Empathy—the feeling that you understand and share another person’s experiences and emotions: the ability to share someone else’s feelings.
By the time I became a third-year medical resident, I had mastered the repertoire of “don’t tread on me” behaviors that seemed essential to survive as a senior level trainee. I emulated my supervisors, mostly residents, as they advocated for themselves in the face of an onslaught of demand from other departments and from patients. I remember one occasion when, in front of my intern, I firmly “told off” a patient who was obviously poor and possibly homeless and who I thought was faking pain in order to get admitted to the hospital and receive analgesics. I was pleased with myself when I informed the ED staff that I would not accept the patient onto the medical service.
In retrospect, I wonder how and why I had become a “tough guy”? What had happened to my desire to “be there” for patients in their hour of need? Had I lost my aspiration to care for others, fueled by role models like my father, an internist and pillar in the community?
Does Empathy Decrease over Time?
A number of studies support my personal observation that physician empathy decreases during the training years and later persists at lower levels.1
Can We Increase Empathy?
In a 2012 study, Helen Reiss and colleagues randomized residents from several specialties into two groups, one receiving standard post-graduate education and a second whose education included three 60-minute empathy training modules. The empathy training consisted of the following elements:
- Neurobiology of empathy;
- Approaches to increase awareness of the physiology of emotions during patient encounters;
- Skills involved in interpreting the meaning of facial expressions; and
- Breathing exercises and mindfulness practices to enhance empathic responses to patients.
Using a validated instrument to measure empathy as rated by patients, the study reported increased empathy scores for the residents who participated in the empathy training program. An important skill the residents learned in the training was the ability to read/decode the facial expressions of patients and use that information to alter their behavior, thereby increasing patient-reported empathy.1
The authors point to the need for more studies to learn if, and to what extent, empathy training can improve performance in key areas like patient outcomes, malpractice claims, physician well-being, and patient satisfaction. Furthermore, they concluded that “long-lasting improvements in empathic clinical care cannot be sustained without organizational changes at all levels of healthcare. Such cultural changes require a commitment from clinical and administrative leaders to place empathic care at the forefront of institutional missions.”
Committing to Enhancing Physician Empathy
The Cleveland Clinic has addressed empathy as an important element of its institutional mission. Consider the following initiatives and interventions:
- The health system’s CEO publicly prioritizes empathy as a path to better patient experience and caregiver well-being.
- There is a chief experience officer position.
- All employees receive specialized H.E.A.R.T. (Hear, Empathize, Apologize, Respond, Thank) training; embedded approaches and practices support ongoing prioritization of empathy.
- All employees are trained to see themselves as caregivers.
- Physicians and trainees receive training in communication with patients.
- The health system holds an annual national summit on empathy and patient experience.
If you haven’t seen the Cleveland Clinic video that has gone viral, Google “Empathy: The Human Connection to Patient Care.” The video takes advantage of a universal human trait: When we truly know what another person is experiencing and feeling, we can experience and feel the same thing.
Can Hospitalists Retain an Empathic Approach over the Long Term?
I believe hospitalists can retain or regain the empathy that led to our choice of medicine as a career. To do this, we should consider a few critical practices, some of which occur at work and some at home. These include the following strategies:
- Find ways to be fully present in your human encounters with patients and co-workers. This includes minimizing interruptions whenever possible, sitting with people, making eye contact, and putting your phone away.
- Reward yourself for hard work. Make rewards, which needn’t always be expensive, a regular part of your life.
- Take measures to avoid overwork. Know when to say “no” to added responsibilities. Find time to add a wellness practice to your life, such as exercise, art, literature, spending time with your spouse/children, or community service.
- Express the gratitude you are feeling to those you work and live with.
Resources for Empathy Training
Empathetics.com offers CME and nursing continuing education credits for training in “how to detect and manage the emotional states of patients and how to respond with empathy and compassion, even in difficult interactions.”
PaulEkman.com has a series of training modules geared to detecting the “unspoken feelings” of others by recognizing the meaning of facial expressions.
- Reiss H, Kelley JM, Bailey RW, Dunn EJ, Phillips M. Empathy training for resident physicians: a randomized controlled trial of a neuroscience-informed curriculum. J Gen Intern Med. 2012;27(10):1280-1286.