Of the many potential barriers to effective patient-physician communication ( Table !), the most important is the health professional him- or herselfA6!7 and !8> Although practising primary care is stressful because of the rapid pace and an obligation to accommodate patients' demands at inopportune moments, health professionals must meet these challenges by being empathic, assertive, and respectful. This is more easily said than done.
Table 1 Challenging situations in the consultation
Being empathic is a first step in developing a patient-physician relationship. Empathy is defined as the ability to reflect accurately the inner experience of another person. It allows the clinician to open the door to patients' emotions. Despite their belief that empathy is important, physicians often are not empathic. (!9> In order to express empathy, the physician must be courageous enough to tolerate and accept patients' feelings, secrets, and fears, and be willing to reveal feelings and emotions to the patient when it is appropriate and useful. Empathy requires patience. Physicians' emotions—anger, irritation, sympathy, attraction—interfere with their ability to be patient, and to listen to what their patients are trying to express. By cultivating the capacity to be aware of their own emotional reactions, physicians can fulfill their moral obligation to be respectful, that is, to put the patient's human dignity above their own values and needs. Physicians who are confident yet know their limitations can face difficult situations with flexibility and humility. An assertive positive attitude can help the professional avoid feeling aggressive, passive, or defeated, and maintain serenity. Without denying his or her emotions, or suppressing countertransference, the physician can 'recycle' feelings in a positive way. (29
Allowing the expression of negative emotions in the patient-physician relationship has been associated with improved outcomes. (9) This 'emotional friction' is often perceived positively by patients as a marker of genuine caring. A psychiatrist can assist the primary care physician by normalizing and facilitating the patient's expression of emotions. This is especially helpful when the physician is overwhelmed or experiencing burn-out, and allows the physician to recast a positive relationship with a patient.
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