From Steve Dubansky, SVP, Medical Director, Palio
Empathy is one’s ability to feel what others feel, to identify with and understand their feelings. It implies feeling with the person rather than feeling sorry for the person. Clinical psychologists speak of two kinds of empathy, cognitive and affective.
Cognitive empathy is the ability to understand what the other person is thinking: “He must be telling himself that this is a bad diagnosis.” Affective empathy is the ability to understand what the person is experiencing emotionally: “He is likely really worried by this diagnosis.”
Sir William Osler
Empathy for the patient is a key component of any successful doctor-patient relationship. As the famous Hopkins internist Sir William Osler suggested 80 years ago, “It is as important to know what kind of man has the disease, as it is to know what kind of disease has the man.” He told his students to “listen to the patient,” because “the patient is telling you the diagnosis.”
Research has shown that when doctors respond empathically, their patients are more satisfied and more motivated to adhere to treatment. Multiple studies in both the legal and the medical literature support the fact that malpractice suits are fewer when the doctor-patient relationship is strong. Data suggests that empathic physicians are less likely to experience burnout. Sadly, doctors far too often miss the opportunity to display empathy in conversations with their patients. Often they do not even leave time (notice I did not say “often they do not have time”) to have the opportunity to empathize. One makes time for what is important.
I’ve always contended that listening to the patient requires both time to be and the ability to be empathic, and sadly, both qualities seem to be continually diminishing among many practitioners. Knowledge, no matter how limited, can, albeit with a great deal of effort, often be enhanced. All MDs are not created equal, intellectually. After all, half of medical school graduates were in the bottom half of their class.
Unfortunately, I believe that empathy cannot be learned. You either have it or you don’t. Rarely, a life-changing event can make the affected un-empathic individual “see the light,” begin to sincerely care about other people, and be able to empathize. Ironically, while it cannot be taught, feeling for patients and the ability to empathize can be lost over time, replaced by a limited and limiting feeling for money, lifestyle, time off, and abject disregard for the professed reasons they entered the profession in the first place.
A study published this month in The Canadian Medical Association Journal recognizes these facts, and its authors call on medical schools to place greater emphasis on empathic communication. The authors disagree with me when they contend that, “Even though physicians differ in their innate capacities, as with any other skill in medicine, clinical empathy can be taught and acquired.” Perhaps I’m a pessimist, but twenty years teaching in medical schools has given me the polar opposite opinion. When taught, many students are able to understand the concept of empathy, and some will even practice it transiently, but for those who never had it, the recidivism rate is very high.
An assistant professor of psychiatry at the University of Rochester studied the interactions of oncologists and their patients. She concluded that showing empathy saves time for busy physicians, in part I believe because, as Dr. Osler said, “the patient is telling you the diagnosis.” She states, “When the physicians in our study made empathic statements, the patient exchanges actually took less time. When they didn’t respond empathetically, patients were likely to repeatedly raise the point in an effort to get the response.”
The study demonstrated that oncologists showed empathy in only 22% of oncologist-patient interviews where there was a chance to display it. How about this example from the study?
Patient: “I was doing a man’s labor and I was always told I had a good strong heart and lungs. But the lungs couldn’t withstand all those cigarettes …”
Doctor: “Yeah.”
Patient: “… asbestos and pollution and secondhand smoke sand all these other things, I guess.”
Doctor: “Do you have glaucoma?”
The oncologist either didn’t pay attention to what the patient said or didn’t care enough to empathize, affectively or cognitively. The doctor just went on with his review of the patient’s organ systems instead of truly hearing the patient’s regretful admission of his lung abuse. This doctor, like far too many others, talked to his patient rather than with his patient.
Perhaps you’re fortunate enough to have empathic physicians. If, like too many people, you’re stuck with doctors who have neither the time nor the inclination to empathize with you, doctors with whom you aren’t at all comfortable, simply switch doctors. After all, the clothes on your back aren’t as important as your health, and you don’t hesitate to return them if they don’t fit.
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