Bringing empathy back into the doctor’s office

Excerpted from “Instilling empathy among doctors pays off for patient care,” CNN. March 26, 2015 — Developed by medical faculty at Duke, the University of Pittsburgh and several other medical schools, "Oncotalk" is part of a burgeoning effort to teach doctors an essential but often overlooked skill: clinical empathy. Unlike sympathy, which is defined as feeling sorry for another person, clinical empathy is the ability to stand in a patient's shoes and to convey an understanding of the patient's situation as well as the desire to help.

Clinical empathy was once dismissively known as "good bedside manner" and traditionally regarded as far less important than technical acumen. But a spate of studies in the past decade has found that it is no mere frill. Increasingly, empathy is considered essential to establishing trust, the foundation of a good doctor-patient relationship.

Studies have linked empathy to greater patient satisfaction, better outcomes, decreased physician burnout and a lower risk of malpractice suits and errors. Patient satisfaction scores are now being used to calculate Medicare reimbursement under the Affordable Care Act. And more than 70 percent of hospitals and health networks are using patient satisfaction scores in physician compensation decisions.

"The pressure is really on," said psychiatrist Helen Riess. The director of the empathy and relational science program at Massachusetts General Hospital, she designed "Empathetics," a series of online courses for physicians. "The ACA and accountability for health improvement is really heightening the importance of a relationship" between patients and their doctors when it comes to boosting adherence to treatment and improving health outcomes.

Commentary

CMDA Past President and Oncologist Al Weir, MD: “Is it possible to ‘instill empathy’ into our healthcare professionals, and is it a good thing to try?

“It is certainly good for us to have and demonstrate real compassion for our patients. Those of us who love Christ should have His compassion flowing naturally from us to those who are suffering. If we do not, there is something wrong with our relationship with the Christ. Perhaps, if we learn to love Him more, we will indeed love our patients more and demonstrate that compassion better.

“This is foremost, and all the training in the world cannot mimic true love for those we serve.

“However, though our character of love is most important, we certainly also need to develop communication skills to best demonstrate that love in a way that best demonstrates the heart of God. Communication skills can indeed be learned and practiced so that we ‘do best’ what we ‘are’ inside. I am familiar with the training instruments listed in this article. They, among others, can be quite valuable tools for Christian healthcare professionals to use in honing our skills, so that our communication actions might match our hearts of compassion.

“Just as a missionary physician must learn new roads to carry his message of Christ into the deserts of northern Sudan, all of us should learn new skills of communication through which we may best carry the message of God’s love to each patient we serve.”

Resources

Grace Prescriptions – Learn how to share your faith in your practice
Spiritual Assessment in Clinical Care – Part 1: The Basics
The Practice of Medicine: More Than Just Science

Recognizing and relating to a patient’s emotions

Excerpted from “Should Your Doctor Cry With You?,” U.S. News & World Report. July 2, 2014 — Doctors deal with intensely emotional situations every day, in the face of which they are taught to remain objective. But there’s a growing recognition in clinics and medical schools that empathy and emotional intelligence have a prominent place in medicine, too.

If doctors really want to connect with their patients, says Peter Ubel, a physician and behavioral scientist at Duke University, they should model themselves after Starbucks’ employees. Baristas are trained to handle angry customers using the “latte” method of communication, which stands for: listen; acknowledge the problem; take action to solve it; thank them for bringing it to your attention; explain what you’ve done to fix the problem.

Instead, doctors often dismiss a patient’s negative emotions, Ubel continues. Studies have shown that when cancer patients expressed feelings such as ‘I’m in pain’ or ‘I’m scared,’ their doctors – mostly experienced oncologists – said nothing or changed the subject. But simple acknowledgment of the patient’s feelings – with something like "Oh, I can understand why this must be scary for you" – can open up an emotional channel that improves the relationship as well as, potentially, clinical outcomes.

At the same time, the distance that doctors are taught to maintain from patients is important to uphold. “You don’t want your doctor blubbering around the hospital,” Barron Lerner, an internist and professor of medicine at New York University School of Medicine, says. “There’s a professionalism associated with being able to deal with profoundly emotional situations in a dispassionate manner.”

