Monday, May 4, 2015

Interview with Dr Linda Beeney, psychologist

Dr Linda Beeney in action with Harvey.

Dr Linda Beeney is a psychologist who I met because she teaches communication to veterinary students. But when I dug a bit deeper I found out that she specializes in helping people with chronic medical illness – the psychological aspects for example of managing diabetes and other conditions. Veterinarians don’t often consider the psychological aspect of disease on patients (or clients), so talking shop with Linda is particularly fascinating.

She did a degree in psychology, a PhD in Medicine (endocrinology) at Sydney University, and a postdoc at Harvard Medical School. Since 2000 Linda has been an Associate Lecturer in the Faculty of Vet Science. She does research in health professional-patient communication, psychological adjustment to medical illness and health behaviour change interventions, which has been supported by funding from the NHMRC, National Heart Foundation and various other granting bodies.

She’s also just infectiously energetic and cool. So I was thrilled when she agreed to have a chat with SAT. Here Linda talks about what her job involves, how she manages to recharge, breaking bad news and improving communication, her own experiences with vets and how we can perhaps do better.

Who are you and what do you do?

I’m someone with a great passion to use my gifts and skills in psychology to help hurting people. I’m blessed to be able to combine a few different roles: Health psychologist, lecturer, speaker, researcher, helper, in service to others, daughter, friend, cousin, slave to Jasmine and Harvey!

I try hard to use my skills to help people make sense and meaning out of circumstances they would not have chosen for themselves – that might be their own personal situation or those of the people they are trying to help.

I have what I think is sometimes called a “portfolio career” – I am self-employed – no one can give me the job I want with the flexibility I need! 

We tend to think of medical and psychological conditions as different, but one of the areas you focus on in your work is the psychological aspects of medical illness. What sort of psychological impact do diseases such as cancer, diabetes and heart conditions have on patients?

Someone else did an elegant job of describing medical illness-specific psychological issues as “the essentially healthy reactions of ordinary people struggling to master a novel and burdensome situation”. Most of what I focus on in my work with medical patients are these reactions, whether being experienced by the patients themselves, their family members or their health professionals. We’re not talking pathology here – illness distress originates in the nature of the medical condition and the demands on the patient – the grief over actual and anticipated losses, the complex challenges and burden of self-management, the emotional and social consequences, the impact on identity and self-perceptions, and the ongoing uncertainty of prognosis and fear of complications or death.

If this kind of distress is not identified and the person helped, then the distress may grow and develop into depression and or anxiety that requires more intensive interventions.

Some specific issues for example: distress about complex treatment the patient has to implement themselves; poor communication with health professionals about diagnosis or prognosis, or the difficulty of establishing a collaborative relationship. Sadly, even in the best of relationships, having a family member diagnosed with a serious medical illness has the potential to disrupt and rock the emotional boat, so attending to the needs of relatives is also an important part of the role.

On a deeper level, how we view ourselves, our very identity, can be shaken by a medical illness.  

You also counsel health professionals. What is the impact of these diseases on the health professionals who treat affected patients?

Research shows stress and burnout are more common than we realize among our human health professionals - a recently published report by Beyond Blue uncovered high rates of distress, burnout and psychological issues among our medical professionals in Australia.

It’s well known that even experienced clinicians experience distress and grief in response to their patients' suffering. Health professionals who commonly experience patient loss and are often affected by unprocessed grief are expending high levels of Emotional Labor. These reactions can compromise clinicians' personal well-being, lead to burnout, moral distress, compassion fatigue, and poor clinical decisions which may adversely affect patient care. Interestingly, research shows that a lack of confidence in communication skills is associated with higher levels of stress and burnout symptoms in medical professionals.

