Is Healthcare Inside Out?

In “Inside Out”, Pixar Animations 2015 blockbuster movie, we watch as 11-year old Riley, whose life to-date has been largely driven by Joy, learns the value of Sadness as she comes to grips with a life changing event. In so doing she has to let go of a piece of her childhood self but ends up a better balanced person and closer to her family.

What most movie-goers don’t know is that the story has an academic foundation in the work of, among others, Dacher Kelter, a psychology professor at the University of California Berkeley and an expert in the social functions of emotion, whose insights also have reflective implications on the practice of medicine and delivery of care. 

 In a 1993 paper, Dr. Keltner and his colleagues added valuable detail to our understanding of how emotional states affect cognitive processing, specifically our appraisal of others. Keltner has also established that emotions influence interactions in relationships, where they serve to a) “help individuals know others…beliefs and intentions, b) evoke complementary and reciprocal emotions in others and c) serve as incentives or deterrents for other individuals…behavior.”   Given the power of emotions to influence knowledge, attitudes and behavior in relationships, we need to consider how human connection and depth of patient-provider relationships may be important drivers of the Triple Aim. While we typically seek to keep emotions in check in medicine, we may want to consider a more active role for them in the design of our care delivery and value-based payment systems.

Some recent evaluation research points to relationship continuity as being a critical success factor in achievement of dramatic levels of Triple Aim performance. Our experience has demonstrated that breaking down some of the traditional “professional distance” increases the likelihood of personal connection and accountability, creating a space where patient and provider find meaning and value from each other, and, in doing so, also within themselves. I call this "professional intimacy", and it can be a driving force behind improved regimen compliance, information sharing, collaborative care planning and the desire and motivation to achieve more in one’s life. 

It turns out that this may also support the additional Aim of provider well-being and revitalizing the professional experience of delivering care. Considering Dr. Keltner’s research, we might see how a physician’s underlying emotional state may have adverse effects on their capacity for clinical appraisal and potentially interfere with their ability to meet societal expectations for quality of care and clinical outcomes.

Read more about it here: https://bit.ly/2iRtIIL