Being Present, Not Perfect in Health Care

Elaine Meyer ’75, at left, with colleagues from Australia and Abu Dhabi who were part of the Saudi Health Simulation Conference in November.

You never know where a TED Talk will lead you. For Elaine C. Meyer ’75, a Watertown, Connecticut, native, a TED Talk led her to dozens of speaking engagements across the globe, from Saudi Arabia to Buenos Aires.

And that’s because her TED Talk, and her research over the years, involves the ethics of having difficult health care conversations, particularly conversations about end-of-life care.

“I think for patients, they’re waiting to be invited to have these conversations,” she says. “Patients may be interested in telling their story but don’t know if they have permission to share.”

Meyer’s TED Talk, “On Being Present, Not Perfect,” is approaching nearly 100,000 views.

How did it come about? Boston Children’s Hospital had sponsored a TED event, and Meyer was asked to speak about the “human side” of health care. “In my TED Talk, I share personal experiences as a patient that sensitized me and stories as a nurse and psychologist caring for patients,” she says. “Even if we do not have the perfect word or the perfect solutions to make things better in health care, we can always listen and affirm the patient’s story, so they feel understood and respected—and not so alone.”

“I found that health care providers were unprepared and somewhat fearful of challenging conversations in health care—when serious diagnoses must be conveyed, when treatments are no longer working, when a cure cannot be achieved, or when a mistake has occurred. ‘On Being Present, Not Perfect’ encourages health care providers, and all of us, to lead with our humanity and to bring our courage, brains, and heart to our conversations and relationships,” she says.

Meyer’s work emphasizes patient/family perspectives and priorities, end-of-life care, challenging conversations in health care, and simulation education. Her bioethics interests focus on everyday clinical ethical encounters, serving vulnerable populations, and humanism in health care. She is a fellow of the Society for Simulation in Healthcare and has published over 100 peer-reviewed articles.

Meyer is a clinical psychologist at Boston Children’s Hospital, nurse, and bioethicist. In addition, she is a faculty member at the Center for Bioethics and associate professor of psychology at Harvard Medical School. She is a founding member of the International PERCS Collaborative (Program to Enhance Relational and Communication Skills) that has partners in Italy, Australia, Germany, and Argentina. She serves as a health care educational consultant at Fundación Garrahan in Buenos Aires and senior scholar at the Academic Research in Complementary and Integrative Medicine Institute in Filderstadt, Germany.

“A recent invitation to Saudi Arabia has been a highpoint. I attended the fifth Saudi Health Simulation Conference in Riyadh, Saudi Arabia, this past November. I was a plenary speaker based on the TED Talk and have been invited to collaborate on a research project and design a course focused on difficult health care conversations in the Saudi context.

“My work at Hospital Garrahan in Buenos Aires also brings great satisfaction as a public hospital with a big heart,” she says. “The Fundación Garrahan provides fundraising for the hospital so that all children and their families can be served across Argentina and South America.”

Meyer has also researched thorny issues related to education in health care conversations, such as when—and how—to share potentially life-altering news. Many factors can affect these kinds of conversations, she says.

“For clinicians, time and...the busy, demanding environment can create many obstacles,” she says. “Time, privacy, space, and more” can impact how a health care conversation can go.

“Many clinicians can be so exquisitely trained in their areas of specialty, yet they can feel unprepared and afraid that open communication will upset the patients, who may be sad or angry,” she says. “How can I handle strong emotions? How can I initiate the conversation?”

Meyer is dedicated to helping frontline health care staff and researchers discover new strategies for holding conversations about serious illness and end-of-life care. She has found that both clinicians and patients and their families, listening goes a long way toward a successful discussion.

“Patients want to feel listened to, to feel heard, to know somebody knows their story, even though they may not be able to make it better,” she says. “Patients know they’re in a hospital and, for example, they might need surgery, so how are we to engender trust? With a child or someone very ill, we want to provide information that’s age-appropriate and sensitive. What are they afraid of? What are they wondering about? Sometimes just being in the room with someone and lending your presence is what’s needed.”

Families may not want to hear bad news, but Meyer says it’s important for clinicians to begin the conversation where the family and patients are. “We are wading into the pool with them, not jumping into the deep end.”

“We work as part of a team in health care, but we all need to be attentive to patients’  psychosocial and emotional care,” she adds. “To understand and be able to scaffold what you’re doing for the patient medically, in a broader so vital. Taking time to talk with patients and tending to the emotional standard of care allows for the patient to be seen as a whole person. A lot of times that’s where the good stuff happens.”