EP158: Gaslight Effect Author Dr. Robin Stern on Emotional Intelligence and Healthcare

Emotional Intelligence in Healthcare: Insights from Dr. Robin Stern

In this episode of 'The Girl Doc Survival Guide, Christine welcomes Dr. Robin Stern, a key authority on emotional intelligence. They discuss the vital role emotional intelligence plays in healthcare, exploring its impact on patient interactions, workplace challenges, and the parallels between parenting and medical practice. Dr. Stern emphasizes the importance of recognizing and managing emotions through practical strategies such as self-talk, emotional regulation, and creating internal space. The conversation highlights the psychological aspects of emotions, the empathy trap, and effective ways for healthcare professionals to maintain emotional balance while providing compassionate care.

00:00 Introduction to Dr. Robin Stern

01:14 Parallels Between Parenting and Doctoring

02:51 The Importance of Emotional Intelligence in Healthcare

04:30 Impact of Emotions on Daily Life and Decision Making

07:56 Recognizing and Managing Emotions

17:16 Balancing Empathy and Professional Detachment

22:02 Strategies for Emotional Well-being

27:26 Final Thoughts and Gratitude

Transcript

Christine Ko: [00:00:00] Welcome back to The Girl Doc Survival Guide. I'm very pleased to be here with Dr. Robin Stern. Dr. Stern is a key figure in the field of emotional intelligence. She has significantly shaped how we understand and apply emotional skills in various settings, and she has in particular been working with doctors and nurses and healthcare providers over the last seven to eight years. Today, she's here to share her insights on enhancing healthcare interactions and managing workplace challenges in a way that actually works. She's also the author of The Gaslight Effect, which I confess I have not read yet but it's definitely on my list of books to read next. Welcome to Robin.

Robin Stern: Thank you so much. I am just honored, Christine. I really appreciate being here. And thank you for your incredible work putting this out there. I mean, we were just talking about parenting before we started recording, but it's not that far afield [00:01:00] from doctors and nurses who are focused on helping their patients to have experiences of well being but often neglecting to care for themselves emotionally while their patients are going through things. So is that a good place to start? 

Christine Ko: Yes, it absolutely is. I do think there are parallels between how I feel as a mother to my two children and how sometimes I feel as a doctor to my patients. Not to paternalize being a doctor necessarily, or I guess maternalize it. But in the sense that, as a doctor, hopefully I know more than my patients, at least about a given disease or diagnosis, and I'm able to counsel them. And similarly, hopefully as a parent, I'm able to counsel my kids on different problems they may have or issues that arise. So, that's what I mean by I think there are parallels. And I think the other parallel for me is that I realized that [00:02:00] I don't think I was ever really taught how to be the best parent I can be from those kinds of skills. Like, how do I really navigate emotional waters? For example. And similarly, I don't think I was ever taught really that emotional, that soft skills aspect of doctoring, or maybe some people call it the art of doctoring, that I think is just so important. Not that medical knowledge and knowing all about diseases and the proper treatments and everything isn't important, but I think the vast, vast, vast majority of doctors, almost all the doctors I know, they are very knowledgeable. But this piece of the art of medicine was never really taught to me, and I think I was deficient.

Robin Stern: I'm sure you were not deficient. It would have been helpful for you to feel more skilled in a certain way because, after all, medicine is a relationship. Emotions are social, and when you are in relationship, whether it's with your patient or with [00:03:00] your colleague about a patient or a family of a patient, everyone's having emotion, even if you're not aware of them. So being emotionally intelligent very simply means being smart about your emotions. Knowing how to use your feelings to inform your thinking and knowing how to use your thinking to inform your feelings. So it may be that you're about to have a meeting with somebody you know drives you crazy. You need to have some awareness of that in order to be able to manage those emotions with your hand on the doorknob before you walk in the room, so that you can take a breath and say, okay, I'm just gonna let it go. This will be over soon. Little self talk to get you through the moment because if you're not aware of it, then you're walking into the room, and you're going to be caught up in this feeling that you aren't prepared to manage. Not that you can't use an immediate strategy, but if you're not practiced, that immediate strategy may not [00:04:00] come to you. 

Christine Ko: Yes, I like that. I have learned a lot through David Caruso, actually, who's a well known colleague of yours.

Robin Stern: Yes. 

Christine Ko: He was the first one who introduced me to a lot of these concepts around emotional intelligence, as emotions researchers think about it. And, I like what you just said about practicing beforehand, before you're in a given situation, in order to sort of have those skills firmly in place when all of a sudden, life happens, right? Life comes at us. 

