Empathy in patient encounters

Hey. All right, let's give them the invitation to the rest so we can get started. Then we're going to open our website so that we can Perfect. Let's see, we have a few today. Alhamdulillah, that's great. And it is 7 minutes past the hour. I'm going to give a couple more minutes, and in the meantime, I will be welcoming my brothers and sisters here. So good to see everybody. Salaam alaikum. So it would be nice to refresh what are the expectations here. We are meeting once every Saturday, inshallah, in order to discuss bridging theory to practice in light of your clinicals about to start. Inshallah, you started them already. And each one of them are— is a topic that is coming from you, or one of you. And today's topic is about how to approach a patient with empathy. What I mean by that is, um, we had— what I mean by that is we had so far a, um, few We had so far a few topics. We did a topic about how to approach a patient, how to interview a patient. Then we did 3 possibilities framework, crafting a differential diagnosis, and we discussed about how to stabilize a patient in the emergency room. Then after that, we discussed how to document the patient encounter last time, and we had a few examples of how to put together one of the most popular ways of documenting, which is the SOAP note. It allows you to not just to document, but it is a message between you and a brother or sister or colleague in order for them to find the right information quickly. And now today, Now that we have a little bit of a framework how to approach the patient, how to make them talk, how to ourselves feel confident, we would like to work about how to approach a patient with empathy. A patient who is completely in shock, quiet, just blank, and they're bleeding, or they have a fractured leg, or they have chest pain, or they can't breathe because they have asthma attack. Asthma is called the biqa. How do you call it in your dialect. Feel free to come off mute. Feel free to use the reactions. Feel free to type in the text. It would be motivating for me, inshallah. So there's this patient who is completely silent. And then there's the angry patient. Everything that you do is not good. Everything that you do. So, for example, if you ask about the pain that they have, the pain is, I'm in pain. And then you say, well, where is the pain? And they don't hear it as a help me explain it so I can help you. Um, they hear it as you're attacking me, you don't believe me. So Some of you are texting me to see if I can, uh, help them get in, so that's why sometimes I stop. Um, and you answer them No, no, no, I'm just asking you, where is the pain? It's all over, it's all over. And so how do you direct someone who is talking all over the place? Um, so have any of you been in that situation before? Nothing in the chat. Let's see. We have Mina that's joining us. Rabu, audiq nafas. Thank you, Rula. Thank you. Rabu or audiq nafas. Taib. Is that something that's okay? I'm glad you are interacting on chat. And they are like this. How would you deal with a silent patient? Can someone share with me a previous experience? Okay, so for example, it happens to me with my own father. Many of you know that he is in the hospital. And when I was just talking to him yesterday, I was heading to Friday prayer and I thought, let me call him beforehand and let him know because unfortunately he is in the hospital and he is bedridden. He cannot go to the hospital, to the mosque, masjid. So I called him and he was telling me He was just watching, looking at the camera, and it was painful to ask, how are you? And the first question, and they answered, alhamdulillah. Yes, okay. How are you? And he tells me, I have pain. And now what do you do with that? You're like, well, Where is the pain? And he knows we've been through this before, but at that moment he just did not feel like talking because of the pain. So my job at that time is to find a way to extract from him the information while letting him know that I'm there and I believe him. So let me start by giving you something that will probably help. If you are complaining to a friend of yours, if you're complaining to a friend of yours about work and the friend is just quietly listening, well, that's good. But at the same time, you feel like you want somebody who interacts with you, right? On the other hand, if every single moment your friend keeps interrupting you to ask a clarification and say, well, hold on, well, you said that your friend did this. Is that the other friend or this friend? Oh, okay, okay, fine, fine. I'll just go quiet. Keep going, keep going. And then 2 seconds later, well, hold on, was that Tuesday or Wednesday? Um, well, hold on, was that And at some point it's frustrating. It doesn't feel like it's helpful. Is that correct? Have you guys been in that place before? Okay, so where am I taking this? Is there is a, um, method that is called Mirror and validate. Mirroring and validating means that first and foremost, something that is