CEA skills

Milagros Neri, MD
 Patients consult for two reasons:
 They have physical symptoms

 They are anxious about the physical symptoms

 Upsetting
 Distracted
 Physical symptoms
 Diagnosis and treatment

 Anxiety
 Education
 If not addressed
 They are not really treated
 Difficulty of absorbing our attempts at educating them
 Correct Misperception
 Perception ≠ reality

 Through the use of active listening skills, the

physician can identify the perceptions that are most
anxiety- provoking
- Emotionally Critical Misperceptions
 CEA Method
 Active listening skills and health education

 Catharsis, Education and Action

Catharsis
 Emotions
 Becoming aware of hidden emotions
 Be able to name the feeling
 Mad
 Sad

 Glad

 Afraid

 Perceptions
 Becoming aware of what’s behind the feeling
 Four Steps to promote catharsis
 What came to your mind when you started feeling
the symptoms?
 What feelings came out when these thoughts came
to your mind?
 What do you think is the worst thing that can
happen to you?
 Summarize the ECM and the emotions associated
with it.
 Active Listening Skills
 Paraphrasing
 Saying in 10 words what the patient said in a
hundred
 Doctor, a month ago, I had this sore throat, so I
went to a doctor and he gave me penicillin for it.
So I took it seven days and it went away. But a
week later, I had the sore throat again. The
doctor gave me amoxicillin this time and I took
it and the sore throat went away. But a few days
ago, the sore throat came back. I just can’t
understand what’s happening.
 Attending Skills
 Non-verbal- body language
 L- lean forward
 O- open stance

 V- voice of compassion

 E- eye contact- facial expression

 R- relax position

 S- sitting position at right angle

 Reflecting feeling
 Articulate for the patient the emotions
 Mad, sad, glad, afraid
Educate
 ECM identified and should be prioritized
 Doctor has been listening and understands the
patients concerns
 “Emotional connection”

 Perception > reality- allay the anxiety

 Perception < reality- increase the anxiety

 Pathophysiology and pharmacology
 Speak in the language of the patient
 Use analogy and metaphors

 Use anecdotes or testimonies

Action
 Propose an action plan
 Goal setting and behavioral contracting
 Address ECM about treatment
Good physician cures sometimes, palliates often
but comforts always