Prescription for Better Health Care: Empathy
If you've waited days to see a doctor - or well past the time of your appointment until the doctor was ready - you know physicians are busy. If your time with the doctor felt rushed, that too is a reflection of her packed schedule. If your visit focused on symptoms, tests, treatment options, and prescriptions, with little time for small talk because your doctor was so busy, you at least got a no-nonsense, get-to-the-bottom-line approach. All of this, of course, is not bad medicine. But it could be much better - for you and your doctor.
What may be missing for both of you can be glimpsed by looking at a study of malpractice claims. In this study, primary care physicians who had no claims filed against them were compared with those who had two or more. "No claims" physicians did more to educate their patients about what to expect from the visit. They laughed and used more humor They were also more active in inviting the patient's opinion, encouraging him or her to talk, and checking to make sure the patient understood. They also spent more time in routine visits - though just slightly over 3 minutes, on average. These behaviors help describe empathy.
Empathy has significant health benefits, but it is not the same as sympathy. A doctor may feel bad for his patient's plight, but that does not mean he actively seeks to understand the situation from the patient's point of view. That takes more skill - and often more time.
Patients who perceive their doctor is empathetic rate their confidence in the doctor, and their satisfaction and care higher. Empathy skills can be learned, and patients report higher satisfaction when their physicians have gone through a program that teaches how to increase it in their practice.
Doctors who show empathy can sometimes ease their patients' pain. Neuroscientist Naomi Eisenberger found that the same parts of the brain are activated when we are in physical pain as when we are feeling social exclusion. This suggests that doctors who lack empathy may be treating their patients as "outsiders" in the clinical situation. The feeling of being left can be felt as pain. This is why patients sometimes say that the way they were treated hurt. Studies with couples show that an increase in empathy is related to a feeling of less pain, from something as simple as just holding a hand. Indeed, as cardiologist Heider Warraich has put it: "If chronic pain is an emotion as well as a sensation, then it is unlikely to be managed successfully without compassion."
The key question, of course, is: does empathy improve outcomes? Confidence and trust in physicians, a product of empathy, leads to more adherence to treatment recommendations. Nonadherence can rise 19% when the doctor has poor communication skills. Adherence is 1.62 times higher when the doctor has gone through training to improve those skills. There is evidence, as well, that empathy-induced adherence matters. In one study of diabetics, patients whose doctor showed empathy achieved better control of their average blood sugar.
The benefits of empathy flow not just to the patient. Studies suggest that empathetic doctors also feel less burnout, perhaps because they feel a closer connection with their patients and more reward from their work as a result.
The potential of empathy offers benefits to the wider health care system too. Higher patient adherence to health care instructions can reduce doctor, hospital, and emergency room visits. In reducing pain, it could lead to less reliance on drugs, especially addictive opiods. It can result in fewer malpractice claims and less physician burnout, perhaps encouraging more to enter the medical profession. All of this translates into cost savings.
As technology and expanded delivery vehicles are increasingly applied to medical care, the application of empathy will require more than a few training sessions for doctors. How do you build empathy in a smartphone medical app? How do you assure empathy in virtual medicine, where the doctor appears only on screen or as a voice? How will the potential of artificial intelligence to make better and faster diagnosis and treatment recommendations be married to empathetic delivery of that knowledge? How will the increasing delivery of medical care in storefronts and pharmacies, where the setting is often noisy, hectic and administered by non-physicians, insure that empathy is applied?
Nearly a hundred years ago, Dr. Frances Weld Peabody of Harvard Medical School said that "The secret of the care of the patient is in caring for the patient." That requires empathy.
Photo Credit: Alex Proimos
