The absence of empathy in the doctor-patient encounter can negatively impact both participants.
A study published last fall in Archives of Internal Medicine (2008;168(17): 1853-1858) found that the absence of empathy in the doctor-patient encounter can negatively impact both participants. The study examined conversations between patients with lung cancer and their physicians, but David Clarke, MD, clinical assistant professor, Oregon Health & Science University, in Portland, and author of the book They Can't Find Anything Wrong! (Sentient Publications, 2007), says empathy is lacking in much wider circles.
"I think it's something that applies to virtually every encounter," Clarke says. "If patients feel that their concerns have been heard, they're more likely to follow through with a doctor's treatment recommendations. And they're more likely to feel that the encounter with the physician has been a successful one for them."
The study identified 384 empathic opportunities that occurred during physician-patient encounters, but found that physicians neglected to recognize or take advantage of 90 percent of those opportunities. Pauline Chen, MD, writing in a New York Times blog (September 26, 2008), says that she and her fellow physicians often fear that showing empathy will lengthen patient encounters and further constrict physicians' busy schedule. In reality, however, she found that being empathetic with patients actually alleviated time problems. That realization is echoed by John Tongue, MD, chair of the Communication Skills Mentoring Program for the American Academy of Orthopaedic Surgeons.
"You open up barriers and improve the care of the patient because they feel comfortable enough with you to explain things," Tongue says. "And now you won't get callbacks, and family conferences because mom came home [from the doctor] confused. Developing that trust, in my mind, actually saves you a lot of time."
The problem, says Tongue, is that while empathy can be taught, it just hasn't happened where physicians are concerned. "No one really taught us that the way to join the patient and get them on your side, and the most powerful thing we can do in interviews, is express empathy. It does take a couple of extra minutes to be empathetic initially, but you save time later on because you then have a patient who is more appreciative and trusting, of your care."
Adds Clarke, a physician with good empathy skills will find his or her diagnostic skills will be better as well. As patient satisfaction increases, so will a physician's personal satisfaction with their practice and how they spend their day. But, he cautions, do not confuse empathy with sympathy. "Empathy has to do with being able to really feel what it's like to be another human being, and that's a different entity all together than sympathy."
Change is not easy
Tongue initiated the CSMP program eight years ago, and has conducted hundreds of workshops across the country. The workshops are interactive, and involve role playing of physician and patient encounters. But despite the teachings, Tongue admits that it's often "like pulling teeth to get the physician to use the techniques we've just described. They've just been hit over the head about it, and they can't do it. It's ingrained in our medical culture that you don't want to go there." Time, he believes, and becoming more comfortable being empathetic during patient encounters, will gradually bring about a change.
The University of Virginia Health System, through a culture and organizational change process called appreciative practice of medicine, is working to help its clinicians better understand how to be empathetic in all healthcare encounters. Margaret Plews-Ogan, MD, associate professor of medicine and chief of the division of General Medicine, Geriatrics and Palliative Medicine for the UVA, says appreciative practice encompasses looking at a patient's positive core.
"Instead of looking for and focusing on our patients' problems, we look at what a patient's strengths are, and how we can align with that to address a particular issue the patient wants to change," Plews-Ogan says. "By aligning with patients we're able to move toward a common vision for their health."
Just as with the challenges Tongue has faced in his communication workshops, Plews-Ogan admits that change will occur slowly because "this is a different language for medicine." However, she sees enormous potential for how the appreciative practice of medicine—including more empathetic clinicians—can positive affect patients' well being.
"Does this enhance patients' lives?" she asks, rhetorically. "Are we able, by practicing appreciably, to help patients in a way that we couldn't before? We need to really turn our attention to the therapeutic relationship and how it affects health. That's a big deal. And I suspect that medicine is going to be rolling down that road of investigation. We already are." Ed Rabinowitz is a veteran healthcare writer and reporter. He welcomes comments at firstname.lastname@example.org.