That’s right, I have quite a few health professionals as patients, which I consider a sign of strength and self-insight on their part. A significant part of my work is helping both human and veterinary medicine professionals handle these issues before they become overwhelming.  What I see often is that the qualities that make great doctors and vets – high standards, bright, emotionally intelligent and with a strong desire to help their patients and clients – can also be the characteristics that contribute to the high levels of stress - e.g. perfectionism. A tendency to want to fix things that are beyond the boundaries of your responsibilities is also common among health professionals of all sorts. These limits or boundaries are often blurred and hard to see, so having someone familiar with the medical environment providing an objective opinion can help bring a much needed perspective. Self-care is also a crucial strategy to mitigate the self-harm.

You must hear some really tough things and surely this has an impact on you. How do you recharge and renew your energy when working in a field where clients are often distressed?

You’re absolutely right – there are some terrible stories and experiences in people’s lives, whether medical issues or other things in their background. I’m often humbled by the trust that people show in their willingness to share painful and sometimes traumatic events and responses. There’s a lot of pain under the surface for so many of us and it can be such a blessing to have trust in a good listener to start to unburden yourself of these things. People often say I am the first person they have told things to – my veterinarian clients tell me the most distressing stories about how cruel humans can be – I find those things to be upsetting in what it says about us as humans.

Listening and really hearing and helping with people’s troubles takes significant emotional energy, and it’s important to acknowledge and recognize that. Anything we do where we are genuinely caring and seeking to get alongside people who are hurting will be draining… and that’s OK!

Therefore I find it critical to look after myself and plan ways to recharge, refresh and renew my physical and emotional energy.

Over my 30-year career I have learnt, and am still working on, the importance of setting emotionally healthy personal boundaries and limits.

For example, I try not to have more than 2 very full working days in a row - I need a buffer zone emotionally and physically, time to catch up and exercise and be topped up emotionally myself. If I travel interstate for a LONG day then I know it won’t work for me to start early the next morning. Gosh this is not rocket science is it! But what we often find difficult is to say no to some things that may be good to do but would not be wise choices in the bigger picture. If you’ve been on a plane you’ll know the safety info about the oxygen mask – the advice is to put your own on before you can help others. I find this a really helpful analogy.

I need to manage my time and energy to be fresh, to give my best efforts to my patients and clients and to ensure my own health and longevity. I am self-employed so am fortunate to be able to have a lot of flexibility to manage my workload to suit my needs.

Sometimes I feel guilty that I don’t work as hard as others say they do; but I am learning to compare myself with others less over time.

  • I plan regular holidays. Other colleagues do this too, even with the raised eyebrows this elicits from their patients at times!
  • I also have my animals who are also less demanding emotionally and far less complicated than people! I compete my horse Harvey in eventing – riding and training use different skills and parts of the brain; it’s a good physical antidote to the sitting and listening and talking with people. We putz around in low level eventing - riding him takes all my brain power and full concentration! Galloping and jumping clears out the cobwebs and is also very social.
  • Friends – social support has empirical evidence and also we just know that other people who care for us are very important people. For me it’s my long-time friends and people from church- my faith is really important to me as well.
  • Self-care: eating well, sleeping enough and getting good exercise all VIP, sounds boring and you’ve heard it all before, BUT it’s priceless advice and all the evidence supports the efficacy of these basic tasks in keeping us healthy and better able to work effectively.
  • Also having other professionals to debrief with –this can be as simple as meeting up with others in similar roles who understand the demands of the work.

One of the things you teach is end-of-life communication and breaking bad news. Why is this area so fraught and what are the principles that guide better communication?

Breaking bad news is scary! Generally people like to avoid talking about death or even acknowledging it as a reality and inevitability. Add to this the fact that you are taking responsibility for giving bad news to someone often we don’t know what to say, we can feel afraid of saying wrong thing, there is a desire to want to take bad news back or making the mistake of thinking it’s your fault. These fears may be present whether your patients are humans or animals. Remember that even experienced human medical professionals such as oncologists still feel pangs of anxiety when they are to deliver a diagnosis – this simply shows that it matters to them to do it well.

