Grief Series - Episode 3

Sentara is accredited by the Southern States CME Collaborative to provide continuing medical education for physicians.
 
Sentara designates this enduring material for a maximum of .25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Sentara Continuing Medical Education adheres to ACCME Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of an accredited activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

To Claim Credit for listening to this episode:

1. Click here and enter 17473 as the Activity ID (number).
2. Then go to the MY CME tab and complete the evaluation.
3. Credit hours will be reflected on your transcript, or you may download your certificate.

For more information, click here.

Reach out to Continuing Medical Education at CME@sentara.com for more information.

Transcript

WEBVTT

00:02.829 --> 00:09.829
You're listening to Vital Signs, a podcast for Sentara providers. Welcome to episode 3 of the grief series.

00:10.449 --> 00:15.789
In today's episode we're joined by Tommy Bateman, director of clinical Practice Management,

00:16.170 --> 00:22.040
and Peggy Haymes, licensed clinical mental health counselor. Before we turn things over to the team,

00:22.409 --> 00:28.809
here are a few important CME announcements. This episode is accredited for AMA PRA,

00:28.819 --> 00:34.650
Category 1 credits. For full accreditation, designation, and disclosure information,

00:35.049 --> 00:38.450
please refer to the show notes. And now here are Tommy and Peggy.

00:41.069 --> 00:46.069
Welcome back to Vital Signs, a podcast for Sentara providers. I'm your host, Tommy Bateman,

00:46.139 --> 00:52.750
and this is our 3rd session with Peggy Haymes, our grief expert. And so far we've talked about what grief is,

00:52.790 --> 01:00.139
the difference between complicated normal grief, what it looks like, how it manifests in our health and our emotional well-being,

01:00.459 --> 01:06.129
and then we transition to assessment, what What as professionals and as just normal human beings,

01:06.139 --> 01:14.220
we can do to recognize grief, questions to ask, and then really uh how to recognize it in yourself and the importance of recognizing

01:14.220 --> 01:22.260
it in yourself before or during. Our helping profession life and now we kind of transitioned toward the end of

01:22.260 --> 01:23.919
the last session on how to communicate

01:24.769 --> 01:31.419
as a professional about grief with our clients and our patients and we're going to continue that today.

01:31.580 --> 01:32.300
So Peggy,

01:33.059 --> 01:38.459
we talked about last time naming the grief and saying that's probably one of the best favors,

01:38.540 --> 01:40.720
I guess, or best services we can do

01:41.620 --> 01:47.000
for the people that we recognize as dealing with grief and So we named it.

01:47.250 --> 01:53.769
Where do we go from there? How do we, how do we effectively communicate, um, in such a way that would encourage this person to,

01:53.980 --> 01:55.709
to address and work with it?

01:58.279 --> 02:03.279
So one of the first things is to recognize what our own temptations are, you know,

02:04.279 --> 02:12.539
medical professionals are trained to heal, and if you cannot heal, then at least to um

02:13.119 --> 02:14.779
reduce the pain, to deal with the pain.

02:15.669 --> 02:17.619
To help people be comfortable.

02:19.020 --> 02:23.990
In grief, people are massively uncomfortable, and there's no way around that.

02:25.089 --> 02:32.529
So, as I said, I, I've been a, a therapist for over 20 years now and it is still one of the hardest things I do is to sit with

02:32.529 --> 02:36.669
someone who is in the deep agony of grief.

02:37.660 --> 02:40.639
And not try to fix it or button it up,

02:41.419 --> 02:45.179
um, but simply be present with them in the pain.

02:46.139 --> 02:54.460
Um, in all of these workshops, the feedback always is that one of the most important parts of the workshop was having their pain

02:54.460 --> 02:57.979
witnessed by someone who did not try to fix them.

02:59.330 --> 03:04.630
So what does being present look like? So, um, for someone like me, I'm high energy.

03:05.089 --> 03:11.369
I, I'm, I can't stand pregnant pauses, you know, uh, I am a fixer and,

03:11.429 --> 03:13.669
and I wanna go, go, go. What,

03:14.610 --> 03:21.490
what does being present look like? Cause for someone like me, that sounds really hard. Well, and it probably is hard.