affecting them, what you first do is you have to say, that must be very terrifying. Oh, that sounds painful. Or, wow, that much. And then what did you do? So by doing that, that's active listening. What I have told myself and what I've learned about myself and what I've learned about others that I train is we Arabs are very good at listening. We're not, I'm sorry, we're very good at hearing. We're not very good at listening. Shumanata. You're telling me symptoms or a story. What I do is I hear you, but my brain is constantly preparing the next question, the next comment, the next reparté, the next response. And that's not listening. Listening is literally listening. So first I trained myself to stay completely silent until the other person finishes what they had to say. And sometimes it can be very difficult. Then I started to, once I learned that, I started to be able to pick up on certain things they said that otherwise I was just glazing over. For example, if they say, because I had just finished, well, I mean, I lost my mother when I was— and if I was someone who was just thinking about an answer, I wouldn't have picked on the tone that the person said, I lost my mother 20 years ago, with. If that did not affect them, then why are they bringing it up now? So this is an important piece of information. I have to put it aside, and then when they go quiet, I go back and say, first of all, I'm sorry that you lost your mother. She must have been very important for you. And suddenly you created a connection. You have to mirror. When you want someone to tell you more about something and they say, I'm in pain. You're in pain? Yes, I'm in pain. And that pain comes and goes. In fact, that pain, I don't even know what to do with it. Wow, you don't know what to do with it, huh? All you're doing is taking the words and returning them to the other person. That's called mirroring. So mirror and validate are some of the most powerful, compassionate, empathetic ways of listening and being there for the person. Any questions so far? Have you used any of these in the past? Okay. So I'm going to, for those that joined us, where we are today, we are discussing after we've already discussed what is the information that is important, one that will create a differential diagnosis. How do you extract that information so that you can put it in a differential diagnosis so you can start by creating a framework How to stabilize if it is in an emergency room so that you can have the vital signs and so on and you buy yourself time to extract more information. How do you document that information that we've had with patients but that we've so far learned how to handle? And now we came today to how do you interact with the different types of patients, the quiet one, the talkative one, the emotional one, the angry one, in order to extract information but with kindness and with empathy. And if you wish, you can use the reactions, right? I'm going to share my screen so you can actually see. Okay, so here's my screen. So at the bottom here, you can use reactions. For example, this. Or you can choose to look for the question mark. Or you can choose to say that you loved what you heard. So use reactions or use the chat box right here. Amelet, or you can come off mute and speak to me. I have to share with you that I always look forward to these moments. It is 5 o'clock in the morning. This whole week, So I started last Monday and I'm going there today. And unfortunately, it's a long, long, long days. But even then, I woke up early today and I was looking forward to meeting with you and to give you this, insha'Allah. So let's put something more visual in front of us. When we are talking about communicating with empathy, everywhere you go, inshallah, if you have the chance to go somewhere else, um, in order for you to, um, continue your medical studies what you will see is that we call everything patient-centered. I am a huge advocate for patient-centered. Sometimes what we do is we just keep giving you more information, more scientific information. Sometimes in our learning and how big this is, we forget that there's a human being in the middle. I will tell you an example. Social media, something happened. My father is dealing with water in his chest. And we did a procedure where we removed the water so the lung expanded and he could breathe. Then the fluid came back. And so we did a catheter that we left permanently there. And every day we remove some of the fluid so he can breathe. And Baruch Atah, Tabiba, let's do a CT scan. To follow up on the previous one and make sure that the lung has reinflated. Fa'alitli ahnam al nalu al x-ray and we see that it is inflated. Fa'ikla bas he has pain when he breathes and when they remove the fluid he has this and he has that. If your patient has symptoms and your test does not go with what the patient says, meaning the X-ray looks normal. You have to believe the patient, not the X-ray. So can I please have a CAT scan? So she said yes. Then after an