Hi, good work on all the deep thinking you've already done about your values and beliefs. Now we're taking this reflective work to the next level by identifying ways we have the potential to judge or pull away from other people when our values and beliefs differ from theirs. It's important to note that I said you have the potential to judge or pull away from someone. Most people think, I'm not a judgmental person, and I would say that about myself, as well. But, as you saw on the video with Dr. Peter Attia, when we're not aware of when we might judge, we're more likely to judge others. So I'm asking you to take an honest look at yourself. Remember, we're doing this work so that our values and beliefs don't overshadow the values and beliefs of patients and their families as they're coping with a serious illness. To help you get started, let's look at a 2018 study by Callaghan & Fanning that explored biases or values held by palliative care physicians and nurse practitioners in the United States. Among members of the study group, the most frequently mentioned tendency to judge happened when patients and families wanted to pursue aggressive biomedical treatment. One physician in the study said, I do have a personal bias that, I think because I chose palliative care, I believe in comfort care and allowing a natural death. And I really don't agree with a lot of intervention at the end of life. You may have the potential to judge around a similar value. The second way these providers judge patients happen when they made assumptions about the patients. For example, it can be helpful to generally think about how a new patient may be similar to patients we've had in the past. This can help us focus our thinking about questions to ask or effective treatment plans. However, when we do this, we often don't pay attention to what makes this patient unique. Physicians noted that they often thought they knew what a patient would value, and later realized that wasn't really important to the patient at all. The patient cared about something else. It's easy to misjudge people before we get to know them. We automatically make judgments based on a person's race, gender, age, financial status or other aspects of the person we can see or think we see. The third value most often mentioned in the study was the value of time efficiency. The desire to get a lot done in a short amount of time with a patient. Imposing this value on patients can cause us to emotionally pull away from patients who talk a lot or whose responses don't stay on the topic we want to address. Clinicians in this study were also asked about strategies they used to manage their tendencies to judge or pull away from patients and families. The number one strategy was being aware of the potential to judge. Pay attention when you're listening to the patient or family member and you think, another one of these. That's a red flag that your value biases have been triggered. And you have the potential to shut down the conversation. Other strategies mentioned by providers in the study include focusing on the patient's story, values, and goals of care. We need to keep the patient at the center of attention and remain curious about what makes this person unique. These strategies should sound familiar, because they're the skills you learnt in SNAP. Finally, clinicians said it helped them to talk with other people about their values, biases, and potential to judge. You should also keep in mind that people respond to stress, like serious illness, bad news, and pain, in different ways. In some cultures, reporting pain is considered a sign of weakness. Some people will strive to be perfect patients who won't challenge or be a bother to health care providers. You may have strong feelings for or against these kinds of behaviors. Here are a few other ways you may have the potential to judge or pull away from patients and families in the practice of palliative care. I hope you found these comments helpful in thinking about your potential to judge or pull away from patients and families. You'll benefit from this investment in self-awareness.