03:21.820 --> 03:28.240
Yeah, and I said that, and that's more my natural setting, and it is still hard for me sometimes.

03:28.740 --> 03:30.520
It means slowing down.

03:32.289 --> 03:34.029
It means taking a breath.

03:34.839 --> 03:36.580
And allowing that patient.

03:37.410 --> 03:38.770
Just to take a breath.

03:40.399 --> 03:41.300
Um,

03:43.000 --> 03:49.360
There's a, a shift. I, I have a wonderful, wonderful primary care doc, and I,

03:49.399 --> 03:52.699
I've watched her like shift the tone of her voice.

03:53.949 --> 03:58.009
As we, we talk about a more emotional piece in, in a visit.

03:59.259 --> 04:05.960
Um, you know, she, she's at the screen, but then she turns to face me directly eye to eye.

04:06.759 --> 04:12.720
Mhm. And it's the feeling of, OK, my complete attention is on you. I'm not typing,

04:13.380 --> 04:14.539
my attention is on you.

04:17.890 --> 04:22.079
So to to allow yourself not to feel like you have to fix it.

04:23.920 --> 04:24.779
Um,

04:26.540 --> 04:28.369
To to validate.

04:29.470 --> 04:32.029
That it can be painful and hard.

04:33.470 --> 04:39.470
So now we're talking about people that that you're, you're kind of teasing out that they're grieving and struggling with it,

04:39.989 --> 04:43.470
but just for a, a note for some, some situations.

04:44.559 --> 04:48.309
Loss is a relief and and grief is not a big hard thing. Right.

04:49.649 --> 04:51.839
But when it is, um.

04:53.480 --> 04:58.230
A client told me one time, the most important thing you said to me was that I cannot flunk grief.

05:00.309 --> 05:02.209
Because people are scared they're gonna do it wrong.

05:03.920 --> 05:10.420
So to say this is normal, it is hard, there's no easy way through it,

05:11.239 --> 05:12.029
and

05:13.700 --> 05:15.260
You don't have to go through it by yourself.

05:18.040 --> 05:25.660
Uh, in, in, uh, with a number of hospices, they will offer free grief counseling and grief groups,

05:26.239 --> 05:31.320
and you don't have to have, uh, a person who has been a patient at that hospice.

05:34.209 --> 05:35.450
Interesting, yeah.

05:36.339 --> 05:40.640
The mm you're slowing me down right now, Peggy. Thank you.

05:42.160 --> 05:42.750
Um,

05:45.709 --> 05:50.209
I like that you can't flunk grief. That's a, that's a wonderful, uh.

05:51.029 --> 05:59.230
You know, you would think from a clinical standpoint, OK, if, uh, um, there is a, there is a clinical problem according to the DSM-5,

05:59.269 --> 06:06.829
if it lasts longer than 6 months and it's affecting your life or anything like that, and, and, and so then you get a formal diagnosis of some sort of

06:06.829 --> 06:12.070
disorder and it feels like flunking grief, um, but. Yeah, what's your reaction to that?

06:15.989 --> 06:20.559
Grief stay, it remains a part of our life for the rest of our lives,

06:21.309 --> 06:27.049
and, and it doesn't mean we haven't done it right. It means that grief,

06:27.390 --> 06:35.390
uh, significant grief can significantly change the fabric of our life, and the task of grieving is figuring out

06:35.390 --> 06:37.109
what that next chapter is going to be.

06:37.980 --> 06:39.619
Living with that loss.

06:40.600 --> 06:41.399
Um,

06:42.459 --> 06:48.459
My mother was in her early 80s and one day out of the blue, she said, I miss my daddy.

06:49.380 --> 06:51.660
Who had probably been gone for 60 years.

06:53.940 --> 07:01.980
It pops up and it bubbles up. Um, I, there's a, a new book out and oh gosh,

07:02.059 --> 07:02.660
I'm, I'm.

07:03.500 --> 07:04.989
Not going to call the the title.

07:06.390 --> 07:08.269
Correctly, um.