hour, El-Momarid, Hakim, I, the telephone, and he was telling me, why are we taking him to CAT scan? He's in pain. And I'm like, well, okay, I'm sorry, we need a CAT scan to know why he's in pain. Yeah, but if he's in pain and he's terminal and he's dying, why can't we just give him morphine? Yeah, I mean, the morphine, we thought morphine is a drug. You just want to drug my father until he's no longer here? No, we need to understand why he's not comfortable so we can make him comfortable. Morphine is one of many things that make somebody comfortable. If I didn't do the first scan, I would not have known about the liquid. I would not have put a catheter that is helping him now. So we need to understand in order for us to help. And this is what I mean by patient-centered, that we're not following always what the system tells us to do without any thinking. So I hope that this helps understand the patient-centered. Um, when we talk about communication with empathy, it's not about what you think you're doing. It's about how it is felt by the patient. For I gave you already two things that would help, and those are Mirroring and validating. Let's talk about some more. First of all, before I discuss about anything else, why is it important I gave you an example that medicine is fast, and sometimes you see patients and then your attending calls you for another patient because they just came in, and the nurse downstairs calls you for another patient who's having shortness of breath, and you run from one to the other. You feel that you are rushed, but imagine how the patient feels if you come in and you just ask two questions like you are. And then you leave. And then hasn't it happened to you before where someone rushes you and then they leave and you're like, oh, man, I meant to ask them this question. Why didn't I ask that question? The patient feels rushed. You are rushed. So when you are using empathy, it sometimes can bridge that gap. What is one other example that I use for patient-centered encounter. Had an example, ta'alemtu, mean one of my mentors. She did one time an exercise, and I encourage you to do it. Even I said to myself, I'm only going to try it in my head. I don't need to do it physically in order to understand what she means. And the example was, She said, I want you to sit on the floor and I am, as an adult, gonna come over you and I'm going to not say a word. Not one voice is gonna come out of me. I'm gonna act, hamathil, I'm gonna act as if I was speaking, but you'll only see my face. You will not hear my voice. And as soon as she started talking, I was like this, and I looked at her above me, and her face, because she started to scream but silently, became very tense, and it looked like she was yelling at me, and she was scary. And when she, when we finished, she says, what do you feel? I'm like, I have never experienced this before. She says, you have. When you were a child. I said, well, that's true. So if you don't realize it, you have to put yourself in the patient who is in a bed and you're over them and you're speaking to them and you realize that there's noise. They are, their hearing is not the same because they are elderly and you start to speak, your face becomes grimaced and you start to become aggressive. Without knowing. The action is different. So what I started to do, I will pull up a chair or sit at the edge of the bed or even on the floor. Believe me, putting my knees on the floor does not take away doctor from me. Nobody lacks respect for me because I sat on the floor to speak to the patient. but at least my eye is at the level of the patient's eye. And if I want to speak and my patient can't hear me, I come close to their ear to speak, and then I pull away to see their answer. And I do that multiple times. That helps me remain calm and my voice is heard. Without appearing aggressive and over and rushed and everything else. That helps the patient feel close. Now, there is one thing that I will tell you from my perspective. I always have something in my pocket because if I'm going to come close to the patient's ear, I want to make sure that my breath is not bad. The person who listens to you is going to hear you in a much better way. So we talked about mirror and validate. We talked about the body language, how if you are at the level of the patient, how if you come closer to speak to them, What it means, what it means is it's patient-centered, means you understand the patient agenda before you bring yours. And I remember this story. I walked in to see a patient and I said, how are you doing today? She says, well, why don't you tell me how I'm doing today? I said, what do you mean? She says, well, all of you doctors come in, No one is interested in what I'm feeling. Everybody's just interested to tell me what they think I should be feeling. And I just, you are right, but I really mean it. How are you feeling? And I sat down to hear, well, I'm tired and my children needs me, but I'm here and they are making breakfast for themselves. And she wasn't