Robin Stern: At the Yale Center for Emotional Intelligence, we talk about the skills of emotional intelligence being the mindset that emotions matter, that emotions deserve a seat at the table. No matter what you're doing all day long, we are experiencing emotions. If you think about it, like this morning, when you woke up, what were you feeling?

Christine Ko: I was feeling a little calm and a little stressed that I needed to get to work by a certain time.

Robin Stern: So you were having a couple of feelings, and then you [00:05:00] went to work, and now it's two o'clock. So many things happened in between. And do you think you had a few different feelings along the way? For sure. So we know actually from asking that question to many people and thinking about it ourselves as researchers and practitioners that every day is a roller coaster of emotions. Our emotions can shift and change because we pass somebody in the hallway who gives us a smile, or because we pass somebody in the hallway who says something nasty, or because we happen to open our computer on the way to work or take a look at the newsfeed on our phone. 

The first thing we know is that emotions impact our ability to pay attention, to focus and remember, to learn new things. Our emotions impact our ability to make good decisions. The third is relationships. We are constantly being cued by the facial expressions and the body language and the tone of voice of the people we're with. If there's a constant barrage of negativity, the way [00:06:00] people talk to each other can have a profoundly devastating impact on relationships. Certainly in my time at the hospital, I've heard contempt on the floor, in meetings. Maybe not even deliberate contempt, but contempt nonetheless. And it does, in fact, have that impact of shutting people down. So emotions impact relationships. The first again was attention, memory, learning. The second is decision making. 

One of the studies that is easily translatable is about decision making and emotions. We brought together a group of educators, and we split them into smaller groups and we gave each group a prompt. One group was given the prompt, write about a great day you have in the classroom, and the other group was given the prompt, write about a not so great day you have in the classroom. Then we gave them student work to grade, an essay. So what do you think happened? The group that did the positive prompt gave their students a higher score, but not just a little bit, like one to [00:07:00] two grade points higher. Importantly, our emotions are impacting us and sometimes out of our awareness because when we repeated the study, after they wrote about the prompt, we said, just write down what you're feeling now. And then we gave them the student work to grade. Just being aware that they were miserable if they thought about a lousy day, or they were really happy when they thought about a great day, just knowing that helped to take away that big effect of the emotions controlling them out of their awareness.

Emotions impact our creativity. If you're not able to deal with taking a risk emotionally or to deal with frustration along the way in being creative, you're not likely to be able to go through the creativity process to create something. Emotions impact our ability to have physical and mental health.

So we have emotions every single day, like the roller coaster, and they affect all these areas. What do we do about them? What do we do if we know [00:08:00] that we have emotions all day long? That's where the skills come in. The skills of recognizing, understanding, labeling, expressing and regulating emotions. That applies to ourself and others. We have an expression, if you can name it, you can tame it. If you're seeing a patient, if you're dealing with a tough case, if you're having an argument with a colleague, if you just need to motivate yourself, being aware of what you're feeling; when you name your feeling, you can begin to address it. Most people have maybe five feelings that they can name. Happy, sad, pissed off. Pissed off is maybe two words, but okay. Really annoyed, loving, and something else. But actually, there are 2, 000 words that really relate to your emotions and your feelings. To the extent that you can be more, we call it granular, as opposed to clumping emotions, the more you can name it, the better you can address it. 

Christine Ko: Yes. 

Robin Stern: If you're [00:09:00] frustrated you're going to do one set of things. If you're disappointed, you may address it in a different way. 

Christine Ko: Do you think that there are about 2000 or 2000 plus emotions on that very granular level? 

Robin Stern: They're not emotions, not all emotions, but they're feelings. 

Christine Ko: Okay. 

Robin Stern: Feeling is a psychological experience that you're having of something. So the feeling, for example, of love; the feeling of as opposed to the emotion of desire. An emotion causes changes in your physiology; a change in physiology, in facial expression, in vocal tone. Emotions don't last a really long time. When I'm working with a group, and I ask them, what is the sound of surprise? People can say that sound. They can say the sound of awe. They can make the vocal expression of many emotions, but there is no vocal expression of the [00:10:00] deep feeling of love. And there are other psychological experiences that don't come necessarily with the vocal expression. Every emotion has a psychological theme underlying it. So the psychological theme of anger is injustice.

Christine Ko: Yeah. 

Robin Stern: So that's the difference. 

Christine Ko: That's really helpful. Okay, not to get bogged down too much by definitions, but I like this kind of detail. 

Robin Stern: That's the science, right? We always say, this is your science lesson, and in the presentation, I'm going to talk about emotions and feelings interchangeably, but there is a difference. And then moods, of course, are other prolonged experiences, usually of some combination of feeling and emotion. 

