Tor Erik Blaafjell: 'To improve you have to experiment with communication.'

Norwegian psychiatrist Tor Erik Blaafjell visited Rīga Stradiņš University (RSU) on 2-3 March 2019 to teach a workshop on doctor-patient communication. The workshop was organised by the International Students’ Association.

To start with maybe you can describe who you are, and what it is that you do in Norway. 

I’m a physician originally. I got my degree in Germany, but have studied in Spain, and in Norway. After graduating I worked as a general practitioner for a couple of years, then I decided to specialise in psychiatry. I have worked as a psychiatrist all my life and decided that I wanted to devote my last working years in child and adolescent psychiatry. At the moment I am working with children and adolescents in an out-patient clinic and hospital in Norway. I also teach a lot, both because I’m interested in it, and because I think it serves the public to teach psychiatry and common knowledge about the mind. Information about this is lacking in society. 

Have you noticed a change in society, and between various countries, in how they perceive or think about mental health?

40% of patients visiting a general practitioner have psychiatric problems. In Norway we know this, and we act on it.

I can speak to Norway, which I have best experience of, and Germany, which I know quite well, as well as Latvia, as my daughter Catharina Clara Blaafjell Holwech is currently studying at RSU. I have another daughter who studied in Norway, and a daughter-in-law studying in Hungary. There’s a huge difference in the importance psychiatry is given in medical studies. You can see the ramifications of the educational system – when they don’t educate about psychiatry, there’s very little knowledge about psychiatry out among working doctors. Your university here is excellent in many ways. I have compared it with my other daughter who studied in Norway, and in many ways you’re absolutely up to the same standard, but in psychiatry you are really, really bad in terms of what you are teaching and how you arrange it. In Norway we include psychiatry throughout the medical system because we have taken responsibility for the fact that 40% of patients visiting a doctor have psychiatric problems. We know this, and we act on it. I don’t know how it is with general practitioners here, but if they mirror what they’re learning then it’s too little. They’re not equipped to handle it. 

Do you know what your daughter is taught at RSU?

They have psychiatry in the second semester of the fourth year, but only like two weeks, and maybe something the next semester, but very little. They’re not taught ethics either. There is a course called that, but in Norway ethics is included in every single course. She had a course on patient communication in her second year, but said it was unhelpful.

How will you structure the workshop?

I’ll be giving a practical seminar in groups so people can experiment and role play situations like how to meet a patient, how to talk to a patient, and how to get people to change their minds. Why don’t they take their medicine even if I told them ten times? What’s going on? How do I get them to take their diabetes medicine?

48 students have applied so they will be divided into six groups over two days, and get two or three hours each. I will give them a short lecture to introduce the theories behind what I will be teaching, and what I have learned about psychiatry throughout my life. And then we will act out some scenarios from the doctors’ office. They will act and comment on one another, and try to get a discussion going about what they are experiencing in these situations. 

There are a lot of doctors who are afraid, and even teachers, who are afraid of talking to patients, but they are not afraid if they are in their role. If they want to go outside of what they’re used to, however, then they’re afraid. To become better you have to experiment with communication, with your attitude, with your way of thinking. And that’s scary. There’s a lot of responsibility and high expectations. It’s tough to fulfill all of this. And on top of all that you’re supposed to be a good doctor. It’s not all about the communication, it’s about knowledge and it’s about curing, changing… so I think people have to practice. You can sit and listen to a lecture, but that doesn’t change anything. I hope to set them on to some ideas that they can develop. 

What is something that you’d like to see change in how young doctors are taught to act?

It should be OK to admit if you’re not sure.

I think doctors are taught to become too self-secure and to think they can manage everything alone. They are on the top of the knowledge chain and they don’t ask for help. We are educated to a very lonely position, and I think that’s dangerous. In one way it’s very wise, because in many situations you are alone – you are standing there with the bleeding patient in the streets, and you have to manage, because there’s nobody to help you – but on the other hand it costs you. 

It should be OK to admit if you’re not sure. If you say to a patient ‘I don’t know, but I’ll check it up for you for the next time you come,’ it invokes so much confidence in the patient. People notice if you don’t know. They can sense your body language. Telling people ‘I don’t know, what do you think?’ gives so much confidence and alliance between the doctor and patient.

How have attitudes toward psychology and patient communication changed over the years in your experience?

There is a myth going around that psychiatric problems can’t be treated, but that’s really wrong. You can help, and change people, and give them a better life.

Talking about Norway people have much more rights, and they are much more self-secure. They’re not just kind of delivered into the hands of the doctor for them to do what they want. There’s the internet, for one. People read up before they visit you, which is a huge change. So you have to renew yourself and your knowledge all the time to stay ahead. 

Psychiatry itself has also changed very much – there are methods and models and ways of treating and thinking that work, so if you are a good therapist the average success or outcome in psychiatric treatment today is like in anywhere else in medicine. The results from treating anxiety disorders are just as good as treating hypertension or diabetes – approximately 60-70% get better. 

There is a myth going around that psychiatric problems can’t be treated, but that’s really wrong. You can help, and change people, and give them a better life. This is slowly changing. When people talk about psychiatry, even doctors, they have this idea that people should be completely free of their symptoms, whereas if people have a physical disease or disorder you can just make them better and leave it at that. I mean what do you do with a failing heart? You support it, you stabilise, and people can live with it, and it should be the same for psychiatry.

We are meeting before your workshops, seminars, but what is it you hope to get out of this weekend? 

To see my daughter. [Laughs] I also like to be with these young people. I find it interesting. I’m curious about how they think and I like to see how they reorganise their minds and pick up new thoughts. It’s a marvel.

Do you have any closing thoughts or comments about RSU?

We are thankful because you have admitted our children and we are excited to give something back! But you have to want it.

I am eager to show that there are huge resources among the parents of the international students at RSU. Most kids who come here to become doctors have doctors as parents – all kinds of doctors, with all levels and specialities. It could be a great source for the university to invite us and to use us, but they don’t. We are thankful because you have admitted our children and we are excited to give something back! But you have to want it. 

Had you heard of RSU before your daughter started studying here?

I actually recommended that my daughter apply, because I had an intern who had studied here. He was so fond of Rīga, and he had such good things to say about the university. He was really an ambassador. I’ve sent more students here. So it pays off to use us, the parents, and to see us as a network. There are many people out there with a connection to RSU.