A popular television commercial shows a group of older women playing cards. One woman talks about her friend who is struggling financially since her husband died (the husband only had a small life insurance policy). Another lady said that she doesn’t have to worry about that happening since her husband has an XYZ insurance policy. The other ladies immediately ask about the policy. Then a TV pitchman describes the policy details and how to purchase it. What this commercial illustrates is that the viewers were first captured by the emotional element of the story, then the viewers received the information. We connected first through emotion, then we were supplied information.
In non-emergency cases, we need to connect with patients first on an emotional level to gain their trust. After this process, then we share the information. The greater the sense of trust, the more likely the patients will be compliant. This makes sense on an intuitive level. If there were two people standing in front of you sharing information and one you had a deal of trust in while the other you were not to sure about. Which one would you likely believe? Of course, the one you felt a sense of trust. Emotional connections lead to trust. Trust increases the likelihood of compliance. This has been documented in the literature. A study in the March 2011 issue of Academic Medicine found that physicians with high empathy scores had patients with significantly greater control over their diabetes than patients of physicians with low empathy scores.
Learning about a patient’s work, hobbies and home life
First briefly talk about personal aspects of the patient’s life. How’s their work? Their children? If they mention a big upcoming event, such a child’s wedding, be sure to comment (“Congratulations on your daughter’s wedding. I am sure you are thrilled!”). Note big events in your records to remind you so when they return for a follow-up visit, you can comment (“How was the wedding?”) They will be thrilled you remembered! Of course, they will think you spontaneously remembered.
During the course of the clinical discussion you can find quick personal talking points. For example, if they said they started feeling sick while gardening — briefly ask about their garden. The patient will brighten up talking about their beloved garden.
Look at their clothing, jewelry, buttons and other items. These items may give you things to comment on, such as by saying, “I see your shirt says ‘Beagles.’ Do you have a Beagle?”
Some health care professionals may feel this personal talk is a waste of time and eats away at the little time clinicians have with patients. Keep in mind, we are talking about very brief comments, not long discussions. Clinicians actually report these brief personal chats can shorten the clinical portion of the interview since patients are more at ease and willing to share.
Once again, if a patient is in significant distress, skip the personal talk and get right to their medical issue. There is a time and a place for everything. If I was a patient feeling very ill, I would not be very pleased if the first question a clinician asked was, “How’s your dog?”
In health care, people always talk about empathizing with patients. Empathy means understanding what it is like to be in their shoes. What are they experiencing? I believe health care professionals have empathy in the hearts, but this is not enough. They empathy needs to come out in words. Patients are not mind readers.
Incorporating empathy involves simply thinking of a feeling word and reflecting back on what the patient has expressed. Sounds easy, right? However, it is rarely used in clinical situations.
What are these patients feeling?
- “Two years ago, I had surgery, chemo and radiation for breast cancer. I am always worried about the cancer coming back.”
(Sample empathic response, “Sounds frightening for you.”)
- “I knew I should not have tried lifting that by myself. Now I’m in a lot pain and can’t work for three weeks.”
(Sample empathic response, “I could understand your frustration.”)
Clinicians have a tendency to respond to the above patient statements with medical information. However, we must first address the emotional, then move on to the informational aspects. In the above cases, not using empathy may cause the patient to feel you don’t care about them. These feelings could lead to a lack of trust and compliance.
What if a patient says, “How would you know how I feel?” First of all, it is very rare to have a patient ask this question since they are receptive to the fact you are trying to understand their feelings. However, if they do ask this question, you can say, for example, “I may not have had the exact same experience as you, but I do know what it is like to be scared.”
In some cases, be careful of starting empathic statements with the word, “I.” If a female patient is discussing the trauma of heavy menstrual cycles, a male clinician should not say, “I could understand your stress.” A better response would be, “Sounds very stressful.”
A little empathy goes a long way.
Edward Leigh is founder and director, Center for Healthcare Communication.