Interviewee
Dr Robert Kempainen, Assistant Professor, Department of Internal Medicine, University of Minnesota, MN, USA.
Article
Kempainen RR., Bartels DM. & Veach PM. (2007) Life on the receiving end: A qualitative analysis of health providers illness narratives. Academic Medicine, 82(2): 207-13.
Summary
IPP-SHR host Michael Bouwman talks with Dr Robert Kempainen about his qualitative study analysing personal illness narratives written by health care professionals. Michael and Robert discuss the findings of this research; the unique issues this study raises for health professionals and consumers; and how these findings can be used for educational purposes.
Transcript
Michael Bouwman: I'm Michael Bouwman and today I'm speaking with Dr. Robert Kempainen. Bob divides his time as a faculty member in the Department of Medicine at The University of Minnesota, as a practitioner at The University of Minnesota Cystic Fibrosis Centre and attends the Medical Intensive Care Unit at The University of Minnesota Medical Centre. I’m speaking with Bob about his article, ‘Life on the Receiving End: A Qualitative Analysis of Health Providers’ Illness Narratives,’ which he co-wrote with Dr. Dianne Bartels and Dr Patricia McCarthy-Veach. Welcome to IPP-SHR Podcasts, our congratulations on your work.
Robert Kempainen: Well thanks much, glad to be here.
Michael Bouwman: The focus of your qualitative research is refreshingly original for two reasons. Firstly the data collection and analysis focused on essays written by consumers rather than data collected by interviews and secondly these were the illness narratives of health professionals. What led you to do such innovative work?
Robert Kempainen: Part of my interest in this stems from my experiences tending in a medical ICU. Not uncommonly you’re involved with end-of-life discussions with patients and their families in that setting and so when you’re having these conversations with family members it struck me as very important how well I communicated to them and conveying compassion and understanding. I think what made a very difficult situation for them easier and so from that I developed this interest in physician-patient communication and qualitative research allows you to look at these complex interactions that are very common and happen all the time but are difficult to boil down to check boxes and so that’s where the whole idea of looking at this from a qualitative stand point came about.
Michael Bouwman: Three important categories that you highlighted in your research included psycho-social challenges, coping mechanisms and the patients’ non-medical history. Would you please talk about these categories?
Robert Kempainen: One thing that definitely was apparent was that a persons’ milieu or life situation they come into an illness with or that evolves as an illness develops has a huge impact on how they cope with illness. Some of these challenges were things you wouldn’t necessarily think of unless you were a patient, if you never had that experience before. Even just waiting, there’s so much waiting that goes on. You wait for test results that come back, you wait to have your blood drawn, you wait to be seen by the provider in the waiting room of the clinic. A lot of that sort of stressors, the stress of the uncertainty of not really knowing what’s going to happen, in some cases not really knowing what the underlying diagnosis is. These were things that I wasn’t front and centre in thinking about when I would try to talk to patients and try to be empathic and since doing this study I find myself commiserating or identifying, ‘yeah it must be hard to wait as much as you do or it must be difficult to be unsure of what’s happening, what’s going to happen next’ and it seems like patients really identify with that and get almost, I wouldn’t say it makes it all better but you know this sense of relief that the provider they’re talking to has an appreciation for how difficult those situations are and sometimes just talking about it I think aids in least a modest degree. And so there’s a whole number of other examples but some of them, non-medical history also goes back to things early in peoples’ experiences. You know, a father watching how a parent died in circumstances that went along with that effects how a child might experience their own illness as they get older. There’s all this buried history in there, it’s not something that’s in a chart, you can’t easily look it up. It’s not a medical fact.
Michael Bouwman: Of course, your findings on the importance of humanity and the characteristics of providers both positive and negative have universal relevance to the development of effective health services. Would you outline these findings and elaborate on their practical implications?
Robert Kempainen: We did like other investigators before us, identify how important it is to communicate clearly, to pass on information clearly and also to communicate in a way that is compassionate or empathic and that had a huge impact on how these patients viewed their providers. The notion of patient-centred care isn’t a new one but I think there’s more and more interest at formally trying to look at, well how do we do this better, is there a way that we can teach it better to medical students or other people who are training to take positions in the medical field. Or even people who are already practicing, is it something that can be introduced to be more effective at this and am I doing that? I think there’s a lot out there to show that if you can get the trust of your patients and make them understand clearly the medical issues they’re dealing with and support them through the emotional stress that they’re facing, that they’re going to be able to follow through on things better and cope with their illness better and improve outcomes so I think that there’s some long range ways that if we can tap into this, the way we provide health care will be more effective and hopefully it gets other people thinking along similar lines and we can in a synergistic way learn from one another and move things forward.
Michael Bouwman: Well I’m sure this kind of research will do just that. Thank-you so much for talking with me today about your research.
Robert Kempainen: It’s been my pleasure and I appreciate your interest.
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