Christine Ko: So emotions being something that is a response, a physiologic response to whatever, is it that emotions researchers like yourself say that emotions are short lived because that physiologic response is short lived?

Robin Stern: It's a really good question because a lot of our emotions are [00:11:00] driven by what we call appraisal. If you're walking through a brush and you see a little something rustling in the brush. If you are somebody who studies snakes, you might be very excited because maybe there's a snake there. If you are someone who is terrified, like I am, of snakes, you're not going to be very excited, you're going to be terrified. You're looking at the same thing, and you're having two different emotional responses. So let's say you just was evoking anger and then somebody comes and tells you a story where suddenly you're feeling compassion. You just shifted your emotions through story. 

But I want to say something, especially to the women who are listening, and this is with my emotional intelligence and my gaslight hat on that sometimes when we teach that, when we teach that emotions are the result of appraisal, people hear that as, okay well, are you saying then that if somebody is calling me names and I feel terrible, [00:12:00] I could just talk myself out of it? I could just feel something different about it? Or, that when we teach something called positive reframing, which is the same point. Your kids go to the movie theater expecting a friend to show up, and they get disappointed because the friend isn't there. Then they go back and they make another appointment a week later, and they're still disappointed, and then they're thinking, I can't believe it. What a jerk. They keep making appointments with me and not showing up. You, as the emotion coach parent to your children will say, is there another story you could tell about that? Do you think it's possible that there's something going on at home that keeps getting in their way of showing up? You can see that positive reframe allows you to continue your positive feeling about this person; slippery slope because you can end up tolerating a lot of bad behavior.

Christine Ko: Okay. So emotions are short lived; as you mentioned, there's probably some kind of [00:13:00] psychological theme behind it. And if we can name them... so name my anger and know that there's some injustice. And probably then if I can correct that injustice, it will be better.

Robin Stern: Yes, and you might not even know at the time that there's been an injustice. You just feel the emotion of anger. Our brains are flooded with chemicals and hormones, and we might not be able to think clearly about, okay, what just happened? And, how can I address it? But maybe we want to calm down. Maybe we want to do what we call in the Yale Center for Emotional Intelligence, take a metamoment, which is create some space between the moment that we're triggered and the moment we respond. So we hear something or we see something, we're triggered, we feel angry. And rather than lashing out, rather than our go to automatic, or first, or impulsive response, we think about, what would our best self say?

So [00:14:00] we have created something that is part of that intervening moment, not just counting to 10, or taking a pause. But imagining the self we want to be, and the self we want others to see, specific to their role. If it's your family member driving you crazy, in a moment where you suddenly are angry, or more to the point of this interview, your colleague driving you crazy, you might think, as a doctor, how do I want to show up? As a physician right now, what's my ideal self? And, how do I want other people to see me and talk about me when they're not around? Like, I love working with Christine. Or, Christine's really difficult. She's always angry. What do you want people to be saying? 

Christine Ko: Not the latter.

Robin Stern: We ask people who are learning to take a metamoment to come up with an image or some words that would describe their best self. And in those moments when you are thinking, [00:15:00] okay, something's driving me crazy. Maybe even before you figure it out, you find that image of your best self and you say, as a doctor, as a mom, as a friend, part of my best self is being patient. So let me take a deep breath, try to figure it out.

Christine Ko: I like that. You're probably going to be really nice to me again, but I have said before on this podcast that I'm emotionally remedial, and I'm not trying to put myself down. I've gotten better, through doing this and thinking about stuff like this. When I've spoken to David Caruso, he didn't call it the meta moment, but I think he's talking about the same thing. He didn't tell me to picture my best self, but you can do something like, if you wear glasses, you can take your glasses off, whenever you feel like, Oh, something's going on with me emotionally. And I don't want to respond right away, take your glasses off, or just do something. I'll try to do what you just said to in the future and think about my best self. When I feel that there are a lot of emotions around me. For me, sometimes what's hard is there are so many emotions going around, even they can be positive emotions. People call it being an empath. I [00:16:00] don't know if I'm an empath, but I feel like I'm porous to a lot of people's emotions around me. Emotions are contagious. I'll feel, oh, this person seems really sad, and I can feel that creeping on to me or someone's really happy, and I can feel that creeping on to me, and it's not bad to feel happy. It's not necessarily bad to feel sad either, but just all those emotions coming at me, I find overwhelming. So what I've been doing is, I haven't been imagining my best self, but I imagine like a wall and like, block these emotions. These are not mine. Is that a method, or is that not really the same? 

