The Crying Patient – Another Role Reversal
Recently, I wrote about my experiences of trying to comfort a patient who was in tears. Whilst it isn’t all that difficult to appreciate what a patient is going through, it is impossible to know the full extent of it unless we have been through that situation ourselves. It may sound obvious, but it’s something that we often forget.
Seeing Mr X, the patient described in my other blog post above, did hit a nerve with me. I did feel awfully bad for him, and for his situation. I saw what it was like to be the doctor (or, in my case, the medical student) in a situation like that one. However, I forgot about what it was like to be the patient in that situation, until today. I myself was having a regular appointment with my psychologist when, for the first time in a while, I burst into tears in front of them.
There was a lot to reflect on in this situation with my psychologist. Things that I can, hopefully, apply to my own consultations with patients.
Here are some lessons that I learnt/was reminded of.
As always with posts like this one, some details have been changed.
The ‘hiding’ face
None of us like to cry in front of others. It doesn’t matter how close someone may seem to us – we always try to avoid it. I don’t know why. Perhaps it goes back to the whole mental health stigma, and the crying being seen as an act of weakness. Not that I think it is an act of weakness, of course, but maybe that’s just the way we are programmed to think.
It is no exception with our healthcare providers. No matter how close we feel with them, or how much we trust them, we don’t want to burst into tears in front of them. And so, with my psychologist today, when we were discussing a sensitive topic, I tried to put on a brave face initially. This just ended up looking extremely unnatural to the point that my psychologist saw through it.
“I can see you look rather upset. Are you OK?” is what my psychologist asked.
Of course, I wasn’t. I ended up crying when that question was posed. I am, however, glad that my psychologist asked me. For starters, the sensitive and understanding way in which she said it almost gave me permission to cry. Not only that, but it was difficult maintaining a brave face! In fact, I was so occupied with wanting to keep a straight face that I wasn’t able to express myself properly in the appointment.
It’s funny. We often don’t want our patients to cry, for many reasons. But in cases when they are upset, maybe just making it clear that it is OK to cry and letting them can be helpful.
While in tears, I was embarrassed! This was the first time that I had ever started crying in front of my current mental health team. I had also cried once before whilst I was a psychiatric inpatient, but that was years before. In that instant though, the team had been different.
This time around, it was as though I had burst into tears for the first time in front of friends who had never seen me in tears before. I was mortified. In the case of Mr X, where I was on the other side, I felt embarrassed again. That time, however, my embarrassment came from feeling as though I had invaded his personal space. Well, the embarrassment I felt then was nothing compared to this.
That is something else which I feel is a very important lesson for me. No matter how scared we may be, the patient will always be feeling much worse than how we do. In my case, it was made better by the psychologist saying: “Don’t worry, let it all out,” and just giving me time to readjust myself. It is much better to acknowledge it than to pretend like nothing is happening. That way, I felt as though I really was being listened to as a human being.
At last, I took a deep breath and wiped away the last tear. I looked at my psychologist in a rather sheepish sort of way, before saying: “Sorry.”
Her response was to immediately say that I had nothing to apologise about. After checking to make sure that I was OK and if I needed anything else, she asked if it would be OK to continue with the appointment. It was completely fine by me, and we then continued as though nothing had happened.
I really liked that approach.
By first asking if I was OK, it made it clear to me that she did want to make sure I really was fine. Then, by continuing with the appointment as though nothing had happened, it made me feel less embarrassed. The last thing I wanted at that stage was for her to start talking differently, for I too wanted to forget the crying experience as soon as possible.
It’s a fine line, as I learnt with Mr X. On the one hand, you can’t change the subject immediately, making it seem as though you feel awkward by their crying. On the other, you can’t stay on the subject, for the patient will want to forget about it too ASAP.
None of these experiences as a patient are particularly nice. However, if there’s one good think about them, it’s that it gives me a full flavour of what it actually is like to be a patient. I hope to adapt that all to my own practice. Having said that, it is also important to realise that not all patients are the same. Just because one thing works for me does not mean it will work for another.