244
think, ‘Oh no, you’re gonna end up just like your father.’ Everyone made fun of him
because of his disease. It was so hard being a child when your father acted so goofy.
I don’t know what I’ll do if I find out I have this gene.”
Primary empathy: “You seem scared that you have Huntington’s, too.”
Advanced empathy: “Are you afraid people will be saying the same things about
you?”
Confrontation: “This seems to be very distressing for you, and I’m wondering
about the fact that you haven’t had testing until now.”
- 35-year-old prenatal patient: “I’m afraid my husband will not understand my
reasons for wanting to continue with this pregnancy. He might try to talk me out
of my plan. I’m afraid he won’t understand how I feel.” - 25-year-old male patient: “I don’t know whether or not to be tested for SCA
(spinal cerebellar ataxia, type 6). I’m so frustrated! You’d think after watching
my father with this disease that I’d know what to do.” - 50-year-old woman talking about her 25-year-old child: “He knows that he can
take advantage of me because of his albinism. If he gets sunburned or begins to
talk about how he feels worthless and hopeless, I go crazy. He gets everything he
wants out of me, and I know it’s my own fault. But I still love him very much.” - 17-year-old male prenatal partner: “My girlfriend is pregnant, and the baby has
abnormalities. She says she want to have an abortion. She says it’s her problem
and she can handle it without me. She never even asked me what I think she
should do! I mean, it’s my baby, too!” - 10-year-old boy with Duchenne muscular dystrophy: “My classmates don’t like
me, and right now I don’t like them! Why do they have to be so mean? They
make fun of me because I can’t walk or play with them. Gee, they don’t have to
like me, but I wish they’d stop making fun of me.” - 16-year-old with neurofibromatosis (NF) and a lot of visible nodules: “I’m only
here because my mother made me come.” - 32-year-old mother and her husband who are from India and have three daugh-
ters: The mother says (looking tearful), “We want to have a boy.” - 38-year-old woman with a history of five miscarriages and no living children:
“No one really knows how I feel. I know it’s just miscarriages, and not like losing
a real baby.” - Prenatal patient who has a child with cystic fibrosis (CF): “My husband wants
me to have prenatal testing for this pregnancy, but I just don’t know. Susan, our
daughter, is doing so well, and we love her so much.” - 30-year-old woman: “My family does not talk about how so many people in our
family have cancer. I can’t talk to my husband about it, either. And I don’t know
what to think about my two daughters!” - Consanguineous couple from the Middle East: “I don’t think this is a genetic
problem. All of my sisters married cousins, and their children are all normal.” - 25-year-old African American woman who has one child with sickle cell anemia,
had an elective abortion of her second pregnancy, is pregnant again and consider-
ing prenatal testing: “Everyone tells me that this baby will be affected because I
ended the last pregnancy.” - 35-year-old Arabic woman whose newborn has Down syndrome: “What will she
look like when she is older? Will she look abnormal?”
8 Responding to Patient Cues: Advanced Empathy and Confrontation Skills