Week 10: Reassurance

Reassurance may be cognitive or affective.

Affective reassurance comes from the way:

  • we behave; calm, assured, confident, kind and gentle.
  • Eye contact
  • Appropriate touch, a hug even.
  • The way we dress – smart but not overly formal
  • The way we move; at ease, but not slovenly, can be reassuring to patients.
  • The way we arrange chairs in a room, even lighting, pictures on the walls, space on our desk, tissues to hand, but not too obvious.
  • Buildings can put patients and clinicians at ease with clear signs and helpful receptionists, considered acoustics, quiet spaces and immediately accessible lavatories.
  • Continuity of care is an important aspect of reassurance – a familiar clinician, receptionist or other member of staff, in a familiar place, especially in the context of a serious, ongoing illness makes a great difference.

Cognitive reassurance includes:

  • Information – not only clinical details about the condition, treatments and prognosis, but also facts about waiting times and how to get help and support.

Reassurance can damage

There are times when reassurance may not be appropriate or even possible, especially when the prognosis is very poor, as in this wonderful essay by David Steensma about a young woman with metastatic cancer,

It’s not that I can’t understand the impulse. Medicine would be a chilling enterprise without the motivation to do whatever possible to make bad situations a little better. But a lie breathed through silver is still a lie. Careless or glib reassurances do harm. Worse than platitudes, they are a betrayal. In the face of this woman’s darkness, it seems to me that any reassurances must come from the sphere of the chaplain, not the honest physician.

It cannot be assumed that patients want reassurance. Attempts may be perceived to be patronising, a dismissal of their underlying concerns or a cover for the fact that the clinician doesn’t actually know what’s going on.

There are times when reassurance can do damage, this project is not for reassurance once a diagnosis or prognosis is reached but a provides reassurance to those waiting in uncertainty.

I think that reassurance is a clinical skill that is as vital as any other. It begins with listening to patients and depends on empathy, which can be taught and learned.

Dr Jonathon Tomlinson, 2016

It would be cool if I could create a handbook for healthcare staff on how to reassure patients and it talks about affective reassurance vs cognitive and affective – the way we behave.

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