This area of practice can often be approached with fear and trepidation – vet students often worry that they’ll cry or get upset along with the owner. BUT I think we can get confused and expect there’s a conflict between being professional and kind simultaneously. You CAN be both! We are all carrying different temperaments and some of us simply feel and express emotional reactions more intensely. Here are some random thoughts on how to guide more effective communication…

It’s highly unlikely that you will say “the wrong thing” if you are genuinely trying to care for the human owner and have done some preparation or training in communication skills, such as in our courses in Year 4.

Actually silence is OK – people need time to react to and process for example bad news that you have just delivered. Learn to be comfortable with silence and not need to fill the gap.

You can’t take the bad news back; your job is to share this with as much compassion as you have while explaining what options there are for treatment.

We worry about being the bearer of bad news and making people cry – this makes many reluctant to do so – the sense I’ll be making them cry and be upset and maybe angry… reframing your thinking to see that this task is actually part of providing wonderful care for people’s animals and is such a critical stage in that process.

Only a relatively small percentage of these encounters will be difficult and the vast majority of clients will be hugely appreciative! It’s a wonderful thing to show compassion in helping an owner, or human to deal with their bad news situation.

Can you tell us about the companion animals in your life - who are they and how did you meet them?

Linda and the late Celeste.
I have 2 current animals in my life – one horse and one cat! Harvey is a 9y/o thoroughbred gelding who I have owned since he was 4 and a half. He has been a handful at times but I love the fact that he has a big personality and we have developed a lovely partnership and understanding now so taking him showjumping and eventing is (mostly!) a lot of fun.

Jasmine is 10 years old this year – she’s a desexed ginger tabby rescue kitty; she was dumped in the street around Anzac Day aged about 6 weeks and found her forever home – she’s quite fearful of strangers but so very loving and a great lap cat in cool weather!

Before Harvey I had a beautiful first horse Celeste, a feisty off the track 5y/o TB mare who I had for 15 years and enjoyed eventing and dressage and trails. Sadly she had to be euthanased due to a paddock incident – I was devastated and it took me some time to be able to talk about her without crying.

Most of my life I have also owned pet dogs – in particular Carla my Border Collie, and Skye, Sophie and Blake, my 3 Weimaraners. I enjoyed doing obedience and showing with them all and bred a couple of special litters of Wei puppies, they are SO cute! 

How have animals changed you as a person?

I can’t imagine life without an animal of some sort in it! Before I had my own animals I was watching Lassie on TV, reading Silver Brumby and Flicka books and dreaming of the day when I could have my own pets. I have been enormously blessed to have a variety of animals as pets and companions over my lifetime, family pet cats as a child, then moving on to dogs and then adding horses to the mix.

I have learnt (still learning!) how to be gentle, to have empathy and to appreciate and seek the others’ point of view. Animals are so forgiving, they gently teach grace. Animals teach you to see another’s point of view, to have empathy and understanding. Animals teaching me to communicate more clearly, bearing their language in mind.

I’ve also made lifelong friends with people via dog obedience training, showing and via horses. Of course my animals have also brought many special humans into my life! From fellow competitors in eventing to people I have met walking the dogs, going to obedience training – animals can be very successful in promoting social contact!

Other things I’ve learned:

Unconditional love, teamwork, empathy and compassion– cooperation and that special relationship you have with your dog or horse when working on tasks together; about loss and grief and the pain of death as well as learning responsibility and care for another living thing.

Can you tell us about any experiences you have had with vets, what they did well and what they might have done better in terms of communication?

I have been exceptionally well served by my vet practice who have taken care of my animals over several decades. The illnesses and deaths of all 4 of my dogs has been so well handled, they have been open + honest and appreciated how much all four have meant to me.

