Support

Support is a response that indicates an interest in or an understanding of the patient. Supportive remarks promote a feeling of security in the doctor-patient relationship. A supportive response might be ''I understand.'' An important time to use support is immediately after a patient has expressed strong feelings. The use of support when a patient suddenly begins to cry strengthens the doctor-patient relationship. Two important subgroups of support are reassurance and empathy.

Reassurance

Reassurance is a response that conveys to the patient that the interviewer understands what has been expressed. It may also indicate that the interviewer approves of something the patient has done or thought. It can be a powerful tool, but false reassurance can be devastating. Examples of reassurance are the following:

' 'That's wonderful! I'm delighted that you started in the rehabilitation program at the hospital.'' ''You're improving steadily.'' ''That's great that you were able to stop smoking.''

The use of reassurance is particularly helpful when the patient seems upset or frightened. Reassurance must always be based on fact.

Empathy

Empathy is a response that recognizes the patient's feeling and does not criticize it. It is understanding, not an emotional state of sympathy. The empathetic response is saying, ''I hear what you're saying.'' The use of empathy can strengthen the doctor-patient relationship and allow the interview to flow smoothly. Examples of empathy are the following:

' 'I'm sure your daughter's problem has given you much anxiety.'' ' 'The death of someone so close to you is hard to take.'' ' 'I guess this has been kind of a silent fear all your life.'' ''You must have been very sad.''

' 'I know it's not easy for you. I'm delighted to see that you're trying to eat everything on your tray.'' ''That's wonderful that you have stopped smoking.''

The last two examples illustrate an important point: giving credit to patients to encourage their role in their own improvement.

Empathetic responses can also be nonverbal. An understanding nod is an empathetic response. In certain circumstances, placing a hand on the shoulder of an upset patient communicates support. The interviewer conveys that he or she understands and appreciates how the patient feels without actually showing any emotion.

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