Sometimes our feelings are difficult to manage. When working with patients and colleagues, recognizing, understanding, and labeling our emotions can help us to respond more thoughtfully.
Lifelong Learning in Clinical Excellence | July 15, 2020 | 5 min read
By William Wright, DO, MPH, Johns Hopkins Medicine
“He sounded harsh and insensitive,” the resident said after she hung up the phone with a physician colleague about a mutual patient. On most days, she had found many of her physician-peers compassionate and warm. But on that day, she felt this physician was insensitive, distant, and regimented. “Like a robot,” she said.
The interaction had been efficient—history and symptoms reviewed, test results assessed, and medications ordered. “Maybe you’re just not used to seeing the situation from someone else’s perspective or understanding what emotions they were feeling at the time?” I offered. She shrugged unconvincingly, “It felt like an unpleasant interaction,” she added.
Emotional intelligence (EI) is a set of skills that helps individuals reason with and about emotion. These skills are key building blocks for children and adults with positive outcomes to cognitive and social functioning, psychological well-being, academic and workplace performance, and leader effectiveness. We can view EI as an opportunity to know ourselves better and sharpen our ability to handle our emotions in everyday decisions and our interaction with others.
An evidence-based mindfulness practice that can help us cope with everyday emotions in learning, decision-making, relationship quality, and mental health is called RULER (Recognizing, Understanding, Labeling, Expressing, and Regulating). Here is an example of how RULER has helped me—on some days doing rounding on the hospital consult service, I think, “How am I feeling and expressing myself today?”
First, simply identify emotions in ourselves and others. This begins by recognizing emotions in faces, voices, and body language. It’s wearing your heart on your sleeve. This casual phrase simply means we are exposing our emotions and making ourselves and others vulnerable by letting it all hang out. For example, if I’m feeling anxious on a particular day, rather than trying to minimize or ignore these feelings, I pause and notice how this emotion is being reflected in my face, voice, and body language for others to see.
Second, I work to understand the triggers and causes of my emotions. Oscar Wilde said, “I don’t want to be at the mercy of my emotions. I want to use them, to enjoy them, and to dominate them.” In the example of feeling anxious, I can explore why I’m feeling this way and how feeling this way influences my behavior. Causes of this emotion might be due to an upcoming exam, work-related deadline, health-related issue, coworker relationship, family matter, or personal expectations. Reflecting on my own emotional response to a situation or event can help me to anticipate, manage, or prevent unwanted feelings or responses in myself or others. It also can be used to promote wanted feelings or actions in myself or others. This is probably the step that takes the most practice.
Next, I investigate the words that best describe these feelings to be able to communicate these feelings accurately. The less aware we are of our emotions, the less likely we are to figure out how to best regulate them. For example, if my patient is not compliant with a treatment recommendation I’ve worked hard to develop and implement and I’m only aware of the anger this non-compliance made me feel, I might think that I’m justified in lashing out. But if I work to be aware that my emotional response also includes anxiety about having to resolve the mistake, I might be more motivated to downregulate my anger so that I can recruit my patient’s help. Examples of my anxiety might be things such as: Did I spend enough time with this patient to address all the needs? Did I fully explain all the details of this treatment plan? Did I discuss with the patient the benefits and side-effects? Did I go over the clinical follow-up plan effectively in the short time I have with each patient? Did I miss something? Did I effectively answer all the patient’s and family members questions? In this second scenario, our relationship remains strong, and we effectively work together to solve problems and reach common goals. Therefore, accurately labeling our emotions in nonjudgmental ways can help us regulate them better, and consequently, navigate our environments more smoothly.
With the next step, I practice identifying with these feelings in learning how to act appropriately and skillfully in social situations. Emotions communicate meaning and intent. It may help for me to ask questions such as, What do I want the other person to learn? Or what is the message I want to communicate? If I’m a supervisor, it’s critically important to know that I’m either irritated with someone because they’re late for a meeting or I’m worried something happened to them en route to the meeting. Since emotions are a form of information, it’s important to accurately convey those to people and in a way that they will also accurately perceive our intent.
Most people respond to emotions by either acting out or suppressing them. Acting out with a strong emotion like anger will most likely create undesirable consequences in both work and social relationships. The ripple effects of acting out usually provoke more anger, which leads to more difficulty. The consequences of suppressing emotions can be even more dangerous. Suppression doesn’t make an emotion go away, it just stays inside causing more pain. Developing strategies to manage and regulate feelings allow us to make wise decisions about how to respond to emotional situations and be more effective in reaching goals.
This five-step process to cope with emotions was challenging when I first learned it. But what began as an effort for me to systematically go through each step is now a habit that provides greater awareness and peace of mind on each day’s journey. It also allows me to be more engaged with my colleagues and more importantly my patients. RULER has helped me to support my patients better because effectively understanding their emotions – happy, sad, or angry – makes me more understanding and empathetic to their feelings and needs. RULER in essence allows me to truly individualize my patient care If you’re interested in and new to RULER, I recommend starting with learning more from Dr. Marc Brackett, founding director of the Yale Center for Emotional Intelligence.