I have enjoyed caring and professional treatment, good advice and especially skilled end of life care and advice. My vet gave me his mobile number for emergencies out of hours when my Wei Sophie was in the last days of life. It was an upsetting experience taking her to the emergency vet in the wee hours of the morning when she was in distress but the young vet on call there really had no idea how to handle the situation and I ended up ringing my local vet at 2am and travelled there to have her euthanased at the surgery. He was great. You really need someone who can show compassion at crucial times like that.

Only a few exceptions I can recall – many years ago I was advised that my 2 young dogs at the time did not need heartworm preventative treatment, so, as you do, I followed this advice. They were both subsequently diagnosed with heartworm by another Vet who successfully treated them – quite an ordeal – and they went on to live long and happy healthy lives. Getting your facts right is an obvious lesson there!

The other situation was with my beloved horse Celeste who was found in the paddock unable to get up. I was hysterical when I got to her and the first vet who attended really showed no empathy at all, couldn’t give me a clear answer, then left. The second vet who came eventually euthanased her but not until almost midnight. He appeared very uncomfortable in the situation and said very little. Silence can sometimes be good but not when there’s a vacuum of information! His communication was unclear and we ended up waiting for probably about 1.5 hours while she was sedated, before he realized I was waiting for him to administer the green dream. That situation occurred on a Thursday night and I was teaching vet students the following Tuesday about breaking bad news, grief and euthanasia! My reaction was to never want to see those vets again or let them take care of any of my animals in the future. You can see how personal it gets and how important are the small courtesies and caring attitude.

What are three things vets can do to improve their communication with clients?

  • Listen first, pay careful attention to what people are saying, both their words and non-verbal channels of communication.
  • Be brave and take any training opportunities that come your way – we often are scared of role playing and practice, however ample research demonstrates the effectiveness of this approach. The Argus Institute at Colorado State University has some great online resources in the area of communication they have made freely available. 
  • Seek feedback – we all slip into habits that are comfortable – imagine you have access to audio or video record of yourself in a consultation – I have done this with giving talks – it’s amazing and a bit scary what you can see when you have feedback. 
  • Prepare as well as you can, debrief with peers, or others in your practice
  • Know yourself!

Oops, that’s more than 3 things!

Any parting words of wisdom for aspiring vets?

Be aware of the emotional stresses of the job, knowing yourself and looking after yourself are critical for managing a long and healthy career. There is lots of talk about work-life balance and that’s because it is important!

Recognize your style – do you tend to introversion or extroversion?  If like me you tend to recharge away from groups of people and need time to yourself, don’t feel badly about this! Instead recognize that this is how you are put together and work with your strengths and personality style.

If you are struggling in some way, PLEASE don’t think it’s a weakness for you to ask for help! Sadly there seems to still be a degree of stigma associated with stress and mental health issues, but at any stage seek advice and support – people are there for you.

Ask others for feedback – not just on technical skills but also how you come across. Communication skills can be learned and improved, and ample evidence shows greater skills and confidence pays off in less emotional stress and burnout; being humble and willing enough to learn from others and teachable is a crucial character trait, not just for professional life as is recognizing you don’t know everything!

In human medicine there has often been a tendency to glorify those who overwork – it’s seen as a badge of achievement to say you’ve worked 40 hours straight in the ED or whatever. I think that’s foolishness and a terrible example to set others more junior. Sure, work hard and go out of your way to provide a great service to clients and patients, but workaholism is unhealthy and unsustainable. It’s also a likely sign that your identity is so intertwined with your work that you cannot separate them.

Look to wise and balanced people as your role models and mentors. Find bright and empathic individuals who you consider to be well-balanced human beings, and who are able to say no to things, nicely. I learnt a huge amount from working with Phil Hungerford, an ED and ICU specialist at Tamworth Base Hospital, highly intelligent and a great teacher, calm under pressure and who also manages to have a life as a singer!

Thank you Linda! If you want to find out more about Linda, visit her website here or follow her on twitter @DrLindaJBeeney