Empathy has at its goal imagining how it feels to be in another person's situation, and to focus attention on the patient. 

 Source: PDF page 2

Emotional attunement operates by shaping what one imagines about another's experience. 

In clinical practice, the challenge is to use skillful attunement, not in leisurly fantasy, but in multiple, rapid, ordinary clinical interactions, and to take cues from a patients tone (pg. 2-3)

The clinically empathetic practitioner will:

• take cues from the patient's tone
• think if the patient may be angry about the medication's side effects.
• think if the patient feels hopeless about getting well
• think if the patient thinks the meds are useless since she feels asymptomatic. 

Emotions guide thought by linking by linking one idea to another in an associative way. 

We link ideas that have affective, sensory, and experiential similarities. 

Why isn't "logic" enough when taking a comprehesive patient history?

What should logic be supplemented with when performing a patient history?

Because the cognitive tasks physicians face are at least as complex as the tasks of daily life, and logic alone cannot determine which matters are most important to pay attention to.

Logic should be supplemented with emotional attunement. 

(source: pdf page 3)

Empathy directlt enhances therapeutic efficacy. Enegaged communication has been linked to decreasing patient ansxiety, and, for a variety of illnesses, decreasing anxiety has been linked to physiologic effects and improved outcomes (therapeutic efficacy).

Source: PDF page 3

1. patients sense whether physicans are emotionally attuned
2. patients trust physicians who respond to their anxiety with their own responsive worry. Trust has been associated with better treatment adherence.
3. It matters how and when physicians ask patients about their feelings, and empathic attunement guides physicians about when to ask questions, when to stay silent, and when to repeat important words. 

Source: PDF page 3-4

It guides practitioners about (1) when to ask questions, (2) when to stay silent, and (3) when to repeat important words. 

Source: PDF page 4

(1) emotional attunement helps practitioners appreciate the personal meanings of patient's words.

(2) Practitioners' emotions focus and hold their attention on what the patient is anxious about. 

(3) empathy facilitates patient trust and disclosure

(4) empathy makes practicing medicine more meaningful

Source: PDF pages 3-4

Burnout less frequently.

It illuminates the real meaning practicing medicine.

It enriches clinicians' experience of treating patients. 

Source: PDF page 4

Yes. Empathy can enhance medical diagnosis. It enhances patient-physician communication and trust, and therefore improves treatment effectiveness.

Source: PDF page 4

What is the sign of an overly empathetic practitioner?

What should be supplemented with clinical empathy to ensure proper treatment?

Once empathy is seen as depending on emotional responses, a critical problem arises. 

A practitioner's skills of objective reasonsing and logic should be used to investigate their empathetic intuitions. 

Source: PDF page 4

(1) Anxiety interferes with empathy. This can be provoked by the a pracitioner's impatience due to time pressure.

(2) Many physicians still do not see patients' emotional needs as a core aspect of illness and care. 

(3) Negative emotions which arise when there are tensions between patients and practitioners

Source: PDF page 4

involves carefully observing a patient to predict her/his illness. It entails doing what needs to be done without feeling grief, regret, or other difficult emotions. 

Source: PDF page 1

A physicians who listens empathically without becoming emotionally invovled. 

Source: PDF page 1

recognize what it feels like to experience something. 

Source: PDF page 2

Emotional attunement undermines, and goes against, the "detatched concern" model of empathy.

"Detached concerns" invovles listening empathtically without becoming emotionally invovled.

Emotional attunement, however, focuses attention on the patient, and involves the pratitioner understanding the patient's perspective (without having to experience such emotions themselves). 

Source: PDF page 2

(1) the ability to understand and share the feelings of another and recognize that they are not your feelings. 

(2) requires being moved by another's suffering, recognizing what it feels like to experience the same thing. 

(3) it is to resonate with the patient's experience but ont fully experience the suffering of each patient

(1) helps clinicians understand the unique, personal aspects of what the patient is saying. 

(2) builds trust, leading to sensitive and more information revealed in history. 

(1) Transtheoretical Model of Behavior Change

(2) The BATHE method

(3) The motivational interview

it is an integrative, biopsychosocial model to conceptualize the process of intentional behavioral change. 

can be applied to a variety of behaviors, populations and settings. 

useful for selecting appropriate interventions.

the patient...

(1) may have no intention at this time

(2) may beuninformed or underinformed about the consequences of their behavior

(3) may have failed solving their health issues in the past

(1) what would have to happen for you to know that this behavior is a problem?

(2) what warning signs would let you know this is a problem?

(3) have you tried to change in the past?

Contemplation is the stage in which people are intending to change in the next six months. They are more aware of the pros of changing but are also acutely aware of the cons. This balance between the costs and benefits of changing can produce profound ambivalence that can keep people stuck in this stage for long periods of time. We often characterize this phenomenon as chronic contemplation or behavioral procrastination. These people are also not ready for traditional action oriented programs.

what are the features of the action phase in the Transtheoretical Model? 

*probable test question

Action is the stage in which people have made specific overt modifications in their life-styles within the past six months. Since action is observable, behavior change often has been equated with action. But in the Transtheoretical Model, Action is only one of five stages. Not all modifications of behavior count as action in this model. People must attain a criterion that scientists and professionals agree is sufficient to reduce risks for disease. In smoking, for example, the field used to count reduction in the number of cigarettes as action, or switching to low tar and nicotine cigarettes. Now the consensus is clear--only total abstinence counts. In the diet area, there is some consensus that less than 30% of calories should be consumed from fat. The Action stage is also the stage where vigilance against relapse is critical.

Maintenance is the stage in which people are working to prevent relapse but they do not apply change processes as frequently as do people in action. They are less tempted to relapse and increasingly more confident that they can continue their change.

Regression occurs when individuals revert to an earlier stage of change. Relapse is one form of regression, involving regression from Action or Maintenance to an earlier stage. However, people can regress from any stage to an earlier stage. The bad news is that relapse tends to be the rule when action is taken for most health behavior problems. The good news is that for smoking and exercise only about 15% of people regress all the way to the Precontemplation stage. The vast majority regress to Contemplating or Preparation.

(1) Precontemplation

(2) Contemplation

(3) Preparation

(4) Action

(5) Maintenance and Relapse Prevention

it is a psychotherapy technique, a screening tool, and enables you to answer the following questions:

(1) what about the presenting problem is concerning to the patient?

(2) what is the patient hoping you will do?

(3)why is the patient coming for help at this time?

it is...

(1) an effective way of talking to people about change

(2) evidence based

(3)effective among a variety of professions/settings

(4) effective across cultures/countries

(1) ask open-ended questions

(2) impact affirmation

(3) impart reflections

(4) impart summaries 

(5) utilize change talk

(6)come up with a plan