be connecting with you. And I see that because I'm paying attention to you. I'm not only listening to what you're saying, I'm watching your face. I'm picking up on your body language, the patient's body language. Andi, I'm seeing them shake their head or squint their eyes, and I'm understanding that how my words are impacting them. And I can keep on changing my strategy and acknowledge it seems like what I'm saying isn't quite connecting with you and asking open questions. How can I explain it better? Or how am I missing the mark or What is your biggest worry? How do we make sure that we connect with your biggest worry today, but continually starting from where the patient is is truly a tested way of connecting with folks that will will work if you keep on coming through the window in the back door. All right. Thank you so much, Jen E. Just jump in here on that one. That was great. That was a great question of the great answer. Jen, I also think that you know, if the strategy doesn't work and the patient goes around and around, we have other strategies. We utilize empathic redirection to bring people back. And that's a way to, uh, let them know that you're here. If it's okay with you, I I need to move to this. Um, it's a full set of strategies. We can't go through the whole course here, but there are other ways to bring patients back. The other thing I wanted to just add to that is, if the strategies don't work in the patient's escalating, then we have to address that, too. So we do have some boundary setting and some other strategies that we do to follow through on any kind of boundary settings that we put in place if the patient becomes abusive. Inappropriate, um, or disrespectful. Thank you, Sheila. Um, the audience is wanting to know a little bit more about what does de escalation mean when it goes beyond that initial validation of frustration. And I can, um, share just experience that I had. When I first started working with patients at Mayo Clinic, I was validating the emotion that was present in the moment. So certainly they were frustrated based off of the tone of their voice and those types of things. And so I would often say, You're really frustrated about the experience that you're having. That was my initial validation. Ben, can you speak to a little bit more about kind of going deeper there with that validation when that initial frustration or initial validation isn't really kind of settling with them? Yeah, absolutely. And and it's a great question because while 99% of our patients, even those that have become upset for their family members, have become upset with that validation, that that's gonna be all you need, really, in most cases. But in the rare cases that you know, validation and empathy isn't working, Andi, it's getting to the point of verbal abuse. Perhaps then we need Thio to assert ourselves. We need to make it clear to them what is and is not acceptable, um, in that environment, so you know, we use something called contrast ing statements. Because you know what, Mrs Jones? What can't do today is continue to have this conversation. If you're going to scream and swear at me, what I can do is continue this conversation. If you're willing Thio to communicate with me in a way that's respectful, we name the behavior specifically that's happening. We never tell people Calm down. I'm sure everybody can guess what happens when you tell somebody to calm down. It tends to have the opposite effect, especially anybody married. Listening knows exactly how that goes. Eso don't tell people to calm down or stop that or that's inappropriate. Name the behavior. Mr Jones, you're swearing at me. Please stop over. And then, if necessary, we also put some consequences there. Mr Jones, you've I've asked you to stop swearing if it happens again. Here's the consequence. Here's what I'm going to do. And those of course, will be very specific. The consequences will be specific to your institution, Andi, even the specific department that you're working in. Thank you, Ben. And and the audience has asked when you kind of get to that tough love conversation and then you alluded to that Ah, little bit that there are times when we need Thio manage the escalated patient when empathic communication isn't working. And so really putting in some of those boundaries where you know the inappropriate behavior or misconduct that's happening in the moment. Isn't Eisen being respectful to the person in front of them to the organization? And so certainly there are times when we have to shift the communication approach on, get more into that kind of tough love, if you will. Then I'm going to ask you another question only because I know you've done a lot of work around misinformation, so there's a lot of inaccurate information that's out there. They're people's fingertips. Or maybe there's politicized views right on policies of recommendations. So how do we handle those types of conversations from our patients and visitors and their families? Yeah, absolutely. You know, we stick to the facts, right? We stick Thio. What Mayo Clinic says Here's here's the evidence. Here's our our approach to managing this pandemic, Um, and that's the information that we share with our patients. At the same time, we can't ignore the information that they bring with them right into the exam room were discussions with us. So the first thing that we'd