I couldn’t get pregnant because I was missing some critical organs. It was a very dark period in my life – being faced with a health situation that was out of my control. My doctor, let’s call her Dr. Nassairia, was very tough and serious. She didn’t have many warm words of comfort, but at the end of countless appointments, she always patted my knee and smiled into my eyes. I called it the Nassairia knee pat. It wasn’t much, but her demonstration of empathy was just enough to keep me going.
Have you ever thought of how your display of empathy affects your patients? Empathy is essentially two aspects in a conversation. It marks the ability to perceive or feel another’s experience and then to communicate that perception back to the individual so they feel heard. Studies show that health practitioners who have greater empathy for patients have patients with better control of their diabetes as well as cholesterol levels (1, 2). Did you know that conveying empathy can be as simple as the knee pat and eye contact? Basic body language can make your patients feel as though you are empathetic to their needs and can impact trust and perhaps even compliance. If you want to see an immediate improvement in the way you make your patients feel, here are some ideas that convey empathy – even on your worst days when you might not feel empathetic. Because, let’s face it, we all have bad days.
When you conduct a history and physical, consider rewording your questions to mirror the Kleinman’s Questions to Assess Health Beliefs (3).
- What do you call the problem?
- What do you think has caused the problem?
- Why do you think it started when it did?
- What do you think the sickness does? How does it work?
- How severe is the sickness? Will it have a long or a short course?
- What kind of treatment do you think you/the patient should receive?
- What are the chief problems the sickness has caused?
- What do you fear most about the sickness?
These yield the same clinical information as your usual questions, but make the patients know that you are really hearing their feelings and can put yourself in their shoes. Just try one today and see what kind of response you get.
In addition to basic body language and the way you word your questions, you can try putting into play some other empathetic tactics. For instance, you can rephrase some of your instructions from you statements to I or we statements. Try this one out: Mr. Davis, you’ve been back three times with sugar levels that are too high. Can you really work on your diet this month? A simple rephrase can convey empathy and make a patient feel more engaged. Mr. Davis. I am very worried about how many times your sugar has been high and I’m afraid you’re going to have bigger problems soon. What can we do to help you better follow the diet we talked about last time? Try one on your own – it may help you in other relationships as well!
The bottom line is that most of your patients need to feel you are engaged with empathy. It will be good for you both. What are some other time-neutral ways you convey empathy? Please share.
Our Guest Blogger this week is Meredith Masel, PhD, MSW. She is at the Oliver Center for Patient Safety & Quality Healthcare.
References
- Del Canale, Stefano, et al. “The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy.” Academic Medicine 87.9 (2012): 1243-1249.
- Hojat, Mohammadreza, et al. “Physicians’ empathy and clinical outcomes for diabetic patients.” Academic Medicine 86.3 (2011): 359-364.
- Kleinman, Arthur, Leon Eisenberg, and Byron Good. “Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research.” Annals of internal Medicine 88.2 (1978): 251-258.
Join us for a real-time discussion about questions raised by this essay on Tuesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.
Image Source: Metropolis (1927) – http://www.imdb.com/title/tt0017136
Rodger Marion 
October 19, 2013 at 11:31 am
Keven Horrigan wrote about empathy in today’s Austin American Statesman:
Plautus, the Roman playwright, wrote… “‘Man is the wolf to men.’ It suggests that it is the nature of human beings to prey on other, presumably weaker, human beings.
I mulled this over. I said, ‘So if Plautus, and Dr. Freud, are to be believed, it is in my nature to be cruel to other people.’
‘Yes, sir, but recall what Katharine Hepburn said to Humphrey Bogart in The African Queen.’
‘What was that?’ sleepily said I.
‘Nature, Mr. Allnut, is what we are put in this world to rise above.’”
(http://www.mystatesman.com/news/news/opinion/horrigan-have-your-chauffeur-drive-you-to-empathy-/nbQyB)
October 22, 2013 at 4:19 pm
Transcript – Weekly Discussion on Aging – Held in the virtual world of Second Life – 10-22-13
Five people in today’s discussion about Empathy
[10:00] Rodger Markova: Hello Tim
[10:00] Tim (tskillian): Hi Rodger.
[10:02] Rodger Markova goes inside to load the media screen
[10:03] Rodger Markova: I always need to refresh my memory of the blog. Ah, empathy
[10:03] Tim (tskillian): yes
[10:04] Barbie (barbiedoll.somerset): Hello ツ
[10:04] Rodger Markova: hello Barbie
[10:04] Rodger Markova: Are you here for the Weekly Discussion on Aging?
