Jake and Neytiri in Avatar. Source: Allstar Picture Library / Alamy Stock Photo

I See You: Putting the Patient in the Center of the Healthcare Team

What Avatar Teaches Us About Using an Empathetic Approach to Treating Patients

In our blog post for this week, guest blogger Rebecca Bryan, DNP, adult nurse practitioner and Owner of Rebecca Bryan Consulting LLC, discusses the importance of understanding health concerns from the patient’s perspective.

My favorite moment in the movie Avatar is the love scene between protagonist Jake and Neytiri, a female Na’vi on the planet Pandora. Neytiri finds Jake’s Na’vi avatar unresponsive in the forest and realizes that his human form is in the mobile lab.

She jumps through the shattered window to find him unconscious and near death, suffocating in Pandora’s atmosphere. Desperately placing the oxygen mask on his face, she watches as Jake comes to life, looks Neytiri in the eyes, and says, “I see you.” Neytiri, who prior to this point, has only seen Jake in his avatar form, smiles and responds tenderly, “I see you.”

To appreciate the fullness of this moment, understand that humans were the enemy to the Na’vi, appropriating and destroying their sacred planet. Neytiri had fallen in love with Jake in his avatar form and was devastated when she learned he was human. This love scene was the moment when masks, paradoxically, removed, and soul saw soul, regardless of form.

Etic vs. Emic

That’s the shift in perspective from etic to emic.

That’s the paradigm that can put the patient in the center of the healthcare team.

I have been lecturing about, and helping organizations become, trauma-informed since 2013, but only recently discovered the vocabulary of “etic vs emic” as two ways to understand human behavior. This language was first coined by Kenneth Pike, a linguistic theoretician, in 1954, with etic pertaining to objective findings and emic pertaining to the meaning behind a finding.

With regard to human behavior, particularly through biomedical lens, an etic approach looks at a problem from the outside in. It relies on objective criteria to make a diagnosis, which is consistent with the traditional allopathic model.

Take cigarette smoking, for example. An etic intake would include the patient’s age of smoking onset and packs smoked per year, and the diagnosis would be ICD-10 code F17.200: Nicotine dependence, unspecified, uncomplicated.

An emic approach would respond to that ICD-10 label with a snort; is cigarette smoking ever uncomplicated?! Because an emic approach looks at things from the patient’s perspective – or, from the inside out, so to speak. An emic intake to evaluate cigarette smoking would include understanding what was happening when a patient started to smoke, the good things that smoking does for the patient (“it calms me down…it distracts me from my pain”), the barriers to quitting and the level of desire to quit. Asking patients questions like these gets to what I like to call “the root of why.” It gets to the bottom of things and can be transformative.

The Importance of Personal Experience

Trauma-informed practice calls for shifting from etic to emic, from “What’s wrong with you?” to “What happened to you?” The kind of trauma I am writing about here is relational, as compared to situational trauma like a car accident or a hurricane. While trauma can occur at any age, it is particularly impactful in childhood, and much of the science generating evidence-based practice stems from the Adverse Childhood Experiences (ACEs) studies.

ACEs are common, cumulative and strongly associated with most of the leading causes of death in the U.S., as well as health risk behaviors like smoking, disordered eating and substance abuse. ACEs impact brain development, immune and hormonal systems, and even genetic expression – across the entire lifespan.

Positive events like growing up in a loving home, living in a safe space, and getting good at something counteract ACEs, again across the entire lifespan. In other words, our lived experience becomes our biology.

Walk a Mile in the Patient’s Shoes

That’s why it’s important to understand health concerns from the patient’s perspective. Research from the Robert Wood Johnson Foundation found that 80 percent of health outcomes are the result of factors other than healthcare. Traumatic experiences and adverse community challenges play a big role in this.

When we take the time to step in the patient’s shoes, we have a better chance at understanding what is driving health outcomes – and how to intervene. After all, the patients are the experts of their own lives!

Affirming patients’ experiences and helping them connect the dots across their lives is healing and places them in the center of the healthcare team. It facilitates relationships that are empowering. It says, loud and clear, “I see you.”