Wednesday, January 09, 2008

Learning -- and teaching others -- to care

"What's so hard about caring? I'm a good person, I care? Why do I need to have training to visit people in a hospital?"

These are some of the kinds of questions I hear sometimes from folks who are interested in doing work as a chaplain. There was a really good article in the New York Times recently that was a good reminder of just how challenging the business of being caring for people can be. The article is about the oncologists -- the doctors who care for cancer patients. The problem is not that oncologists don't care -- they do, according to a recent study cited in the article -- but that they don't know how to express that caring.

Where the caring breaks down, especially, is when a patient expresses a fear about death or about his or her illness, the study says. Doctors, too often, miss this cue and respond in a way that patients experience as dismissive of their fears and emotions:

The researchers recorded 398 conversations between 51 oncologists and 270 patients with advanced cancer. They listened for moments when patients expressed negative emotions like fear, anger or sadness, and for the doctors’ replies.

A response like “I can imagine how scary this must be for you” was considered empathetic — a “continuer” that would allow patients to keep expressing their emotions. But a comment like “Give us time; we are getting there” was labeled a “terminator” that could shut the patient down.

The team found that doctors used continuers only 22 percent of the time. Male doctors were worse at it than female ones: 48 percent of the men never used continuers, as opposed to 20 percent of the women.

That sounds like bad news. The good news however, according to the study's authors, is that it's not that hard to teach doctors how to be more caring and that it doesn't mean that they have to spend a lot more time with their patients.

[M]ost doctors can be taught to respond in more helpful ways. Brief, empathetic responses will suffice, the researchers said; they are not recommending extensive counseling or endless dialogue.
The idea that it doesn't have to take a lot of time for doctors to be caring with patients (and that it is a skill that can be taught to doctors) is something I have written about before (God in five minutes or less). Barry Bub in his Communication Skills that Heal does a wonderful job of writing about this from a practical perspective for doctors.

Of course, Clinical Pastoral Education (CPE), itself, is founded on the idea that being caring with people is indeed something that can be taught. It is something I believe very strongly and it is why I have committed so much of my current time and energy toward training to be an educator -- which we call a supervisor -- in CPE.

And the article is a reminder to me about how I think about modern chaplaincy. It reminds me that most of the actual caring in the hospital is not provided by chaplains themselves (doctors and nurses do that). But someone needs to form the center for caring, to be the reminder for people -- the catalyst, the educator, the motivator -- about the importance of caring and just how it can be done. And that is something the chaplain really can be the expert at. We are the people who immerse ourselves in questions of ultimate importance for people -- the questions that create meaning and significance for people. And we are the people who develop the expertise at helping people in the midst of crisis and death -- the very times when these questions of ultimate meaning and significance are most in focus for folks.

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