like to do is reflecting Validate. And we're saying that a lot today, but that's important. So if somebody comes in and sharing with me, that how awful this this Kobe 19 stuff is and how it's impacted their Children and how they're they're just not gonna wear masks anymore. And they're not gonna get tested despite having symptoms, whatever that might be, rather than just saying Oh, my gosh, you have you This is the really important information for you to hear. Before I do that, I need to acknowledge and say, Mrs Jones, this pandemic, the distancing strategies have been really have really impacted you and your family. And you're worried about you know, the social lives of your kids. I need to acknowledge that and then pause and say, Ask permission, Justus. Dr Siddiqui, share it with this story. It's okay with you. I'd like to share with you some of the strategies or the the data that we've gathered here Mayo Clinic. Would that be okay? And even if the person doesn't necessarily want to hear what you have to say right then and there 99% of the time, they're going to say yes. And you've You've opened that opportunity to share with them the information you have. We're starting with that validation, offering choice and and taking a more collaborative approach to correcting any information that may be clinically important for us to correct. Great. Thank you so much for that. Ben. Ah, Sheila. As our quality administrator, we're getting a lot of questions around, um, training staff. So we talk a lot about the importance of using these types of skills and strategies with our patients and their loved ones. How do we do that at Mayo Clinic? Yeah, So we have, ah, model of communication that has overarching principles. And then it has elements and strategies as part of the model. And so those strategies such as that key sharing back asking permission, legitimizing there's just a whole range information exchange how we educate, advise and exchange information with patients, how we use partnering language. So there's all these different elements, and we try thio use those same elements and all of our training so that we hardwire the skills in our staff. And by the way, the skills that we teach our just for patients there for our interactions with each other as well, so we can have challenging encounters with each other. We can address misinformation with each other, and we can validate and hear one another. We certainly did a lot of workshops with a lot of role play before the pandemic head. And so times have changed. And we've responded to that by making a lot of our courses digital. We have learned very quickly people like they quick bites. We have what we call lively lessons where we have three minute little bits of information and education that is very helpful to people. We also dio, you know, for some of our we talked a little bit about when the when the conversation gets abusive, we also have what we call safer and safer stands for step up address. The behavior focused on our value of respect and, um, e is explain our expectations and ours reported document or recorded document. And so we have a whole list of those trainings weightless that people want this training so that they can address misconduct in many ways and other challenging conversations. So we do feel that that skill building in that practice is important. So we do a lot of zoom trainings as well, and we do sustainment boosters where we can, you know, highlight these skills. We also engaged with partners around male clinics so that we're all speaking the same language using the same strategy so that the skills are hard wired. Right, Sheila, thank you so much for sharing that on. Please. If you have other questions about the training that we have in place at Male Clinic, feel free to put those questions in the Q and A and we'll try toe go a little bit deeper with any other questions that you might have. Gen We've talked a lot about the health care organization, right and how we respond Thio patients and how we respond to each other and support each other through this pandemic. But we have some school nurses on the Webinar this morning, and they're asking about how do we communicate or use these skills and strategies to communicate with teachers, right with Children in the school system and other individuals. How can we utilize these same skills, or are they comparable in those different settings? I think that's a great question. Thank you for asking. Um, part of empathic communication. Part of the heart of empathic communication is meeting people where they're at and approaching people with genuine curiosity. And I think that that's applicable, no matter who were talking to. If it's family, if it's folks in other industries, in school, in government, high emotion impairs communication and fear causes high emotion and meeting folks where they're at with genuine curiosity, using open questions, listening closely for the emotion behind their statements, um can connect us. And so when you're responding or communicating to someone with high emotion, never ever respond to that high emotion with facts with objective information by explaining things by saying, Let me show you the websites, Uh, but rather responding to emotional statements of fear of worry, responding to those emotional statements with an emotional statement back that re phrases and reframes that