[10:04] Tim (tskillian): ok. hi Barbie
[10:04] Barbie (barbiedoll.somerset): yes ツ
[10:05] Rodger Markova: Excellent.
[10:05] Rodger Markova: Barbie, this is Tim. He’s at the University of Arkansas
[10:05] Tim (tskillian): Hi Barbie
[10:05] Barbie (barbiedoll.somerset): Hi Tim ツ
[10:05] Tim (tskillian): Nice of you to join us.
[10:05] Barbie (barbiedoll.somerset): ty
[10:06] Rodger Markova: Have you attended before?
[10:06] Barbie (barbiedoll.somerset): No, my first time
[10:06] Rodger Markova: Excellent. happy to have you
[10:06] Barbie (barbiedoll.somerset) smiles
[10:06] Rodger Markova: Our discussion is based on a blog. and the current topic is up on the screen above the fireplace
[10:07] Windy Howley: Hi
[10:07] Rodger Markova: Hello Julie
[10:07] Tim (tskillian): Hi Windy — I mean Julie.
[10:08] Rodger Markova: Julie, Barbie is a new participant.
[10:10] Tim (tskillian): The topic for the week was interesting Rodger.
[10:11] Rodger Markova: This was written by Dr. Meredith Masel who is a health educator
[10:12] Rodger Markova: I picked the graphic and while I thought the kindly robot was appropriate, today Bill Clinton came to mind
[10:13] Tim (tskillian): why Bill Clinton?
[10:13] solik Bayard: Hello all*)
[10:13] Tim (tskillian): Hi Solik
[10:13] Rodger Markova:He was big on empathy, “I can feel your pain” was a trademark almost
[10:13] Rodger Markova: Hello Solik
[10:14] Rodger Markova: Welcome
[10:15] Rodger Markova: This weeks topic is empathy. and it’s particularly relevant when working with older people
[10:16] Rodger Markova: Anyone like to hazard a guess why?
[10:16] Windy Howley: Sometimes it is fine line so the elder doesn’t feel that the clinician is condescending or treating them like a child
[10:16] Rodger Markova: Yes
[10:17] Rodger Markova: anything else come to mind?
[10:17] Tim (tskillian): right
[10:17] Tim (tskillian): social relationships become particularly salient to older people.
[10:17] Barbie (barbiedoll.somerset): It helps us to share what they are experiencing
[10:17] Rodger Markova: yes
[10:17] Windy Howley: Empathy is about respect and acknowledgment of a problem that it is real and important to that person
[10:18] Rodger Markova: yes, and that fits into the relationship aspect too
[10:20] Windy Howley: Can you speak more to the relationship aspect? Because with physician and patient there is not the not equal power in the relationship
[10:20] Rodger Markova: I’m reading a book by Richard Rohr, Falling Upward, where he posits two stages in life. In the first half we are interested in external things and in the latter half we switch to the internal. With that internal focus comes a greater awareness of our relationships and their value. Thus, as we become more focused on the internal, or spiritual, we want to spend time on our relationships and thus when a care provider is business-like or brisk it implies not listening.
[10:21] Tim (tskillian): Barbie mentioned that it helps us to experience what they are experiencing and I read an article about families with older persons who recently received a diagnosis of dementia.
[10:22] Tim (tskillian): These families experienced guilt for blaming their family member for their odd behavior.
[10:23] solik Bayard: Well, I think too often the elderly and their diseases are a burden on health care teams in hospitals, so really empathy in these places*
[10:23] Rodger Markova: I can see that about families feeling guilt
[10:24] Rodger Markova: Why a burden?
[10:24] solik Bayard: too many jobs, for France Hospitals. Just what i can see*
[10:25] Windy Howley: In many families the parent (patient) is very old and the adult children are aging with their own health care problems. and sometimes managing grandchildren
[10:25] Rodger Markova: Do you think the French hospitals are overburdened with patients?
[10:25] solik Bayard: I mean too busy at work & lack of staff yes. Not really the time for empathy with patients
[10:26] Rodger Markova: yes, and when staff are stressed it becomes harder to spend time with patients
[10:26] solik Bayard: sure!
[10:26] Tim (tskillian): and harder to be empathetic.
[10:27] solik Bayard: cela demande beaucoup de temps, beaucoup d’écoute auprès des malades
[10:27] solik Bayard: it takes time, a lot of listening to the sick people
[10:27] Barbie (barbiedoll.somerset): Does France have an aging population as we do in America, as represented by the “baby boomer” generation?
