Enlisting A Patient’s Family To Improve Patient Communication And Outcomes

While reading a book a couple of weeks ago, I came across a term that I had not heard before: limbic resonance. Upon further explanation by the authors, I realized that we all experience limbic resonance hundreds, if not thousands, of times every day in almost every environment where there is another human. I did not realize that there was a neat and tidy neuroscience nomenclature for this phenomenon.

Now rather than just tell you right off what limbic resonance means (all those smarty neuroscientist guys already know but the likelihood that they would be reading this is about the same as finding an iceberg in Phoenix in July), I want to put you into a setting where you can recall the feel of what it is. That way, you likely will remember the concept a bit longer.

Hearken back to the last time you were at a CME meeting. During the break, you may have started talking with some colleagues you have not seen in several years. The conversation was likely bathed in negativity. Yes, it was pessimism with deep despair, talking about how everything is terrible and nothing is good. Take your pick: staff issues, the state of the profession, reimbursements and yes -- those demons of all demons -- health insurance companies.

Recall how you felt. It was probably worse and worse the longer you chatted with your colleagues. You quickly went from the mental state of the wonderment and excitement to learn to a downer outlook of “Wow, I need out of this profession, situation or whatever I am in as fast as possible.” 

Whoa now, you got to be kidding me. I can become happy around happy folks and depressed around depressed folks? Negativity transfers at a conduction velocity much faster than positivity and the amplitude unfortunately is much higher. If that is the case, then I need to do some rapid human changes in my circle of daily human interactions ASAP, get down to the Blue Martini and speak with my spiritual adviser Chamberlain the bartender.

Now Chamberlain is an interesting cat. Turns out that he punted a cognitive behavioral psychology practice a decade ago to do mixology. He tells me he is much happier and makes far more money now. “Give me my usual,” I instructed Chamberlain as I pulled up to the bar. He nodded and greeted me with his usual tone of a sophisticated English gentleman: “Good day, sir.”

“I need tutelage, Chamberlain,” I implored, picking up my drink.

“What can I impart?” he deliberately responded.

“Well, I want you to tell me about limbic resonance.”

He smiled and rested his elbows on the bar. “OK, how are you feeling right now as we do this limbic dance?” he asked.

“To tell you the truth, once I got over the image of you trying to dip me in a tango move, I feel a calming emotion that I am about to learn something,” I replied.

Chamberlain started his discourse. Psychologists have known for decades that we share moods with those folks that we are around. It is a primitive, deep subcortical experience that has evolved over millions of years. It is so deeply ingrained in our brains that you simply can’t control the fact that you are controlled by emotion. Now that is something that the big, tough, pessimistic, macho dude does not want to hear but it is so.

While shifting on the bar top to straighten out some of the containers of condiments, he started giving me his insight.

“So you see, there is a deep spot in your brain, far below the neocortex of homo sapiens, that is a little center of neurotransmission that rings out its carillon based solely on the interaction you are experiencing at that time with another human. Now most people don’t really give this much thought as it is so instinctual. However, with introspection and self-examination, you can dial down and mute but never completely control this emotional arbiter. It is more than how you respond to the other’s words. It is so much more than what is being spoken. Your mind is calculating thousands of bits of information at incredible speed. This includes things such as smells, ambient temperature, facial muscle activity, tone of the conversation, how your clothes are fitting just at that time, music that is playing, maybe even a distant memory that is triggered by something during that interaction.”

“Some would call this a gut instinct,” I proffered while he paused.

“Yes, some would call it that,” he answered.

“Is it experiential?” I asked.

“Have you ever experienced the drastically different dynamic of when a patient was visiting you with his spouse versus the time he just had a consultation?” he inquired.

“Oh, man, you are right. It is like a completely different person,” I added. 

Chamberlain then went on to explain how surgeons sometimes get in trouble not because of their interaction and treatment with the patient, but rather the interactions with the family and significant others involved. He also deftly explained how you can effectively enlist the aid of the significant others to actually help you facilitate a better outcome. “Get some others to do the limbic dance with you. The patient may resonate better with you this way.”

I cleared my throat as I tried to digest Chamberlain’s expert wisdom. He immediately sensed that I did not fully grasp what he was trying to convey. “Have you ever been in a seemingly great relationship with someone but there was something just not quite right?” he asked.

“Yes,” I quickly responded.

 “Tell me,” he commanded.

“I had this relationship in college with the smartest, sweetest and most beautiful girl. However, there was just something on the unconscious level, which I did not realize until just now, that was not right.”

He chuckled. “Yes, sir, you two were stepping on each other’s feet during your limbic dance and never recognizing it. With other partners, you might have been Fred Astaire and Ginger Rogers. When you interact with your patients, pay attention to this dance. There is always a dance. Don’t be afraid to ask for a different ‘dance partner’ if you’re stepping on each other’s feet or the ‘line dance’ with them and their family is clumsy.”