emotion to show understanding Because truly, no matter who were spoken, speaking, Thio just really needs to feel heard and understood to build trust. And that trust opens pathways where we can share information in a way where that information is going to be believed, um, more likely to be believed that you are going to be more likely to be trusted as a reliable source of information when you've taken the time to do that, to meet people where they're at. And so in that case, off needing to communicate in the schools with with staff who are really frightened. Um, I can't stress enough that validating that fear and empathizing with that fear by refer rephrasing that and handing it back so they feel heard and understood and then asking permission before you share that information. Um, is not just for health care. Thanks, father. Yeah, thanks, John. That was a great response. And certainly I think being transparent is another really important piece of the work that we do right is not dismissing the fact it sometimes it can be uncomfortable for us. Is the person on the receiving end of those conversations toe want to kind of just shy back and and kind of avoid the conversation? But we really need to be good support systems for each other. And this type of communication approach can really provide the sport that people are looking for. Dr. Siddiqui, you talked earlier about kind of your experiences in the hospital practice and and working with patients and staff. Um, some questions have come through about supporting family and friends, so we've talked about the importance of communication. But what else does Mayo Clinic recommend about supporting these individuals during this time of stress? Yeah, take the extra time toe, Have the conversations with family and friends that is, you know, a huge component of what we do, you know, pre pandemic. You know, we would have multiple visitors in an outpatient clinic along with the patient, for example. You know, a Nen tire family may come for a discussion about a new diagnosis of cancer, but of course, that has now been limited 21 on site visitor in the clinic. When we've incorporated that, we have to still remember, there is a family that is behind this individual who is seeing you in clinic. That really would love to be part of the discussions and and be a part of the support system. So very practically a lot of patients will say, Would you mind if I got my son daughter, you know, spouse on the phone with me, and we have this conversation together. Would it be okay if I, you know, brought them in on facetime or video check? We allow that, um, we encourage it because it's not just the patient. It's an entire family that you're treating on the hospital side of things because things are a little bit different there. We are not allowing visitors to the hospital with with extreme exceptions. Um, again, the advice is, take the time to have those conversations. If a patient wants to have their family member on the phone while you're there visiting, do it, it really goes a long way to helping the patient and the family member be more comfortable with the extreme circumstance that we are in. So take the time to do it. Um, as as Sheila mentioned previously, Yes. If you invest in the time now to have these conversations, you will find that you will have spent less time total because you've addressed the underlying emotion. You have addressed the underlying concern. You have used active listening and reflected back what the patient and family are trying to tell you. And so it becomes the conversations become much more rich, they become much more, um, applicable And instead of talking past one another, you're you're talking with each other, and I think you know, that's a subtlety that is very often missed. But it's so, so crucial, right? Thank you for sharing that perspective, Dr Siddiqui. Um, Sheila or Ben? I'm gonna or any of you, actually. But, you know, interestingly, the question has come up with that. Sometimes this can feel condescending, Or it can perceive be perceived by the person on the receiving end as, um kind of talking down to them. So I'm wondering if you could speak to that a little bit and maybe even give some examples of what, What what it might sound like if we taken attempt for a new initial attempt. That may not be a full empathic response. So just to kind of showcase the difference, I think, might be really helpful for the audience to hear. I know I put two of you on the spot, so maybe we'll start with Sheila eso. I think that it is true it since it is a skill, it does take practice. And when you're first learning the skill, what you tend to dio is, um, formulate in your head. I'm listening, but I'm formulating at the same time what I'm going to say and what happens is you respond quickly with you're feeling frustrated. You're feeling really frustrated and that's a that's a go to People are usually frustrated when they come with high emotions and people say, Well, yeah, of course I'm frustrated. So it does feel a little bit like Why did you say that to me? And as you as you begin to practice this where you can dive deeper into what you're hearing, So it's not just you feel frustrated, but it's really important to you that you came here for this. This is not what you got. This is not what you expected. You go to the core of their values. You know, if this is what you