07:09.450 --> 07:14.220
But, but she has a wonderful line of grief is like wearing skin.

07:15.100 --> 07:17.049
You just have to live inside of it.

07:18.839 --> 07:20.010
And uh

07:21.619 --> 07:23.329
In in a sense, I think that's true.

07:24.510 --> 07:29.350
So this is not a problem that we fix, it is a journey we undertake.

07:31.730 --> 07:37.089
And so to be patient with ourselves and others as they, as they go through it is a really important thing.

07:37.130 --> 07:43.929
And in this high pressure medical world where you have to turn over patients and go to the next thing as quickly as possible,

07:44.049 --> 07:49.290
there's, there's not really uh an incentive to do that. In fact, um, you know, it feel,

07:49.450 --> 07:54.480
it feels like my energy that I bring to a room is the appropriate one business-wise, but, uh,

07:54.489 --> 07:54.910
the

07:55.839 --> 07:59.709
For the grieving patient that may, we may be doing them a disservice by not

08:00.600 --> 08:04.359
sitting in it and not recognizing it and saying, I see you.

08:05.130 --> 08:06.470
I see you dealing with this.

08:07.399 --> 08:11.450
Well, I tell you, it is hard for me because, you know, I'm doing a clinical note and if, you know,

08:11.730 --> 08:14.190
insurance looked at it, well, what were your interventions?

08:15.170 --> 08:21.359
I sat with them. Right. And I listened and I witnessed and validated their feelings.

08:21.649 --> 08:21.989
Mhm.

08:23.260 --> 08:29.239
And they're not going to move on, uh, you know, if you're scoring things uh on an assessment,

08:29.859 --> 08:35.219
they're not going to move up that assessment or move down, it is just where they are.

08:36.869 --> 08:42.909
Are you telling me you didn't, uh, reframe the logical belief to, into something that, right,

08:43.229 --> 08:48.330
yeah, yeah, but not helpful, not helpful. So very good. So,

08:48.510 --> 08:56.630
um, what are, what are the common pitfalls, uh, when it comes to communicating with people experiencing grief or what are the

08:56.630 --> 09:02.049
big no nos? What are we, what are we trying to avoid here, uh, um, that, that, that.

09:03.010 --> 09:07.440
You know, even, you know, we, we have to move quickly. I think that's a reality of life. We have to move quickly,

09:07.510 --> 09:10.409
but maybe taking that moment to have that, that.

09:11.239 --> 09:16.320
Not pregnant pause, but that eye to eye connection that the person can be seen, is,

09:16.640 --> 09:21.919
feels seen when they walk out of the room. But what, what are, what, what are some pitfalls that,

09:21.979 --> 09:30.090
that, uh, if you've seen or can really, I don't know, stop the person from pursuing what they need to pursue

09:30.090 --> 09:32.219
or which, would, would be better to pursue.

09:33.039 --> 09:33.849
Um,

09:35.309 --> 09:40.030
Assuming you know how they should be feeling. Mm hm hm.

09:41.219 --> 09:45.080
Uh, and sometimes we base that on our own experience, sometimes we base it on the culture.

09:47.200 --> 09:48.320
Um,

09:51.500 --> 09:56.960
Yeah, I've had people say, well, it was just a dog. Well, no, it wasn't. It was my family.

09:58.580 --> 09:59.440
Um,

10:01.940 --> 10:04.520
Asking him, are you doing better now?

10:07.020 --> 10:15.099
Uh, instead of asking how are you doing, because that, that question of, are you doing better now, what it can trigger in people is what I call

10:15.099 --> 10:20.150
performative grief, that they're going to try to match their grief to what you expect of them.

10:20.770 --> 10:20.780
Yeah.

10:21.849 --> 10:27.049
And if they aren't doing better, there must be something wrong with them. Yeah, you should be doing better is what it's saying.

10:27.289 --> 10:31.179
Yeah, yeah, you should have this, you know, be wrapping this up. Yeah.

10:32.580 --> 10:33.330
Um,

10:34.130 --> 10:41.429
You know, and I know the, the time constraints that, that doing the swivel in the chair and meeting eye to eye.