Robin Stern: Does it work for you?

Christine Ko: It does. But by doing that, I'm shutting things out, right? I think that it isolates me to a certain extent. It's like, block this. And sometimes you do want the emotional contagion. You do want to be feeling what other people are feeling in a good way or in a bad way. Like, Okay. I feel for you. I feel with you. I'm here with you. And so the question that I [00:17:00] haven't answered for myself yet is, how much isolation is necessary? And so to bring that sort of to the workplace, between like doctor and patient. I'm sure you'll have insight since you've worked for seven, eight plus years with health care individuals. I think that's the tension in people's minds of, oh, don't be emotional with patients, when you're on the physician side or the, health care provider side, and, leave your emotions at the door, is what Dr. Osler had said. 

Robin Stern: As if that's even possible. 

Christine Ko: I do think emotions between doctor and patient are very important. But there is this tension of, if a patient is completely tearful and crying, right? I don't want to take on all of that emotion, like with that intensity, and just start bawling myself, right? So there's a certain amount of, I think, detachment, that is necessary. So a certain amount of blocking, if I use my wall that I'm trying to put up. At the same time, if [00:18:00] I fully block myself off from a patient or whoever, I think it is very isolating and probably the patient would feel like I'm not connecting with them.

Robin Stern: First of all, thank you for sharing that, and I think it's great that you came up with something to help you. For every strategy we have, it's important to give ourselves feedback. Is this working for me? Is this not? If it's working, okay, but what are the consequences? So put in a different way, I years ago wrote about something that I called the empathy trap where you feel so much for someone else, you're taking on their emotions. Good empaths do, right? Because it brings you closer and it allows you to know their experience, but then you get stuck in their shoes. You get so stuck in their shoes that you forget you even have shoes of your own. So I feel like it's more about getting that perspective that really you are not that person. You can feel with somebody for a moment, and you might have a [00:19:00] very strong impulse to cry, or you might have a strong impulse, like a pain inside, actually thinking about somebody's very difficult diagnosis or somebody's very difficult family situation. But it's theirs. And so finding some other strategies, like talking to yourself about it, saying like, this is where I am, and this is where they are. And even using the strategy of a best self, who am I? Who I want to be? Who I want to be as a doctor in this moment? You want to give them compassion. You don't want to lose yourself in their feeling. Having that internal conversation and being ready with some strategies that you can use for yourself; how do you pull yourself out if you find that you are stuck in that empathic position? I'm reminded of a friend of mine who was telling me about a friend of hers who she finds it hard to be open with because every time she's open with her [00:20:00] friend about something difficult going on, her friend will say, Oh my God, that's so horrible. And her friend gets so overly involved in her drama that she ends up taking care of her friend. Not that you're asking your patients to take care of you, I don't hear that at all. But you don't want to be so involved that you're stuck there in the person's shoes and maybe even experiencing something more profoundly than they are because you're adding your own experience to it. 

Christine Ko: Yes. 

Robin Stern: I do think this is really important to highlight because, in working with doctors, particularly surgeons, they've all been taught, don't have your feelings. People who are my age who went to medical school before emotional intelligence was popular and before emotions were seen as important to have, to explore, and to cultivate in the operating theater and in the consulting room as well. Many doctors, not just surgeons, were probably taught, don't have too many feelings. Or as you said, leave your feelings at the door. That's [00:21:00] probably more the actual teaching. Leave your feelings at the door. You had a fight with your wife, leave it at the door. You have a sick kid, leave it at the door.

But we actually know you can't do that. And so when you come in with your own feelings, and you're experiencing perhaps what we call emotional labor already, where you're putting on a face, but you're having a feeling on the inside that's different than the face you're putting on. You can't greet your patients with your problems, but you're having your big feelings, and then all of a sudden they're having their big feelings. It can be very overwhelming and being granular, being able to name your feelings, will allow you to use a strategy to help you unpack it. Even if you need to take a break for a minute: just take a breath, or go get a drink of water. Sometimes, things are just happening so intensely, one after the other. 

I love that you can feel your feelings. It is a gift, but it's a big gift. [00:22:00] You have to have a place to put it. And one of the things I'll share, my secret of being a therapist. It's not so much a secret as just something that I don't necessarily talk about. When I come into my office in the morning, I do a little bit of a meditation, usually a gratitude meditation, but I also do a meditation where I create this visualization that I have very big space inside of me, and I can hold a lot. And so as people come in and they tell me what's going on, I have those feelings inside, and that experience with that patient, and I can go visit it and sit next to it. But it doesn't become me, so it's not as easy as it could be to get stuck there when you can create space. And so you step into that space or sit down next to that feeling inside of you. I don't know how you feel about meditation or how other people might feel about that kind of a mindfulness exercise, but it works for me.

