Making your skills sustainable

I was trying to explain what happens at a VitalTalk course to a savvy clinician last week. “I’ve heard all that stuff” she said, “my issue is the families who are so demanding & unrealistic. The ones who just don’t get it.” She’s onto something—the question that every doctor or nurse faces at some point is: what do you do when the demands are escalating, yet you're tired?

While we can't control the demands that come our way, what we can control is how we respond to the demands. An oncologist, Andy, who just finished a VitalTalk course wrote us: "[I] saw an upset patient because I was running late and discussing her new diagnosis of breast cancer (I treated her three years ago for anal cancer). [Her] husband [was] really mad at me for being late [he said] 'no one cares…[this is] unacceptable.' I ROLLED WITH THE RESISTANCE and didn’t feel threatened by it. That was liberating.”

What he’s talking about is a skill we’ve adapted from the world of motivational interviewing—they call it rolling with resistance.* We usually call it just ‘rolling’ because in the context of serious illness, the issue isn’t ‘resistance’ but rather big emotion—that husband was angry, frustrated, and hurting. A less-skilled clinician might have responded with irritation (‘I’m not that late, this anger is not justified’) or   feeling overwhelmed (‘Yikes i’ve got just too much to do’) or by standing in the patient’s shoes might be sucked into empathic overload (‘I can see you’re overwhelmed and…now i’m overwhelmed too…’).

Andy had learned to step back from the husband’s emotion and see that it was not about him. Then he used a skill to verballly acknowledge the anger without trying to fix it. He drew on the backlog of micro-moments of resonance he had built with this couple from their prior relationship around breast cancer therapy, so that he could stay present to express his caring for them. The result,  his words: ‘liberating....really important for me and for [my] sustainability...I'm having more fun and less stress.

[The motivational interviewing people have changed their terminology too, to avoid labeling patients as resistance]