Facial Expressions

00:06 This next one is one of my favorites because we're all guilty, I will say I know I'm guilty for sure. We judge people based on their facial expressions. Neutral non-expressive and affective expressive. With non-expressive, we think about a poker face, some people call it RBF, I won't go into what that stands for but it emphasizes non-emotional communication and hiding feelings. So sometimes we judge and label people. We think they're mean and they're not. You don't know what's going on with them, it could be a cultural thing that people are taught to express feelings and I give a couple of examples of that. And then expressive communication or affective communication, people share feelings a lot and they express how they feel. So I've been told in the past you can tell how I feel based on my face, well I have worked on that because sometimes I don't want to communicate something negative even though I'm feeling it, I don't want to take that out on other people. So, in terms of patient care, I've taken care of patients from multiple different cultural backgrounds who were taught not to show pain.

01:15 So, going back to my labor and delivery experience, oftentimes you have patients with no epidural, you look at the monitor and those contractions are off the chart, you palpate the contraction and you know it's painful. The person is not crying and they have a poker face. Well, guess what? We tend to say well "Oh my God, they're faking" because they're not crying, they're not trashing and that's kind of what we're taught. Right? But I want us to rethink that. We have the faces scale and all this. Remember pain is what the person says it is. So even if we label it a 10, a 10 to someone else may feel like a 1 to me. So, just believe the patient. Am I talking about when people are being manipulative? Absolutely not. I'm talking in general.

01:58 So don't think "Oh my God, they're asking for pain medicine and they're not even crying." It doesn't mean that they're not in pain and it doesn't mean that is not at the level they say it is. With expressive communication and sharing of feelings, I can recall conversations being had about patients and families, "Oh my God, all they do is complain." "Oh my God, all they do is ask questions." Well, they have the right to ask questions. And maybe they are complaining because they're afraid.

02:29 Maybe they are complaining because they don't know, you know. So, we just need to get to the root of whatever the issue is versus labeling people and knowing that when people are in a vulnerable state sometimes it changes who we are and we don't want to put those labels on and either didn't I care or treat people some type away. And one thing I do want to talk about in terms of that is when we're given report, we don't want to do that. We don't want to induce bias by saying "Oh my God, patient in x, y, z got on my nerves today." Well, that has happened and obviously as a human, I'm going to internalize that to a certain extent. I'm scared to go in the room number 1 because what am I walking in to. And then number 2, it might create this defense that I walk in there with this armor and I might want to react before something even happens. So just remember that should not be a part of the report.