even worried about the pain that she had. She was worrying about her children. And people, when they ask, when they share this with us, we sometimes make the mistake of wanting to fix it. She wasn't asking you to fix it. She just wants to be heard. Somebody hears her and mirror and validate and say, if I were you, this would be very difficult on me. I have no idea how you do it. But if there's anything you think I can be helpful with, please tell me what it is and I'll help with it. I'm here to tell you two things, and maybe we can speed them up so that we can get you home early. What do you think? Then she was ready to listen to me. Bad. And I listened to her. Yes? What do you guys think? I'm looking at the chat. I don't see anything. That's great. So that means I'm doing okay. So we are going to continue. Inshallah. Okay, what it's not. What it's not sometimes, nice just to be nice, and that sometimes can be fake, and that sometimes can destroy trust. Abdur Rabbi, ana lamakunt lissam min khadrig min kulithat thib. I had an accident and it was a bad accident and I fractured my head. I had to have surgeries and so on. And my friends used to come in. They're my friends. And I would tell them, scared, look what happened to me. What's going on? Am I going to be okay? They say, yeah, that you're going to be okay. When in fact I heard later, I will know that they were talking about me having brain surgery the next day. And don't be nice for the sake of being nice. Be truthful. So agree with the patient with everything the patient says. Not always. I sometimes say, I hear what you're saying, and to share with you that I heard you, What you heard me say is that, inshallah, with the surgery, all of the cancer will be gone and you're going to be back to being yourself. What I am sharing with you is I will be surprised if you go back to being yourself. So those are some sentences that I started to use instead of saying things that feel very hard for us. I started to use sentences like this. When someone says to me, am I going to live? I say to them, well, I'm not God, but I would be surprised if this was it. I think that you still have some distance to go, but I can't be God. So let's try and see what happens. Or when somebody says to me, how long do I have with this cancer? Well, I'm not God, and I will be surprised if you're around for Hajj. And that gives them somewhat of an idea. I don't tell them you will die. I don't tell them 3 months. I don't tell them. I just say I would be surprised and I would celebrate with you if you are still with us. Does that make sense? So those are some ideas, some words that I use to signify to people what I'm trying to tell them. You cannot spend unlimited time on every visit. What I teach my students and residents is the art of leaving. You have to understand you are there. In their mind, you are busy. So if you spend a lot of time there, you must not be busy. So I'm just going to keep talking. So at some point, I learned sentences that are very well— well, I'm gonna take everything you say to me and I'm gonna go put in some orders and talk to my nurse. If I stay here, then I will not be able to take care of you. And I make it into a humorous way. Or if you don't mind, other families need me for their loved ones just like you needed me for yours, so I have to go take care of them. Those sentences are very hard to come up on the spur of the moment. So what I do, I write them down. I have them on my phone or in a piece of paper, and I try them out. I rehearse them. I rehearse them. If I use them when nothing is happening, when I need them, I can say them quickly. And you don't let the patients dictate the plan. When the patient says to you, well, I want you to do this, and I want you to call this other doctor, and I want you to What you say is, what are they meaning by this? They're just scared and they want to feel taken care of. So I'm not going to do all that they're saying, but I'm gonna make them feel that I heard them. I'm not gonna lie to them, but I'm gonna make them feel that I heard them and that I'm in charge. Okay? So two interviews happen at once. You interview the disease, you interview the illness. The disease is the biomedical model he learned at school, the symptoms, the severity, the test, the physical findings. And the other one is how is the human experience of being sick, the fears, the belief, the expectations. So, a disease interview is what is wrong, the onset, the duration, the associated symptoms, the aggravating and relieving factors, the previous workups and treatments. And what about the experience? What scares them the most? How it affects their life? What they think is causing it? What they hope, how they hope they will do. They go hand in hand when you ask your patients. And the empathy is diagnostic. The patients communicate distress in many forms: anger, silence, Repeated visits, non-adherence to treatments. If somebody's non-adherent to treatment, you can't just tell them you ought to. We are not