Social & Psychological Elements Are Vital to Rheumatology Care

Talk to Your Patients

Ms. Rose said one clinician recently did not want to prescribe infusions to a patient who routinely missed appointments, worrying the patient wouldn’t be able to maintain the rigorous infusion schedule. But Ms. Rose suggested the doctor take the time to talk to the patient.

The clinician told the patient she thought an infusion might work best, but added, “I know you have had trouble getting to your appointments in the past. What do you think about this?” The patient said she didn’t want steroids any longer. “I am concerned about you getting here on time each week for the next six weeks,” the clinician continued.

The patient said, “Well, this is important to me. Since it’s only six weeks, I can arrange with my daughter and her husband to pick up my grandchild, so I won’t have to pick her up and be late.”

“That sounds like a plan,” the clinician said.

“It took a little bit of time,” Ms. Rose said, “to assess and to share and to come to a decision together where the clinician assessed what was valuable to the patient.”

Empathic Care

Ms. Batterman

Adena Batterman, MSW, LCSW, senior manager of inflammatory arthritis support and education programs at the Hospital for Special Surgery, said rheumatic disease has a profound impact on patients physically and emotionally. Patient-centered, empathic care, therefore, must to pay attention to both.

“Each patient who walks into our office has their own unique story and background, so we must broaden the focus of our inquiry and discussion like the lens of a camera,” Ms. Batterman said. “It requires adjusting and widening the field of vision.”

Healthcare providers must be attuned to subtle clues embedded in speech, the stories patients tell, non-verbal communication and health behaviors, she said. These clues can reveal vital information about unresolved feelings about the illness and treatment, unspoken fears about their condition, or depression and anxiety, she said. Understanding and acknowledging the patient’s full experience is essential to developing trust in patient-provider relationships, and positively impacts treatment discussions.

Picking up on patient clues requires “active, empathic listening and observation,” and being in-the-moment during the patient encounter, she said. Sometimes, this can be as simple as pausing after describing an aspect of treatment, rather than rushing on to the next point. Research has found this tactic effective.²

“When physicians acknowledged the emotions of the families and allowed a pause, rather than quickly continuing the discussion about treatment, families were significantly more likely to share concerns, hopes and values,” she said.

Mental health issues, such as depression, are more prevalent in inflammatory arthritis patients and can affect not only relationships and quality of life, but also limit treatment efficacy and adherence and contribute to long-term disability, pain and mortality, Ms. Batterman said. She underscored the need to engage a multi-disciplinary team, and to assess and treat, and provide support and education around these issues.

Providers must take care of themselves, too, by maintaining activities outside of work, talking to friends, colleagues and family, getting enough sleep and exercise, and creating space for colleagues to share support in processing sometimes difficult and challenging feelings related to caring for chronically ill patients.

All of this helps clinicians connect with, and be present with, their patients, she said.

“Examining our own experiences and backgrounds, and how these influence our perspective, is an integral part of empathic care,” Ms. Batterman said, “and benefits both patient and provider.”