COMMUNICATION AND EMPATHY WITHIN PERSON-CENTERED MEDICINE: A DEVELOPMENTAL POINT OF VIEW
AbstractCommunication between patients and health care providers (HCP) is at the heart of medicine and even more within its person-centered paradigm. Within a person centered medicine (PCM) perspective, it is thus crucial, for both the HCP and the patient, to build on a relationship with the objective to establish a therapeutic alliance and share decision making related to the patient’s health issues and to integrate the subjective aspects (and not only the objective aspects) of these healthIssues.After showing that the effects of communication go beyond mere cognitive and affective sharing, particularly in highly emotional relations, this paper’sobjective is to understand more thoroughly what is transmitted in the patients/HCP relation and how some of the child and adolescent developmental psychiatry processes (i.e., early mother–baby interactions and transgenerational transmission of attachment) provide good models to understand this transmission.Building on these models, the paper will discuss how and at which conditions, the HCP’s narrative empathy plays a major role to access to the patient’s subjectivity through the HCP’s subjective experience.It concludes that, therefore, subjectivity of the HCPs should not be seen as a negative side effect of the patient–HCP (or the patient–team) relation but as a crucial clinical tool in person-centered diagnostics and cares if HCPs are properly trained and educated to use their feelings and representations as tools in individual or collective deliberations. But one has to be aware that there is no empathy without subjectivity.
McCormack B, Dewing J, McCance T. 2011. Developing Person-Centred Care: Addressing Contextual Challenges through Practice Development.Online Journal of Issues in Nursing 16 (2): 3.
McCormack B, McCance T. 2016. Person-Centred Practice in Nursing and Health Care: Theory and Practice, (2nd ed), Wiley Blackwell, Oxford.
Eide H, Eide T. 2007. Kommunikasjon i relasjoner. Samhandling, konfliktløsning, etikk [Communication in Relationships], (2nd ed), Gyldendal Academic Press, Oslo.
Bensing JM, van den Brink-Muinen A, Boerma W, van Dulmen S. 2013. The Manifestation of Job Satisfaction in Doctor-Patient Communication: A Ten-Country European Study. International Journal of Person Centered Medicine 3: 44–52.
Smith-MacDonald L, Venturato L, Hunter P, Kaasalainen S, Sussman T, McCleary L, Thompson G, Wickson-Griffiths A, Sinclair S. 2019. Perspectives and Experiences of Compassion in Long-Term Care Facilities within Canada: A Qualitative Study of Patients, Family Members and Health Care Providers. BMC Geriatrics 19 (1): 128.
Babenko O, Mosewich AD, Lee A, Koppula S. 2019. Association of Physicians’ Self-Compassion with Work Engagement, Exhaustion, and Professional Life Satisfaction. Medical Sciences (Basel) 7 (2): 29.
Cosnier J. 2014. Communication et empathie [Communication and Empathy]. In: M Botbol, N Garret, & A Besse (Eds). L’Empathie au Carrefour de la Science et de la Clinique [Empathy at the Crossroad of Science and Clinics], Doin, Paris.
Marvel MK, Epstein RM, Flowers K, Beckman HB. 1999. Soliciting the Patient’s Agenda. Have We Improved? Journal of the American Medical Association 281: 283–287.
Van Dulmen AM, Bensing JM. 2002. Health Promoting Effects of the Physician-Patient Encounter. Psychology, Health & Medicine 7: 289–300.
Langewitz W, Denz M, Keller A, Kiss A, Rüttimann S, Wössmer B. 2002. Spontaneous Talking Time at Start of Consultation in Outpatient Clinic: Cohort Study. British Medical Journal 28: 682–683.
Bensing JM, Dulmen AM van, Tates K. 2003. Communication in Context: New Directions in Communication Research. Patient Education and Counseling 50: 27–32.
Lebovici S. 1999. Arbre de vie: Éléments de Psychopathologie du Bébé bébé [The Tree of Life: Principles of Infant Psychopathology], Eres, Toulouse.
Berthoz A. 2009. La Simplexité. Odile Jacob, Paris.
Emde RN. 2016. From a Baby Smiling: Reflections on Virtues in Development. In: J Annas, D Narvaez, & NE Snow (Eds). Developing the Virtues: Integrating Perspectives. Oxford University Press, Oxford, pp. 69–94.
Bowlby J. 1999 . Attachment. Attachment and Loss (vol. 1). (2nd ed.), Basic Books, New York.
Fonagy P, Target M. 2005. Bridging the Transmission Gap: An End to an Important Mystery of Attachment Research? Attachment & Human Development 7: 333–343.
Botbol M. 2010. Towards an Integrative Neuroscientific and Psychodynamic Approach to the Transmission of Attachment. Journal of Physiology-Paris 104 (5): 263–271.
Iacoboni M. 2009. The Problem of Other Minds Is Not a Problem: Mirror Neurons and Intersubjectivity. In: J Pineda (Ed). Mirror Neuron Systems, Humana Press, New York, pp. 121–134.
Fonagy P. 2001. Développement de la Psychopathologie de l’Enfance à l’Age Adulte: Le mystérieux déploiement des Troubles dans le temps. La psychiatrie de l’enfant, 2 (44): 333–369.
Shore R. 1997. What Have We Learned? In: Rethinking the Brain, Families and Work Institute, New York, pp. 15–27. P 21. Botbol M, Lecic Tosevski D. 2013. Person Centered Medicine and Subjectivity. In: JHD Cornelius-White, et al. (Eds), Interdisciplinary Applications of the Person-Centered Approach, Springer Science+Business Media, New York.