10:43.030 --> 10:45.109
Probably takes 3 minutes max. Yeah.

10:46.630 --> 10:47.609
Um,

10:48.700 --> 10:54.419
And you can also set up the boundaries of the conversation.

10:55.729 --> 11:04.530
So, for example, at a workshop, I have somebody who comes to me who wants to do really deep work and it is 5 minutes until lunchtime.

11:05.369 --> 11:07.989
And, you know, we don't have control over that timing.

11:09.109 --> 11:15.359
And so I would say to them, we have 5 minutes right now. What's a piece you want to do?

11:16.380 --> 11:18.440
So a doctor can say.

11:19.250 --> 11:24.570
Yeah, we don't have a whole lot of time here, but I think this is really important.

11:25.309 --> 11:31.710
And I want you to follow up with this person who can give you the time you need to,

11:31.869 --> 11:34.200
to talk through all of these things. Mhm.

11:36.760 --> 11:42.780
What could be really helpful, and this, this harkens back to an earlier episode I've had with Thomas Link, having that uh

11:43.599 --> 11:44.309
Having that

11:45.380 --> 11:53.520
integrated care manager in the office that can sit a little bit longer, you know, and so the doctor does that initial three minute I see you,

11:53.770 --> 11:58.010
hey, let me bring someone in the room. And so having, having someone there that would be very helpful in those times.

11:58.729 --> 12:05.190
So, I, I worked part time at a, a small community hospital that specialized in like orthopedic surgeries.

12:05.330 --> 12:05.570
Um-hum.

12:07.070 --> 12:15.169
And you would think with like knee replacements, you wouldn't hear a lot about grief, but I would get calls from either registration

12:16.270 --> 12:17.969
or one of the pre-op nurses

12:19.109 --> 12:19.489
saying,

12:20.609 --> 12:25.979
This is the first time. This woman's been in the hospital since her husband died

12:27.000 --> 12:27.719
a year ago.

12:28.520 --> 12:30.820
And there was a lot of grief there. Yeah.

12:32.000 --> 12:39.719
So when you're part of a team, that's where you automatically go to that team and you tell that person,

12:40.440 --> 12:45.380
I'm going to call so and so. I'm going to call social worker. I'm going to call whoever.

12:46.520 --> 12:54.700
Because they are the people who have the time. To sit with you and help you figure out what's your next step with this.

12:54.909 --> 12:54.940
Mhm.

12:58.049 --> 12:58.609
Like that.

12:59.419 --> 13:05.460
So wrapping up this episode, I, I'm gonna repeat it. You can't fail grief.

13:06.219 --> 13:14.039
And I think wrapped up in that from, from the other side, if you're dealing with a grieving person, if you tell yourself that person can't fail grief,

13:14.500 --> 13:20.809
and that naturally tells you as the provider, there are no shoulds here. I'm bringing in my REBTness here.

13:20.900 --> 13:25.919
There are no shoulds, there are no musts here. There are, there is a person in grief,

13:26.309 --> 13:33.219
and this is a person to we need to recognize that grief and and give them space to go through it.

13:33.340 --> 13:38.640
Is, is that a fair, fair summation? Yes, absolutely. Wonderful. Awesome. Well,

13:38.739 --> 13:46.070
Peggy, thank you for this one, and we kind of hinted at it again. I love our transitions that we talked about working with a social worker or counselor in

13:46.070 --> 13:51.619
the office, but let's talk about the getting what that team looks like or or what ways the team can look like.

13:51.710 --> 13:58.369
So that's going to be part 4. Thank you for joining us. Be sure to keep an eye out for episode 4 of the grief series.

13:58.950 --> 14:04.520
You've been listening to Sentara Vital Signs, a podcast created for Sentara providers.

14:05.229 --> 14:11.390
As a reminder, please check today's show notes for details on how to claim your continuing education credits.

14:11.830 --> 14:20.109
That's it for now, but we'll be back soon with another episode of Vital Signs, the podcast that delivers evidence-based education for

14:20.109 --> 14:22.950
physicians and healthcare providers on the go.