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Emotional Intelligence:

Critical for Patient Safety and Professional Success


Amy M. Pichoff, M.D.
Committee on Patient Safety and Education
Della M. Lin, M.D.
Committee on Patient Safety and Education

Marjorie Stiegler, M.D.


Committee on Patient Safety and Education

Professional education and training for physician


anesthesiologists has traditionally focused on a fund
of knowledge, complemented with necessary technical/
procedural skills. An untapped opportunity lies in building
the skill-set necessary to master cognitive decision-making
with emotional intelligence (EI). The original definition of
EI is the ability to monitor ones own and others feelings
and emotions; to discriminate among them; and to use
this information to guide ones thinking and actions.1
Physicians with high EI have greater rates of job satisfaction,

less burnout, improved patient-physician relationships,


higher levels of patient satisfaction, and are more effective
leaders and communicators.2 The Accreditation Council for
Graduate Medical Education (ACGME) has recognized the
vital role EI plays in becoming an effective physician and has
incorporated EI principles into the curriculum for all resident
physicians.3 In this introduction to EI, we will focus on how
the interplay between knowing and managing ones emotions
and recognizing emotions in others improves delivery of safe
patient care.

Amy M. Pichoff, M.D. is Associate


Professor and Director of Patient
Safety, Department of Anesthesiology,
University of Kansas Medical Center,
Kansas City, Kansas.

Marjorie Stiegler M.D. is Associate


Professor of Anesthesiology and
Director of the Consortium of
Anesthesiology Patient Safety and
Experiential Learning (CAPSEL),
University of North Carolina,
Chapel Hill.

Della M. Lin, M.D. is Senior Fellow,


Patient Safety Leadership, Estes Park
Institute; Senior Fellow, Patient Safety,
AHA-HRET, State Coordinating Lead,
Hawaii Safer Care, Surgical Safety
Collaborative, Honolulu.

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May 2015

Volume 79

Number 5

Knowing Ones Emotions


Identifying emotions in real-time allows us to recognize their
impact on behavior and decision-making. Exercising emotional
intelligence maximizes problem-solving by acknowledging the
contributions of both the cognitive/rational brain and the
limbic/emotional brain.
Emotion can influence ones ability to make objective,
rational decisions that directly impact patient care. The
emotional temperature of the physician plays a substantial
part in diagnostic failure and success.4 As an example,
caring for VIP patients may evoke anxiety or frustration,
knowing that additional expectations may be placed on us, our
performance may be scrutinized more closely or that we might
be expected to treat one patient differently than another. The
vulnerable patient those with cognitive impairment, mental
illness or of lower socioeconomic class may strike a chord of
sadness or injustice within us. Difficult patients might receive
less care at times because caregivers, perhaps subconsciously,
may wish for limited interaction. Special circumstances
natural disasters, mass casualties, terrorism and other acts of
violence may have emotional implications for the entire
health care team.
Our emotional reactions to patients and circumstances
occur almost instantaneously and influence our future
processing of information, clinical judgment and decisionmaking, often in a way that is not consciously obvious.4 The
vignette presented in box 1 illustrates how empathy and grief
contributed to a delayed diagnosis and emergency surgery.5

The limbic system plays an important role in emotions


and emotional memory. Emotion, by its very nature, creates
an impulse to act. This fight or flight function allows split
decision-making by rapidly assessing a situation and processing
the threat posed. The tradeoff for this almost immediate
processing is a limitation in accuracy.7 The perioperative
environment, with associated time pressures and high-stakes
decisions, may foster such impulses.
Managing emotions requires discipline and effort, but there
are specific techniques that are effective. Although managing
emotions is sometimes trivialized (e.g., shes condescending
and intimidating, but shes a good surgeon or hes volatile,
but we know how to handle him), it is critical to safe patient
care, good team work, and personal and professional success.

The vulnerable patient those


with cognitive impairment, mental
illness or of lower socioeconomic class
may strike a chord of sadness or
injustice within us.

Reframing is a technique used to manage emotions and


focuses on modulating perceptions. It consists of recognizing
the current frame and emotional association then selecting
a different, more effective frame/emotion. For example,
implementing a new electronic medical record is a major
transition inherently filled with uncertainty. The emotional
association is often negative (e.g., anger over imposed systems,
fear of ones inability to effectively adapt). When faced with
such experiences, one should ask: Does this frame make me
more effective? Which reality will this frame create? Is this
the reality I want? Consideration and selection of alternate
frames that resonate with the thinker (not an artificially
selected frame imposed by others, e.g., Come on, cant you
just think of this as exciting? It will be great!) can alter the
emotional link. The limbic response evolves and a new, more
desirable reality is created. The new frame can be selected
by framestorming alternative ways to view a situation.
(Table 1, page 24)8 New associations are not automatic.
Sustained, deliberate focus on the new association is required
for neural circuitry changes to occur.