parents. They're adults. What you have to is find out, is it a systems issue? Is it GI symptoms? Are they having stomach pains? Do they forget because they are not taking care of themselves because they have a child that is sicker than them? Do they have no transportation to go get them that medication? So when you are empathetic, you go from behind you find your prejudice and your judgment, and you start to say, what am I missing? Am I making sense? Okay, so these are not personality problems. These are clinical signals. And here, you have to respond to it with curiosity rather than frustration. There is a framework, itar fi bit sama, the first 5 minutes. The first 5 minutes of an encounter are important for everything. Shuma anata. Ma anata enno, as someone, especially in the hospital, as someone who is going to see your patient, sometimes your patient is going to die if you don't do something. Sometimes they are in pain. They will be suffering if you don't do something, right? And so to them, you are carrying hope. This hope and trust are not the same thing. Just because I hope you will help me doesn't mean I trust you. So how do I earn trust in a few minutes? Believe me, it's not that hard. You trust someone who you feel is there for you. You do not trust someone who you feel is rushing you just to get the bed ready. For someone else. So you have to remove from them the conspiracy that you are there just to get rid of them. Right? So that's what I mean. I just saw a message. I'm sorry, Rola. What do you think? How can we effectively improve our listening skills? For bad luck, I'm a bad listener. Well, join the crowd. We are all bad listeners. And appreciate the effort. Absolutely. Absolutely. How do you improve your empathy and your listening? Mirroring and validating. Not listening with your mind rushing to what is the next question or how can I. Or sometimes, you tell me that you had appendicitis. And as soon as you say it to me, I say to you, oh, I had that too. And next thing you know, I start to tell you. And I had appendicitis as well. But how it comes across is I'm trying to compete with you for empathy. I'm going to try to one-up you. I'm going to tell you this is what I felt, so that's how you must feel too. So you can tell your experience to the patients, but it's bad to make them tell their own experience. And all you have to say is, I had that too. If they want to know, they will ask you. If they don't, they'll receive the message you had it to, so you must understand. You don't need to overexplain. So, they are, how can I say, ways by which we miss the empathy. For the first minute, there is no second chance in making a first impression. Khalini ul amarataniya. There is no second chance in making a first impression. Fa, how do you have the first impression is very important. Most clinicians interrupt early. These are studied. Studies show that the physicians interrupt patients after an average of 11 to 23 seconds. Smatouha? Between 11 to 23 seconds, his or her sentence. Hold your horses. I think they deserve our attention. They have been studied and timed. This is not somebody's opinion. Then The second one is they usually, patients finish quickly if they are allowed, the majority of them. The best opening, what brings you in today? I usually say, I'm listening. It's usually an open-ended question. And once you say it, you see the reaction of the patient. If the patient starts to speak a lot, then You know you have to switch to closed-ended questions. If the patient is not speaking almost at all, you have to stay with open-ended questions that invite more. And then you go into what brings you in today and you go silent. Resist the urge. I put this a lot. Resist the urge. Fight the urge to speak. Let the patient Talk. Okay, next, listening without steering. Steering, you are the one guiding the patient one direction or the other. Avoid leading questions. Manetta. And you took your medications, right? And I assume that you stopped smoking. Those are leading questions. You are pushing your hypothesis. Premature reassurance. I'm sure this is nothing. Or insha'Allah. No. Jumping to conclusion. This is a pneumonia. Interrupting when the patient pauses to think. As soon as they pause to think, um, we Arabs are very uncomfortable with silence. We like to fill silence. Let the silence fall. Let the patient start to think. And then you start to type on your computer while the patient is sharing an emotion. When somebody is sharing an emotion, stop typing, look at them dead in the eye, or grab their hand, or put your hand on their knee. I have to share with you, Allahikum fi ankhun, when you are in a state of constantly on guard, somebody's going to come from the corner, and it might not be a person When somebody asks you a question, next thing you know, it has been used against you in the past. Well, you were sleeping and you woke up with the sound of an explosion. Well, whatever that might be, you're constantly in a state of on guard. So your patience even more. For