Commentary

Founder, Executive Director and Psychiatrist at Lighthouse Network Karl Benzio, MD: “The Hippocratic Oath is profound in its message as it is a spiritual covenant to hold as the utmost priority the best for the patient and not the best for the healthcare professional or any other third party. ‘The best’ for the patient pertains to the ultimate spiritual and psychological benefits, as Hippocrates said he would not perform an abortion or euthanasia, which would prioritize the physical over the psychological and spiritual.

“Physicians have expertise and healing to impart to patients, but unless a bridge exists to reach patients, healing will be delayed, compromised or not delivered at all. The bridge is relationship, not only doctor-to-patient but also human-to-human. The first step in building this bridge requires communicating understanding, sensitivity, respect, dignity and honor. This is why healthcare professionals ask probing questions, and our demeanor while patients respond allows them to invite us into their pain. Our responses of sympathy and empathy show we are listening and feeling the hurt, fear or uncertainty that can deeply harm them.

Resources

Grace Prescriptions – Learning How to Share Your Faith in Practice
Moving Beyond Physical Healing by Dr. David Levy

Hardwired for empathy

Excerpted from "Study finds that our brains are hardwired for empathy, friendship," Medical News Today. August 26, 2013 -- Perhaps one of the most defining features of humanity is our capacity for empathy - the ability to put ourselves in others' shoes. A new University of Virginia study strongly suggests that we are hardwired to empathize because we closely associate people who are close to us—friends, spouses, lovers—with our very selves.

"With familiarity, other people become part of ourselves," said James Coan, a psychology professor in U.Va.'s College of Arts & Sciences who used functional magnetic resonance imaging brain scans to find that people closely correlate people to whom they are attached to themselves. The study appears in the August issue of the journal Social Cognitive and Affective Neuroscience.

Researchers found that regions of the brain responsible for threat response displayed little activity in the cases of shock to a stranger. However, when the threat of shock was to a friend, the brain activity of the participant became essentially identical to the activity displayed under threat to the self. "The finding shows the brain's remarkable capacity to model self to others; that people close to us become a part of ourselves, and that is not just metaphor or poetry, it's very real. Literally we are under threat when a friend is under threat," Coan said.

This likely is the source of empathy, and part of the evolutionary process, Coan reasons. "A threat to ourselves is a threat to our resources," he said. "Threats can take things away from us. But when we develop friendships, people we can trust and rely on who in essence become we, then our resources are expanded, we gain. Your goal becomes my goal. It's a part of our survivability."

Commentary

CMDA Member and Executive Director of Lighthouse Network Karl Benzio, MD -- "Some Christians have a hard time accepting science, associating science with Darwin, thus getting flustered thinking most science contradicts the Bible. Others really struggle accepting psychological sciences, associating it with Freud or thinking that psychotherapy is man worshipping man, trying to solve problems without God, or looking for an excuse for or to normalize aberrant behavior.

“But science is just the study of: 1) What God made; 2) Understanding how He designed it to function; and 3) Learning how to maximally steward it for His glory and our abundant living. Obviously, I am partial, but God’s two most incredible creations are the human mind and free will (our psychological process which produces decisions).

“As our Creator, like any good developer of a product, God gave us an awesome instruction manual, called The Holy BIBLE (Best Instruction Book for Living Everyday). Throughout the Bible, God clearly teaches us His design for us to be in relationships from the beginning in the Garden of Eden through our ultimate union with Him in the life after this in Heaven. Mark 12:30, the Greatest Commandment, instructs us to love God with all our heart, soul, mind and strength, but then to love others and ourselves (in healthy and Godly ways).

“This study reveals science about the circuitry God created for us to accomplish His command to engage in healthy and caring relationships. The missing piece science has a hard time quantifying, though, is the spiritual sphere, that spiritual part of man that is unique for each of us. Our spirit allows a special connection to God and a special connection to others. Unfortunately, Satan is always attacking our mind, but as we manage life the way the Bible instructs, circuitry for empathy, forgiveness and agape love grow as we carry out the Greatest Commandment and develop the mind of Christ.

“So engage the awesome science of our mind as it helps us understand how God designed us, but more importantly, how to steward our mind to glorify Him and live life abundantly. How you manage every minute is your decision, so choose well.”

Resources
“Cleaning Up” Marital Communication by William Curtrer, MD, and Sandra Glahn, ThM
Summer 2012 edition of Today’s Christian Doctor