want, this is what you're concerned about. And putting that out there usually lets people take a breath. But I'll give you an example. There was one time when you know somebody came screaming over Ah, service value and and I thought I did a great job of just like you know, you you came here. You put a lot of time to get here and you didn't expect this. And this is what happened. You know, of course you're angry over it. And the patients going back. I'm not angry. Don't tell me you're angry. So you know, what can we say that this is Miracle? Doesn't know. But what we can say is 99% of time when we get to the core in the heart of a deeper dive of what people are saying, we are able to connect with them in a way that makes them feel understood, even if we can't fix or give them exactly what Yeah, and Sheila. Sometimes that's, um, you know, really paying attention to what they're not saying or paying attention to the underlying emotions that might be present there. Sometimes we react right to the loud tone of voice or the disrespectful words that are coming out of a patient's mouth. Um, and rather than just responding to that really stepping back toe understandable, you know what's causing this frustration or anger that's coming to them? Yeah, Thank you so much for sharing other. Can I just piggyback on that? Absolutely Second, you know, as a trainer in empathic communication at Mayo Clinic I do see, um, that there's levels of skill among our staff, and it does take a lot of practice toe. Learn this skill and there are levels of reflections and simple reflections can seem very much like that. In the very first lesson, when people learn how to do simple reflections, they'll walk away from that thinking that sounded kind of condescending but truly wonderful. Rich reflections don't just reflect what you see in here, but they make an inference. They make an inference about what you haven't heard. There. You make an inference about what's behind what's being said, and they offer a platform for the patient to clarify their position. Um, and it comes across as curious and a genuine attempt to understand and often a really well, uh, formulated compound. Reflection is even better than a question in evoking how your patient feels or anyone that you're talking thio So it takes a while to learn, and it takes some patients to teach Mhm. Thanks, Jen. Ben, Could you speak a little bit thio, that natural, natural desire to want to jump and defend or jump and explain or provide rationale. Often, that's where we want to go. And people are asking, What's the reaction to that from people on the receiving end? Yeah, so it's a great way. Sometimes refer to it as the writing reflects right, and it's very natural, especially in healthcare. Right, Thio, your you have tons of education. You put a lot of pride and effort into getting where you're at and to be there for your patients. And so whenever we hear something, our immediate inclination is to jump in and fix right or provide correct information. But I think everybody could maybe think of a time when they share something with, you know, maybe the mother in law's on your back and they share something with a friend, and they're like, Oh, my gosh, you know, the same thing happened to me and they kind of make this story about themselves, or they tell you exactly how to fix it, and you feel that little like disappointment, where you just wanted to be heard that that's a very human response, and our patients feel that, too. So somebody a mom comes in with concerns about distancing guidelines and the impact all this has had on our kids. I could just throw information in front of her or say, Well, here's why it's really important. But if I jump right to that, they're not gonna take that information in to the extent that they would have otherwise. And it's certainly less likely that they're actually gonna follow my advice. First, I need to just pause, seek to understand where they're coming from and make sure they understand that I've heard what they've said. I've got some understanding of what their experience waas right? So before I say this is why all these guidelines are important, I need to first say there's been a real challenge for you. Things were so different than you imagined. You just wanted this to be over and then ask permission. It's okay with you. There's some stuff that I'd like to share with you about a way forward. That's how we get people in the position toe. Listen right And here what we actually have to say expanding been just highlighted the three p approach, which is one of the approach that we have. You know, whether you're giving feedback or giving information, that's just one. We have others, but you know, perspective. First, take their perspective Permission as permission to share yours and then share your perspective. So it z really a three p approach perspective. Permission perspective. Thank you so much, Sheila Dr. Siddiqui again as one of the people on the front line. Um ah, lot of times we have can have a strong reaction. So as the health care provider, right, we can have a strong reaction to some of the escalated conversations that could be happening. Tell us, how do you pay attention to your own emotions and manage those among manage those emotions so that you can effectively communicate? Yeah, So there's a rule in medicine is before you give CPR to somebody