Validating strong emotions

A patient who has just received a diagnosis may feel strong emotions including shock, anger, disbelief and shame. At the same time, there is a lot of new information to process. It is vital to allow time for the patient to recognise these emotions and provide immediate reassurance.

Sometimes, professionals such as doctors respond to emotions by focusing on the facts and providing information. For the patient, however, being in a state of strong emotions make it difficult or impossible to process new information, and the focus on facts can seem impersonal.

A key goal for the appointment is encouraging the patient and reassuring them that HIV is much more manageable than it used to be. However, don’t rush into this message, as this may leave the patient feeling their emotions have been dismissed.

For the first appointment, focus on making appointments with support services, providing reassurance, and answering questions. Providing emotional care and containment will make it possible to provide information at a later date.

Contextualise the diagnosis. People with HIV report feeling ‘blind-sided’ when they get an HIV diagnosis and they were unaware they were being tested for HIV. If this is the case, contextualise. You may say ‘in some circumstances we automatically include an HIV test.’ Mentioning why the test has been ordered, before giving the diagnosis, can make it seem less ‘out of the blue.’ It can help the patient understand there were medical reasons for the test and they can benefit from knowing their status.

Doctors’ experiences of diagnosis. Diagnosis can be emotional for the doctor as well. There can be the uncertainty of not knowing, and the fear of saying the wrong thing. It can help to acknowledge these emotions to yourself.

Managing stigma. Sometimes stigmatising and judgmental beliefs can come into play for both the doctor and the patient. Patients in particular may blame themselves, e.g. ‘how could I have been so stupid?’ It may help to remind the patient there are people from all walks of life who are living with HIV and a virus isn’t a punishment or sign of wrongdoing.