Christine Ko: It sounds like some strategies or tools that [00:23:00] you would recommend are being mindful or meditating, actually meditating, or just being aware of things to be grateful for. And I like this idea of you create space in yourself to put things and to imagine that you do have the space within yourself. Those are great things. 

Robin Stern: And I think the number one thing is to give yourself permission to feel. Marc Brackett, my friend and colleague, wrote a great book called Permission to Feel. It's really important because most people don't give themselves permission to feel. And I would say that doctors are among people who aren't trained to do that. As you're saying yourself, they're trained to let their patients have permission to feel. But, when your patients are having feelings, you're having them too. And if you don't give yourself permission, some weird energy happens because you want to be there for your patient, but you don't want to have the feeling. So what happens? Like, do you alienate yourself? And is your patient then picking up something that maybe is not even the [00:24:00] case? Giving yourself permission to feel is a really important strategy. Checking in with your feelings and being able to name and then to choose a strategy to address that particular feeling.

Sometimes the strategy is social support. Sometimes the strategy is shifting your thoughts. Okay, let me focus on the treatment protocol for now, because I'm having a lot of feelings, and I just want to bring them down. Sometimes the strategies are really long term, like making sure you have exercise as part of your routine.

Christine Ko: I have a feeling I know, or I can predict maybe, what your response would be to this, but what would you say to someone who says, Oh, but you're being too emotional.

Robin Stern: I would say there is no such thing. 

Christine Ko: That's what I thought you were going to say. 

Robin Stern: But I also think it's a very common thing because being aware of your emotions and having emotional intelligence is not the same thing as [00:25:00] being too emotional. Too emotional generally means that you are just putting your emotions out there. That's not emotional intelligence. It doesn't usually serve you, right? Being too emotional is generally what somebody is saying to somebody who's having trouble regulating their emotions. 

Christine Ko: Yes, absolutely. And there's a fine line. I think, sometimes anyone who's expressing emotion, especially something " negative" like anger can be seen as, Oh, you're being too emotional. You're being too angry or too irritable or whatever, but... 

Robin Stern: Especially a woman. 

Christine Ko: Yes. 

Robin Stern: We hear that more. Like, you're way too emotional. It is actually something that I've seen a lot of and experienced myself that women are criticized for having a lot of emotions.

Christine Ko: Women tend to be seen as " too emotional", but it relates to gaslighting because everyone has emotions. The other person saying that to me has emotions [00:26:00] as well. I don't know if there's a good way to deal with that. For example, I'm not flying off the handle. I'm not just showering everyone else with my emotions, but I'll express something like, I'm very upset about this. And it's, Oh, you're being way too emotional. 

Robin Stern: Classic gaslighting response, because what does it mean? Either, I don't want to hear what you have to say, or I don't want to be accountable or responsible. So let's just deflect the whole conversation and tell you that you're emotional. Many times a woman, especially, but anyone in the middle of a conversation where that's the response they're getting, walks away and thinks, that's true, I am very emotional. And so the whole point of the interaction, the rest of the interaction, gets lost completely.

Your response could be one of a number of things. It could be, I don't agree. I don't agree. I see that you feel strongly about that, but I don't agree. I hear what you're [00:27:00] telling me. That's not the case. 

Christine Ko: I like it. 

Robin Stern: And then you can simply just reiterate, this thing that happened was upsetting to me.

Christine Ko: Yeah. I love many of the tips you've given us. Think of your best self, try to meditate, be grateful. Create space within yourself. 

Robin Stern: Check in with your feelings. 

Christine Ko: I would love to have you back and talk to you more about gaslighting. 

Robin Stern: I'd love to come back. 

Christine Ko: Do you have any final thoughts? 

Robin Stern: Just a lot of gratitude that you're putting this work out there, that you invited me on to speak about this to your community of listeners, and how important it is to give emotions a seat at the table and the seat at your table, not just your patient's table and your colleague's table, because they matter so much. They define every single day. People deserve to work in an environment where they feel psychologically safe and have a sense of well being and feel like people appreciate [00:28:00] them and care about them. And that happens when you're surrounded by people who can be skillful with their emotions most of the time. We're not perfect, and we all make mistakes. But if you can step into situations day after day trying to be your best self, it's at least a beginning. 

Christine Ko: Yes, that's a wonderful way to end. Thank you so much for your time.

Robin Stern: Thank you so much.