when you reach out to touch the patient, know that even though you are as well from their people as well, sharing their experience. Pay attention to a traumatized personality. A traumatized personality is always just on a fight or flight. So they have to see your hand coming close to them. You have to study the energy. And if they— if you feel that they're kind of backing up, that's okay. You can put your hand on a, on their hand because they control their hand. You can put your hand on their knee or on a shoulder. For the most part, those are things that feel a bit safe. If you are, um, even if you are a woman trying to put her hand on another woman, still these rules apply in a trauma-informed place. Can you share with me your experiences as well? Because I can only learn from what I've been through, but I could use your experiences. Have you tried to put your hand on somebody's hand or on their shoulder? Is that accepted there? How is that received? What do you guys think? I will leave you some time to type or respond, but I will continue. And if you were to feed me as well with any information, okay? What to do instead is to track the emotion as well as the fact. As you are listening, if the voice changes, if they look away, if they just they say something and they just look down, or as you are telling them about the smoking, they look away. Those are things that you need to pick up on. That's when we say empathy, because emotions are data. Okay? Emotions are data, meaning emotion is not an interruption. It is information. If there's a pause, that pause, you stop talking, you stop typing, you make eye contact and let the emotion be present. Sometimes all you need is 10 seconds of pause, and then I go back to typing or writing. And then when you see something, name it. Wow. I see you're very tired today, huh? Or when you spoke of your father, you said it felt like you were sad. It's normal to be sad. Or, wow, you seemed worried that you needed to leave quickly. Is there something you would like to share with me? Oh, my children are with the neighbor and the neighbor just texted or that they're not there, so I don't know what's happening. Stay briefly. You do not need to resolve the emotion and spend 20 minutes with it. A few seconds of acknowledgement. That's it. Okay. Naming the emotion simply. You don't need to be sophisticated. When we are scared, we turn into children inside. And children, they don't use sophisticated words. I am anxious about the potential of this happening. Good. No, I'm just, I don't feel well. I feel frightened. I'm upset. I'm anxious. I'm exhausted. Period. So if you were to make the name of that, if you that actually be— is very powerful. Accuracy beats eloquence. You don't need perfect words. You need just direct statements. And these work better than big psychological language. Okay, we already said about mirror and validate. Validation means the feeling makes sense. You don't need to agree with the reason to the feeling, but the feeling makes sense. You can validate and guide. For example, a patient believes their headache are brain tumor despite the CAT scan is negative. You can validate the fear. I understand why this worry won't go away. Headaches can be really scary. That's how you validate. I hope Rola is here. So just wanted you to know. And, uh, Melak is asking, what's the difference between empathy and sympathy? In other words, can we say sympathy instead of empathy? That's a very good question. And they are slightly different because empathy is the ability to feel the feeling that the other person is feeling. It's understanding the other person's feeling from their perspective. While at the same time staying present and yourself. I see how this feels for you. Sympathy is when you feel sorry for someone from a distance without fully entering their experience. I feel bad that this happened for you. The key difference is the empathy connects and the sympathy just observes. So Empathy here, ta'atuf, and sympathy here, shafaqa. So ta'atuf here, qadra, ala fahm masha'a al-marid min wujihat nadaru aw nadarha, wa shu'ur biha dun fukdanat tawazun. Sympathy here, shafaqa, or ta'atuf al-Atafi means inu shu'ur bil-huzn aw l-asaf tu jaahil marid, but from a distance. Without— and when you are dealing with the patients Does this make sense now? Great question, great question. Yes, I got it. Great, thank you, thank you for speaking. We're coming close to the end here. I wanted to say, I usually, I heard this recently, which is the principle of let them. Let them. You don't need to correct everything. If someone starts to talk about, you know, that there is something in the air and that something in the air is making me sick. And what you're trying to treat at that moment is the fracture of the leg. You don't need to correct them. That is not the time to start and say, come on, the air does not have radioactive material that is making you sick. And so curiosity over correction. Be curious. Let them for that moment focus on what you are