Box 1
A 37 y o G3P1011 at 32 weeks presented with moderate
abdominal pain and no noted fetal movement for >2 days.
IUFD was confirmed, and induction of labor was planned.
The patient had significant grief, and was given some
time alone. Lethargy was mistaken for grief, contributing
to a delay in diagnosis of placental abruption and DIC.
Urgent cesarean delivery, massive transfusion and
bilateral uterine artery ligation were required.5

Managing Ones Emotions


The Joint Commission issued a sentinel event alert
identifying undesirable behaviors that undermine safety
culture. Self-centeredness, defensiveness, and insufficient
interpersonal and conflict management skills were among
provider characteristics cited; production pressure, changing
health care landscape and fear of litigation were key systems
influences.6 Emotional factors contribute to each of these
safety culture threats.

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Continued from page 23

Table 1: Reframing Questions*


How would this be framed by someone who finds it easy?
How would your wise mentor or role model view
this situation?
What does this look like from someone elses view?
How could this be framed so you too would not want to
miss the experience?
Which values or skills may be strengthened through this?
What benefit does this situation give you or others?
Are there different takes/meanings?
Are you overlooking an aspect that you could
pay attention to?
Looking back in 20 years, what will be the constructive
learning?

emotions improves decision-making, increases effectiveness


and enables us to better empathize with others. Modifying
our perceptions of situations, being in control of our behavior,
and understanding others will improve our relationships with
patients as well as with other health care providers. Those
strong relationships make us more effective in delivering the
best possible care to our patients, utilizing both our cognitive
and emotional intelligences.

Is there a humorous way to frame this?


What advice would you give a friend or child?
*Adapted from Prehn.8

Recognizing Emotions in Others


Patient-centered care defined by the Institute of
Medicine as one of six critical domains in quality health
References:
care supports active patient involvement and ensures
1. Salovey P, Mayer JD. Emotional intelligence. Imagin Cogn Pers. 19891990;9(3):185-211.
that a patients preferences, needs and values guide medical
2. Weng HC, Hung CM, Liu YT, et al. Associations between emotional
decisions. We intuitively recognize the importance of
intelligence and doctor burnout, job satisfaction and patient
caring for patients as individuals. In order to provide the
satisfaction. Med Educ. 2011;45(8):835-842.
best possible patient care, we must also acknowledge the
3. Arora S, Ashrafian H, Davis R, Athanasiou T, Darzi A, Sevdalis N.
Emotional intelligence in medicine: a systematic review through the
importance of emotion within other members of the health
context of the ACGME competencies. Med Educ. 2010;44(8):749care team. Effective teamwork and a consistent culture of
746.
safety are often cited as core principles in the delivery of safe,
4. Croskerry P, Abbass A, Wu AW. Emotional influences in patient
quality care. safety. J Patient Saf. 2010;6(4):199-205.
5. Redmon BF, Mayer DC. Cognitive error: the implications of anchoring
The approach taken after the Boston Marathon bombing
bias and the framing effect in the diagnosis of intrauterine fetal
in 2013 is a good example of how emotional intelligence was
demise (IUFD) in the setting of undiagnosed concealed placental
abruption. In: SOAP: Society for Obstetric Anesthesia and Perinatology
used to recognize and mitigate emotions that might negatively
46th Annual Meeting Syllabus; May 14-18, 2014; Toronto, Ontario,
impact patient care. The health care team met prior to the
Canada. Abstract F-13. http://www.soap.org/annual-meetingpatients arrival and explicitly committed to delivering the best
syllabus-5-8-14.pdf . Accessed March 2, 2015.
possible care to all patients, including the suspected bomber.
6. Behaviors that undermine a culture of safety. Sentinel Event Alert.
2008;(40):1-3. http://www.jointcommission.org/assets/1/18/SEA_40.
In addition, the intensivist placed the suspected bomber in an
pdf. Accessed February 26, 2015.
appropriate location within the ICU that was geographically
7. Goleman D. Emotional Intelligence. New York: Bantam Dell; 2006.
removed from where the bombing victims were receiving
8. 
Prehn A. Create reframing mindsets through Framestorm.
NeuroLeadersh J. 2012; 4:1-11. http://anetteprehn.com/wpcare. Acknowledging the emotional volatility of the situation
content/uploads/2012/11/Create-reframing-mindsets-throughallowed the team to actively manage and reduce the stress and
Framestorm2.pdf. Accessed March 11, 2015.
emotional impact of caring for victims as well as the suspect.9
9. Chang BP, Vacanti JC, Michaud Y, Flanagan H, Urman RD. Emotional
intelligence in the operating room: analysis from the Boston
Emotional intelligence plays an important role in our
Marathon bombing. Am J Disaster Med. 2014;9(2):77-85.
ability to deliver safe patient care. Expanding our skill-set
in this area is critical. Identifying and managing our own

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May 2015

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Number 5

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