Chapter 4: Birth of the R.E.D.E.™ Model

Introduction

 Whatever the nature of our wounds, we heal to be healed.

 —ANTHONY SUCHMAN AND DALE MATTHEWS¹

Healthcare providers go into medicine to help alleviate human suffering. Though medical training quickly zeroes in on building biomedical knowledge and expertise, relationships are essential to our health and well-being as well as to our basic survival. Cozolino asserts that we are all social beings, developing relationships on multiple levels "from neurons to neighborhoods."² We are shaped from birth by our dependency on others to meet our basic physical and psychological needs. We quickly adapt—learning how to interact with our environment and develop meaningful relationships that activate development of brain structure and biochemistry.³ Should it be surprising then that these personal connections play a vital role in our physical and emotional development and well-being? Meaningful relationships have been shown to be therapeutic, in and of themselves, resulting in improved health outcomes such as lower blood pressure, better pain management, and weight loss.⁴ Mindful awareness and intentional practice of empirically validated and efficacious communication skills have the power to deepen our connections with others.

Healthcare providers feel deep responsibility in caring for people. Reversing a diagnosis that someone has had for years is delicate work. Getting patients to take medication when they don't believe it will be helpful is challenging. Rather than explore the patients' goals and motivations through meaningful dialogue, clinicians often try to convince patients to do what they want them to do. Perhaps as biomedical advances led providers to become increasingly specialized, the focus of the individual also narrowed. The inability to view the patient in his or her entirety has led many to feel disenfranchised and disengaged from their own care.⁵

At the same time, with increasing consumerism in healthcare, patient-centered care is commonly championed in today's healthcare environment. It has permeated the atmosphere of medicine. Patient-centered care and the inclusion of psychosocial elements in the biomedical framework have been valued increasingly as research unfolds to support a more holistic and humanistic view of disease, illness, and patient care.⁶ One of our challenges in teaching communication skills is to address the disconnect between the doctor-centered, pathophysiology-based perspective and the more holistic, patient-centered perspective. As part of the R.E.D.E. to Communicate: FHC course, we ask providers to recall a positive healthcare interaction they've had as a patient. We then ask them to identify what it was that made the encounter powerful and memorable. Commonly, the stories speak of feeling cared for and valued. They express gratitude that the clinician took the time to get to know them as a person and to listen to and understand their concerns. When they find themselves in the role of patient, physicians value the experience of being seen as a human being. This should not be surprising. As healthcare providers, we have ...