doing. At some point you may go back and go there. But I like to say we Arabs come always with the finger wagging. If it's not because it's the attitude of a parent, we come up with the attitude of an imam or the attitude of, we're always teaching, we are always teaching. It's not always that necessary. Sometimes being curious over correction may establish that trust that you need for the patient to let you treat them. Okay. Excuse me 1 second. So another thing that happens is When you start your encounter by setting what are the expectations, it helps a lot. Means it makes the other person know that you're not going to fix everything. For example, and I tell them it's time to leave the ICU. I learned that I have to set the expectation at that time, which is you are leaving the ICU because you are no longer in need of intensive care. It's not that we believe you are cured. We are going to continue the plan that we talked about, but outside the ICU. 9 times out of 10, it brings the tension down. Okay? So how do you do that in the first encounter? You say to someone, what are you hoping we can help with today? This simple question makes them feel like, well, I'm hoping that you can fix me. Okay, well, I can try to do the workup to understand your knee pain, but I cannot fix you because you have diabetes, you have the heart, you have this, you have that. So you bring the expectation. Why? Because conflict and anger from patients always comes from unmet expectations. And then you say, well, that's unfair. I never said that. Does it matter? That's what they understood. It's our job to set the expectation. Another thing that I do always, the residents, they're going to start with me on a Monday. Guess what I do? I sit with them and I set the expectations. This is what the week looks like. This is when you come. This is when you leave. Around the day, these are some things going to happen. Teaching, here's when it happens. Here's how you communicate with me. If I don't answer, call me again. Do not feel bad. Please call. If there is a code blue, here's what you're going to do. I expect from you to show up every day. And if one of you is not there, the other takes over the patients. I don't need to say that. I set these expectations. Because if I don't, they'll say, well, you never told us that you expected us to be here at 8:00. So we came at 8:30, et cetera. And then you share the agenda. Here's our plan. We're going to do this. I'm going to leave now, but I'm gonna come back in about 30 minutes. In those 30 minutes, here's what we're going to do. We're gonna do imaging. We're gonna do this labs. As we come back with this, we may or may not get the answer, but we'll get some form of treatment. We'll start it with you. And then you have to adapt the empathy to different patients. Some patients are angry, the unmet expectations, or they bring baggage of previous relationship with other physicians. I met this physician, this patient, and I said, we're going to send your mom for a CAT scan. I think she's having a stroke. And we do know that she had a stroke before. And he said to me, hold on one second. Mom is not going anywhere. We were just here at this hospital last week, and the doctor there told us she did not have a stroke. I demand you call that doctor and you bring him over here right now. And so I did. I mirrored and validate. Call the other doctor from last week. I can understand if you've been told one thing and now I'm telling you another. This could be upsetting indeed. Of course it is upsetting. Don't stop talking to me. Go look for that patient, doctor. And I said, sir, if you don't mind, I can give you two options. They cannot both happen because I'm only one person. I can focus on your mom's stroke right now. And once we stabilize her and we started the treatment, we can start to go back to what happened last week because it happened last week. And it's not going to be relevant to what's happening today, or I can leave your mom right now and I can go and stop, start calling on the phone to find that other person. Which option would you like to choose? And that person looked at me and says, fine, take care of my mother, but we'll go back to this. This is not done. Like, thank you. And I walked away. Does this make sense? So sometimes you have to reframe. The quiet patient, this may be cultural, this may be fear, this may be shame. Many times when I ask someone, it's because they did not take a medication and now they feel like they've done it. Or when I ask a family and the person is on the ventilator and sedated, there's somewhere where they feel like if they brought them early that their loved one would not be this bad. So sometimes they're quiet because of fear or shame. And then a few words patient, someone who communicates with just a few words. What you do is you ask direct question. You avoid the open-ended question because they feel vague. That's usually someone who's precise. They don't like to not understand. A depressed patient, you know, the best