Reflective expressive writingLet’s start with a rhetorical proposition.

Imagine there is a new pill. Anyone who takes it experiences happiness forever after. Would you take this pill? Do you want to be happy forever? If you did take it, how long would you retain the concept of happiness?

Just as facing into glorious sunshine means we have a shadow behind us, our moments of basking in true happiness are most likely to exist where darkness lies somewhere in our past.

As we come to the end of 2017, I’ve been reviewing my Oxford Medical Insights blogs from this year. The item which created most discussion, by far, was Detach or Connect – A Medical Dilemma. This piece was written in response to the words of Dr Helgi Johannsson in the BMJ in the aftermath of the Grenfell Tower disaster. Dr Johannsson stated, “I feel I am a better doctor for giving myself permission to stop, reflect on what has happened, an to grieve.”

The problem.

Re-reading my blog, I can see that I make the case for emotional connection with patients. This was welcomed by many doctors. Practicing with detachment is a simplistic, short-term approach with problematic, long-term consequences. It can be compared to an attempt to take the magic pill described above. Empathy fosters connection. Connection fosters trust. Trust increases efficiency and quality of outcomes. To paraphrase Steven R Covey, “Change happens at the speed of trust.” However, I can also see that there was not much offered in the way of how to achieve this.

Over the past few months, the need for practical solutions in achieving this became more and more apparent. During a seminar at the Leaders in Healthcare 2017 conference, patient communication experiences were being discussed. The good, the bad and the ugly. The sentiment that empathy can’t be taught was heavy in the air. In another situation, during an Advanced Patient Communication Skills Course, one doctor stated, “I cannot be weeping in the corner when there is a crisis to be dealt with.” It can be difficult to have the alternative message heard.

Seeking a solution

In finding a solution we have to start with belief. If it is possible to learn emotional detachment then it must also be possible to learn how to practice with connection. But how?

Let’s return to the full quote from Dr Johannsson which I used in the original blog:

“I am much more emotionally affected now than I was on the day. Some would say we must remain emotionally detached and equate that with professionalism, but I am human. I feel I am a better doctor for giving myself permission to stop, reflect on what has happened, and to grieve.“

It helps to read this alongside the words of Viktor Frankl:

Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and freedom.

But where is that space? Our primitive emotional reactions kick in five times faster than our thoughtful, rational and logical processes. Our autopilot reactions are even faster still. So where is the space to create emotional control and empathic connection? It is unlikely to be in the heat of the present of an intense or critical situation.

One solution will be familiar to the majority of doctors but under-utilised by many. Since the mid-80’s, James Pennebaker has championed expressive writing as an approach to supporting people to deal with traumatic situations. Reflective, expressive writing is an excellent example of utilising the space which Frankl describes. Its a means of effectively re-programming our autopilot and nurturing constructive quick-fire emotional responses. Numerous studies by a variety of researches in a broad range of fields have explored the positive benefits that it can have. Expressive writing by patients has been found to improve feelings of well-being, reduce numbers of appointments and even promote improved wound healing.

But that’s patients and ‘other people’. What about doctors? Well its probable that you will have been introduced to the concept of ‘reflective practice’ in the earliest stages of your career. You will write reflective learning statements to support your CPD. You will produce a wealth of reflective documentation to support your progress and appraisal processes. Unfortunately, what is intended as a powerful tool to support development can become under-valued. For too many it has become an unwelcome, repetitive, perfunctory requirement. Any tool used with a lack of understanding, care or attention is likely to offer poor results. In contrast, when placed in the right hands and used with skill, the results can be something special.

Pennebaker’s approach is remarkably simple:

  • Set a timer for 15 minutes, (some people prefer to do 20 minutes)
  • Write about your experiences over the past week
  • Go where your mind takes you with curiosity and without judgement
  • Keep writing for the full time
  • Write only for yourself
  • When the time is up, feel free to throw it away what you wrote or store it away to re-read in future

Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and freedom. You would be unwise to take the forever happiness pill. The positive alternative is a prescription for regular genuine, reflective, expressive writing.

Stephen McGuire – Head of Development