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INTRODUCTION

Clinical Take-Aways

  • Negative emotions are a threat to effective clinical negotiation. When negative emotions arise in patients, they are best recognized, explored, validated, and acted upon rather than ignored.

  • There is no test or imaging study to aid in the recognition of negative emotions. However, humans are excellent emotion detectors, and clinicians can cultivate this innate capacity through curiosity and active listening.

  • Naming emotions can itself be helpful to the patient.

  • Negative emotions in clinical care cannot always be consistently and effectively managed.

  • Clinicians should:

    • Ask patients about emotions directly or by inquiring about impact, attributions, and triggers.

    • Validate emotions by naming the feeling, expressing empathy, and offering support.

    • Tailor their response to negative emotions depending on whether the emotions are a clue to a mental health condition, a manifestation of psychosocial distress, or an impediment to participation in care.

SECTION 5.1: INTRODUCTION

In The Death of Ivan Ilyich, Tolstoy depicts a man transported from a banal middle-class life in the Russian countryside to the killing fields of an unnamed, savagely progressive illness. In a more modern telling, Alice Trillin reflects upon the psychosocial landscape traversed by patients newly diagnosed with a serious disease like cancer, calling it “The Land of the Sick People.”1 The experience of being a patient is not always so dramatic—sometimes a backache really is just a muscle strain—but the experience is nonetheless associated with a range of strong emotions. These emotions are sometimes positive (e.g., a feeling of deep affinity with the provider) but can be negative (e.g., fear, anxiety, irritation, anger, sadness, or revulsion). Patients’ emotional responses to illness or the threat of illness are important not only because they represent important health outcomes in their own right but because emotional distress can disrupt other biomedical healing processes. Helping patients manage emotions, especially intensely negative ones, is one of the six core functions of patient-centered communication.2 Yet this is a tall order on many levels.

Kay S., a 45-year-old divorced female, has been an active runner for the past 25 years. She has run several marathons and logs about 30 miles a week. However, over the past 3 months, she has been experiencing joint pain in her knees, hips, and wrists. In addition, she has been more fatigued when running, something she attributed to warmer weather. Feeling a little feverish, she wonders if she picked up a virus at work. At first these were minor inconveniences, but they have steadily gotten worse to the point she decided to see the doctor. After undergoing various examinations and tests, Kay was diagnosed with rheumatoid arthritis. She is in shock, and over the next several months experiences denial, anger, and depression.

Kay will live the rest of her life with rheumatoid arthritis. She will take a variety of disease-modifying medications. Her quality of life will be affected by medication side effects, ...

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