[10:27] solik Bayard: yes the same
[10:28] Rodger Markova: Well, there is a distinction there, even in a brief encounter one can be kindly, perceptive and supportive… all good components of empathy. It’s the listening part that can be long and time consuming but empathy can be communicated in a moment
[10:28] Windy Howley: I agree the workload in the hospital is heavy and sometimes you forget to be emphatic. Sometimes the staff wants someone to be emphatic and listen to their concerns
[10:29] Barbie (barbiedoll.somerset): That’s a good point Julie. In particular taking care of a family member in the home is very stressful on the care providers
[10:30] Windy Howley: Some families don’t know how to ask for help or where to get help
[10:30] solik Bayard: but mostly a severe lack of staff in different institutions of care
[10:30] Rodger Markova: Yes, care givers need empathy too
[10:32] Tim (tskillian): family caregivers are particularly vulnerable to stress
[10:32] Rodger Markova: yes
[10:33] Tim (tskillian): i agree with Julie they don’t often know how or who to ask for help
[10:33] solik Bayard: nous avons également des visiteurs d’hôpitaux, qui viennent bénévolement tenir compagnie aux malades! Un peu de chaleur humaine de l’extérieur!
[10:33] solik Bayard: we also have visitors from hospitals that voluntarily come be with the sick! A little warmth from the outside!
[10:34] Rodger Markova: Yes, volunteers contribute a great deal. they have the time to listen
[10:34] solik Bayard: yes i agree
[10:35] Windy Howley: Yes, I agree the volunteers are very helpful. Also, patients and family perceive them as neutral and they can talk honestly with them. Sometimes families are reluctant to share with staff because it could cause problems.
[10:36] solik Bayard: yes true
[10:36] Rodger Markova: Right
[10:36] Rodger Markova: That is the value of support groups as well
[10:37] Windy Howley: Do you offer empathy training at UTMB
[10:37] Rodger Markova: Hmmm, good question. I teach a one week seminar on helping your patients to express and deal with their spiritual concerns. That’s an aspect of empathy. and I think every profession includes it someplace, the good “bedside manner” is a staple of medicine.
[10:39] Windy Howley: Sometimes we need to be reminded or reeducated
[10:39] solik Bayard: more & more volunteers replace deficiencies of public services, especially in hospitals for the weel-being of patients
[10:40] Tim (tskillian): solik — i know the area agencies on aging around here sometimes have a hard time recruiting volunteers. do you see a problem with over relying on volunteers in France?
[10:41] solik Bayard: not really we find always some volunteers in France at less
[10:42] Rodger Markova: Coming back to the notion of relationships and Rohr’s idea of two phases of life. I think often care providers are in the first stage, focus on external and older patients are in the second, focus on internal. It makes communication complicated as they don’t share the same point of view.
[10:44] Tim (tskillian): good point Rodger. A big part of empathy is having experienced something similar to the other person.
[10:44] solik Bayard: le gouvernement et surtout les hôpitaux proposent une hospitalisation externe ; in fact, les soins à domicile de plus en plus
[10:44] solik Bayard: government and especially hospitals offer an external hospitalization in fact, home care increasingly
[10:44] Tim (tskillian): healthcare workers are likely to have experienced aging related problems, yet.
[10:44] Barbie (barbiedoll.somerset): One thing i have learned is that it is rare that anyone can step back and see things from the perspective of another.
[10:45] Rodger Markova: Yes Barbie, seeing the other person’s point of view is hard
[10:45] solik Bayard: yes in family, it’s sometimes better for the patient
[10:46] Rodger Markova: We have reached our time limit and I don’t want anyone to feel stuck if you have a next appointment. I like to post the discussion as a comment to the blog. Does anyone have an objection to their comments being included? I can edit you out or change your name if you wish.
[10:46] Tim (tskillian): ok with me Rodger.
[10:47] Windy Howley: OK with me. See you next week.
[10:47] solik Bayard: ok too*
[10:47] Barbie (barbiedoll.somerset): yes, it’s fine with me
[10:47] Rodger Markova: Thank you all for coming
[10:47] Tim (tskillian): thanks so much for having us. yes, a good discussion.
[10:47] solik Bayard: thx all & bye!*)
[10:47] Tim (tskillian): bye solik
[10:48] Rodger Markova: kk. I’ll change your name….. OK I won’t
[10:48] Barbie (barbiedoll.somerset): Bye bye ツ
[10:48] Rodger Markova: Bye
[10:48] Tim (tskillian): bye