cure, the best cure to depression or discouragement is hope. So not false hope, but hope. Hope that help is here. Hope that someone is finally paying attention. Hope that something may be done. And many times patients' families will tell me, we know that, but what we want to know is that someone cared, and that's all people want. The talkative patient, they're either lonely or anxious or both. So you need to provide structure for the kind of person. Here's how I'm going to do. I'm going to ask you for this within the next 15 minutes. I'm gonna finish and go do this. I'm gonna be away for about 30 minutes, and then I'm gonna come back. Try to respect the 30 minutes. If I don't know if I'm gonna come back to 30 minutes, I I do say 30 minutes, but I literally say, please, I'm a doctor and there's lots of emergencies. 30 minutes is not an appointment. It's guidance, but I will try to stick to it as much as possible. And when I come back, and if I'm late, I say, I apologize. This was not out of disrespect to your time, but now you have my attention. I'm listening. And you start there. I hope that makes sense. I hope it gives you some sentences to use. And then Your empathy is sometimes completely denied if you are under time pressure. So even if I have 4 minutes, I use 1 minute to pull up a chair, I use 2 minutes to speak, and I use the last minute to say goodbye. Or if you are burned out yourself. So sometimes what I did this week when I had a patient who's cardiac arrested and we did CPR and the patient was gone, I told my 2 residents, we're going to step out for 2 minutes. You can set a timer. They're like, well, we have this other patient. I said, I said, we're going to step out for 2 minutes. If that code lasted 2 more minutes, we would not find it difficult to stay 2 more minutes. So we can take 2 minutes to just step outside just for a moment so you can change the landscape and you can acknowledge the emotional trauma you just went to right now that went under our skin. Okay? You remain the clinician. The empathy strengthens the authority. You do not let the patient take charge. So I wanted at least with this to give you, um, the framework of empathy. And I think I talked about if you practice, it's gonna become your own personality. Because what do they say? Be careful for your thoughts because they become words. Be careful for your words, they become your character. Be careful of your character because it becomes your personality. And be careful of your personality because it becomes your destiny. So anything that you do repeatedly starts to embed within you. And frankly, at the end of the day, the patients will forget what we said. They will forget what we do, but they'll never forget how we made them feel. If the patient feels safe, that memory shapes everything that follows. Now, share with me your thoughts. How do you feel about this? Is this what you expected? Do you learn something from this? If you don't know what to say, maybe just tell me one thing you've learned from here that stuck with you that you did not know before. So it gives me an insight about, uh, so I can use it for the next time and the next lesson. Let's see, we have been joined by others. Any questions? Any comments? Any reactions? Any chat sentences? I'm going to give myself props. Thumbs up. Party, balloons, until I hear from somebody. Amir, tell me something, or type up something that you've heard today. Not as a quiz, just tell me what you've learned today. Tell me one thing that you've learned today. That stuck with you, or something you saw before, or an example you've been part of. Yeah, I know the reason why I kind of know some of what happened there is because other students like yourselves shared their stories with me and shared their presence and their circumstances with me. Feel free to check in with me, but inshallah, this week I will be posting both in our— I'm glad. I'm going to put some things in the chat as well as on the LinkedIn, and hopefully I will get your experiences there. I'll be asking you for any experiences that you've seen around you, that you've heard your colleagues tell you about, that pertained to empathy. Okay. Yeah. And one more thing. How was the registration? Was it easy to register and to get the link so you can join today? And for those of you who do not know, I actually have a LinkedIn page made for you. And so this LinkedIn page is Gharsat Amal. So I'm going to put the link here and all of that. Thank you, Malek. It was easy. Thank you. Here it is. And I will post a question to Hataam al Maakoun. I will put exercises. So please, as much as you can, on WhatsApp or on here, I would love to interact with you. And if you can teach me How is your circumstances? If you can tell me when you send me a message where you are, or even send me a picture of the hospital or the emergency room or the ward that you start at, or a neighborhood you are in, it just gives me a visual. So I get to learn about you. Insha'Allah. Insha'Allah. Allah take care. Salam alaykum.