by David V. Forrest, MD
The ability to read and reflect back facial emotion is the most basic skill of communicating empathy. This crucial skill allows health professionals to let patients know that we truly understand and care, and allows patients to let their caretakers know they are appreciated.
As a practicing physician for many decades and as a teacher of psychiatric interviewing for my entire professional life, I have found that physicians sometimes need to work to develop this skill. I have tested many groups of students and found that reading and reflecting facial emotion is more difficult for medical students than, for example, acting students.
This is not surprising. In order to become physicians and surgeons, we have had to develop scientific minds, and we have had to learn to control our emotions and keep cool in clinical situations. It may take some time after formal training for students to find a balance between being medically rational and being able to show patients that we do care warmly for them. Recent changes in medical practice, including managed care and the increasing usage of the electronic health record during healthcare appointments, are making it more difficult than ever for providers to make our care for the patient evident.
I was recently asked to create facial emotion workout videos for patients with impaired expressiveness due to movement disorders such as Parkinsons and for people who have trouble expressing emotion, such as those with Autism Spectrum disorders. After completing those videos, I developed a third version for doctors, medical students and other trainees in the caring professions.
So far, I have used the medical student version in teaching affection recognition to Columbia P & S 2nd year medical students as part of the psychiatric interviewing course. First I pre-test them using facial affect recognition exercises from Paul Ekman and Simon Baron-Cohen. Then we watch the facial emotion workout video together. After viewing the video, I begin in the most concrete way: with a review of the anatomy of the face and a requirement that students learn the specific muscles involved in each facial emotion.
I continually check students’ affective perception of each patient they interview and teach them to read lines and creases in the map of the face to ascertain habitual expressions. I find that it’s often necessary to convince them that reflecting back accurately and empathically will help them complete their examinations of the patients. This is because first, the patients will trust in, confide in, and cooperate with them. Second, because investigating affects in a dynamically sensitive interview will get to the patients’ concerns much faster than an overly directive checklist approach. This is a major conceptual contribution we can offer from psychoanalysis, and no medical school curriculum can afford to ignore this teaching of empathy and identification with the patient.
In time, I hope to use the videos to teach residents and nurses as well. I recently learned that the “Making Faces” video will soon be required viewing in a Narrative Medicine course for Medical, Dental, Nursing and Public Health students taught by Rita Charon. I am deeply gratified that our effort will find all these audiences and become an essential ingredient in their development of clinical empathy.
If you feel one of the versions of this video would be helpful for you, please contact me at davidvforrest@gmail.com and specify whether you are interested in the 1) neurological, 2) psychiatric, or 3) physician and student versions. The link and password will be sent to you, free of charge. All feedback is welcome.
David V. Forrest, M.D. is Clinical Professor of Psychiatry at Columbia, Consultant to Neurology (Movement Disorders) and on the faculty of Columbia Psychoanalytic Institute. His publications have included a slang dictionary for international medical graduates, articles on therapy in neuropsychiatric conditions and a recent book, SLOTS, on why people are attracted to gambling machines. He is a Past President of the American College of Psychoanalysts and was the founding editor of SPRING: The Journal of the E.E. Cummings Society.
