Background

We each have cognitive and affective reactions to our experiences. Sometimes, these are strong reactions that are easy to identify. At other times, our reactions can be more subtle and more difficult to identify, but not necessarily any less significant. The ability to identify these reactions is of particular importance in our role as healthcare providers, as our reactions impact how we think and the way we interact with others. While compartmentalization is sometimes perceived as a method to cope with one’s reactions, it is really only a temporary approach to staying focused on a given task, and not a method likely to help us cope with the reactions themselves.  Invariably, the reactions remain, leaving any attempts to “mute” or “turn off” our reactions doomed to failure.

Given this reality, the best approach is to learn to identify our thoughts and feelings, understand their source (our personal context), and work to enhance their positive and mitigate their negative implications. Personal context can be thought of as: “the interwoven fabric of one’s unique and diverse life experiences”.  Our personal context shapes the lens through which we view the world around us.  Personal context is dynamic and formulated throughout one’s life as a result of one’s experiences, values, and culture, among other factors. Like one’s reactions, one’s personal context is neither “right” nor “wrong”, it simply is.

Developing an understanding of the sources of our reactions requires examination of one’s experiences throughout life – starting with those when living in our families of origin and continuing until today. Once we are able to do this, we can begin to develop strategies to help us enhance the positive and mitigate the negative implications of our reactions in future experiences.

This first session of Reflective Practice 101 is focused on the first two steps of the skill that is Reflective Practice – (1) identifying our reactions (both cognitive and affective/emotional) and (2) identifying the sources of those reactions.

Objectives: By the end of the small group session entitled “Reaction & Personal Context”, attendees will:

1. Identify reactions they have had to clinical encounters in the past.
2. Demonstrate the ability to examine the sources of those reactions and understand that these sources (to include one’s culture, background, experiences, etc.) make up one’s personal context – something unique to each individual.
3. Demonstrate an understanding that the same scenario can evoke a range of reactions from different people.
4. Demonstrate an understanding that the same scenario can evoke a range of reactions from the same person when considered at different times in their life.
5. Demonstrate an understanding that one’s reactions are neither right nor wrong, they simply are.

Pre-work

1. Prior to the small group session, think about a patient encounter in which you had a reaction to the patient or the situation.  Come to the small group prepared to: set the stage, identify your reactions, and discuss the relationship between your personal context and those reactions.
2. Read one or more of the above resources and consider how they relate to the concepts of reactions and personal context.

Below are examples of each part of the pre-work. 

• Set the stage.
  • Ms. M. is a 22 year old patient who was admitted to the ward with complaints of paresthesias and diplopia for the past 3 weeks. She was very anxious and worried about what this might mean. Her MRI, done on admission, showed changes consistent with Multiple Sclerosis and when I met her, she had heard this being discussed, but hadn’t had the chance to talk to anyone about it, so I was the first one to start explaining what this meant.
• Describe your reactions. This may include your reaction to the way the patient looked, how they spoke, their physical characteristics, the chief complaint, their healthcare problems, etc. fully.
  • Frustrated – I found myself becoming very angry when I learned that our 22 year old patient had Multiple sclerosis. The situation seemed very unfair to me and I was unable to reconcile her reality with the world as I view it. 
  • Overwhelmed – When I realized that she had Multiple Sclerosis and that this is a lifelong illness, I felt completely overwhelmed and didn’t know what to do or say.
• Relate your personal context. As an example: 
  • Growing in Iowa with my mom, dad and the 5 of us boys meant a lot of rough housing and wrestling matches. Being the youngest of the bunch, you might assume that I was the rag doll who would get pummeled on a regular basis. As it turns out, that did happen from time to time but not as often as you might think. I was saved by our parents’ belief in a “level playing field” which they frequently referred to as “fair play”. In terms of the basement wrestling matches, this meant that when one brother was more than 2 years older than another and we wrestled the older one could only use one arm. I don’t recall my parents putting this rule into place – we just made it up on our own, something I attribute to the five of us understanding and accepting fairness as an important value.