first, check your own pulse and, um, What that means is, is that if you're in an emergency situation and you now have to do emergency resuscitation, you first want to make sure you yourself who is a participant in that resuscitation have the appropriate perspective that you are ready to effectively jump in. If you are, you know, leading an emergency response, and you yourself need to be intervened upon. Then you're not helping the situation. So there's a rule that, you know, before you jump in to do the CPR. You know, check your own pulse first. And that's exactly the same skill that I would employ in a situation that's becoming escalated or very, um, contentious. As a participant. It's really hard not to get drawn into that right. We are emotional beings. And so my go to is to first check my own pulse, check my own reaction and and make sure that you know I'm not making the situation worse because once it goes past a certain point, then it's not salvageable. So you don't want to get to that point of no return in a contentious meeting or discussion. So my piece of advice is, check your own pulse before you jump in because, quite honestly, that will be the biggest thing you could do to make sure that you have a successful outcome at the end. Thank you, Dr Siddiqui. Um, one other question that's come up is is it okay to use this type of approach with individuals dealing with mental illness? Or should my approach be different? So, anybody from the panel what are your thoughts on that? Uh, I'll jump in. I would say Look to the mental health professionals in your institution to give you guidance on how best to communicate with them. That said, I think most of the people on the panel here actually are former clinicians. I've got Sheila Stephens council by training, and so is is Jen Packard. I would say in many cases we used these strategies with everybody, regardless of where they're at validation, feeling heard, regardless of kind of where you're at or which condition or ailment that your may be suffering from can be a strategy that's helpful. But I looked Thio Jen or Sheila or anyone else toe add to that. I agree with the event. I think that, you know, as human beings, we all wanna feel heard and validated. And thes strategies work well with most populations. There are exceptions, of course, and I also want to reiterate there's ah lot of other strategies. We've really focused on the key, which is that empathetically reflected back. And before you can do that, you have to be mindful. You have toe, you know, be aware of your own cringe on what pushes your buttons and how you're gonna manage that. But we have a whole host of other strategies that we utilize. Um, so for people that are ruminative in nature or they're depressed or anxious and they're and they're going on and on about something, we have other strategies to pull them back in to still validate them, but empathetically redirect them back to the conversation. And then, of course, we have strategies on how to deal with bias and strategies on how to deal with abuse of patients. So there's a whole lot of different strategies, depending on the person, the individual and the situation at hand. But the key is to really be mindful and share back what you're hearing. Thank you, Sheila. So we have had a great discussion today, and we have time for one more question before we end our Q and a session here. I'll just leave it open toe, all of you. What are some specific training resource is that you would recommend to the learners or the listeners in today's webinar? How can they really hone in on some of these skills and strategies to be able to apply them in their daily work, working with patients and and others? I did see somebody asked if we were using motivational interviewing. And, of course, some of the strategies strategies we use come from motivational interviewing. We haven't talked at all about health behavior change, which motivational interviewing is really a strategy to resolve ambivalence in favor of change. But many of the strategies that come from that the responding to resistance and and other types of things way use Ah, lot of those strategies and and some of our other communications as well. So motivational interviewing would be one. Yep, so that would be That would be 11 book. There's a lot, a lot of books and a lot of journal articles on that, as well as there's a lot about empathic communication out there. Um, in journal articles, I have a general clinic perspective. Do we offer anything for individuals on the Webinar today? I was just going to throw out there that if you do seek out motivational interviewing training, not all training is created equal. And make sure that you find a trainer who is minutes who has been trained by the Mint. So that's the motivational interviewing network of trainers, and you can find that at motivational interview, uh dot or GTA. So, Heather, this is Mr Kim. I would just add that it's a skill. So whatever resource that you decide to use practice, practice practice is going to feel awkward because it's a new skill. But as you practice, it becomes more and more easier. Thio utilize in your day to day practice. Thank you, Dr Siddiqui. And thank you to all of the panel today for being so helpful in responding to our learners questions. I'm going to turn it over to Karen now. And thank you so much for being here today.