ACKNOWLEDGING EMOTIONAL REACTIONS IN NEWLY DIAGNOSED PATIENTS AND THE ROLE OF HEALTHCARE PROVIDER COMMUNICATION IN SUPPORTING PATIENTS
by Oscar Oglina

Creative Piece

Inspired by the work of Andrew Salgado, I believe this piece of artwork embodies the emotional distress and sense of confusion provoked by a diagnosis. From the viewpoint of a doctor, the painting depicts a patient’s emotional reaction to his diagnosis and prognosis. I have depicted the patient with a puzzled and confused expression, highlighting his shock to being clinically labelled with a condition and feeling lost in this new and daunting chapter of his healthcare. In regards to the composition, I actively chose not to paint a full face to suggest the patient is hiding and withdrawing. This disengagement foreshadows him withdrawing from society and a reluctance to accept his diagnosis and prognosis as if he is ashamed of carrying with him an illness/condition.

The rushed and imperfect style of art aims to convey both the physical and biological disruption of the body, whether that is a visible or non-visible condition. Likewise, it highlights the sense of mental chaos and disorder that include stress, anxiety and isolation. In addition, the rough and static brushstrokes aim to convey the sense of distortion and uncertainty associated with carrying a clinically label and dealing with a poor prognosis. The use of bright and somewhat abstract colours gives a sense of abnormality and unfamiliarity, giving connotations to disease and the invasion of organisms alien to the human body.

EMOTIONAL REACTIONS IN NEWLY DIAGNOSED PATIENTS

Ultimately, when faced with a diagnosis a patient must face up to a possible poor prognosis and/or be forced to reconsider their lifestyle and plans for the future. This can be emotionally taxing. Notwithstanding this, a patient may also feel daunted, facing possible stigma or prejudice against their health condition, which in turn could induce stress. For example, a patient with a physical disability/impairment may fear facing ‘discredited stigma’- a stigma that is clearly known or visible1.

Alternatively, someone with a non-visible condition may become stressed about experiencing ‘discreditable stigma’ - a stigma that is unknown and can be concealable1. This may possibly lead to ‘passing’ - where patients manage their identity and try to pass of as ‘normal’2.

A study held by Gerhard Nijhof found that people with Parkinson’s disease described how the sigma of having trembling, shaking limbs, incoherent speech, and constant dribbling had led some to withdraw from public and seclude themselves3. These symptoms are frequently mistaken for alcohol abuse; hence, patients may also fear judgment and prejudice that comes with being associated with a different illness.

Moreover, a clinical label can have a detrimental affect on the self-esteem of a patient and their body image, whether the condition is visible or not. A physical impairment or visible condition (such as obesity or skin cancer) can make a patient feel not themselves and a somewhat level of shame for being ‘abnormal’. Ultimately, a fear of deviating from the social norm may force people into ‘passing’. Nonetheless, a poor level self-esteem can result in feelings of sadness, anger and possibly guilt if their condition is perceived as self-induced. When a patient’s self esteem is threatened by a negative event, they may develop increased levels of anxiety that may only be worsened when comparing themselves with other healthy individuals4.

DEALING WITH A DIAGNOSIS

Effective and clear doctor-patient communication is an important factor in the delivery of high-quality health care and building a therapeutic and supportive relationship between the clinician and their patient. An open conversation and shared decision making can be instrumental factors in keeping the patient calm. whilst adopting a positive mind set. In order to do so, doctors must recognise the emotional reactions of patients. Patients preoccupied with their emotions or suppressing their feelings cannot focus and listen properly; therefore, cannot make an informed decision5. Hence, talking about feelings is a way of honoring and normalizing their emotions.

Healthcare professionals play a vital role in the management and care of patients both in regards to their healthcare, but also their emotional and mental wellbeing. When faced with adversity, patients naturally react with a range of emotions. Hence, recognizing and dealing with the emotional reactions of newly a diagnosed patient is vital for effective and efficient healthcare.

Oscar Oglina, Whole Person Care, Year One, 2017

REFERENCES

1 Chaudoir S. et al “Discredited” Versus “Discreditable”: Understanding How Shared and Unique Stigma Mechanisms Affect Psychological and Physical Health Disparities. Basic Appl Soc Psych. 2013; 35(1): 75–87

2 Goffman E. Stigma J.Aronson New York

3 Nijhof G. Parkinson’s disease as a problem of shame in public appearance. Sociology of health & illness. Vol.12 Issue 2: 193-205; 1995.

4 Leite M. et al Evaluation of self-esteem in cancer patients undergoing chemotherapy treatment. 23(6): 1082–1089; 2015

5 Just Got Diagnosed. McClain GR. Acknowledging Emotional Reactions in Newly-Diagnosed Patients. 2012 Available from: http://justgotdiagnosed.com/resources/professionals-acknowledging-emotional-reactions-newly-diagnosed-patients/