Incorporate empathy in patient interactions

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?”

Incorporating empathy

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.

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  • Lisa

    I’d hate it if someone if my doctor’s talked to me like the author is suggesting. The responses sound ‘canned’ and not truly empathetic.

    • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

      Hello Lisa: Thank you for your note. It may seem canned if not done properly. I emphasize the need to be authentic. I have been coaching physicians for 20 plus years. I work with many physicians who initially tell me, “I don’t seem to be connecting with patients.” I observed them & there was no emotional element to the conversations. I suggested some of these techniques — leading to dramatic changes. I’ll never forget the physician who called me and said, “I could not get this one guy to take his diabetes meds. I Incorporated your suggestions. The pharmacy just called and told me he picked up his meds!” With best wishes, Edward Leigh, MA, Founder & Director, Center for Healthcare Communication

    • JR DNR

      Where I grew up no one says “bless you”. My last job no one said it. At my current job, it’s a constant. I find it annoying and obnoxious. But they are so ingrained/used to doing it I can’t simply ask them to stop, it’s a habit. And they wouldn’t understand why I find it rude when they were taught it’s good manners.

      Instead, I had to research the appropriate response. “Thank you”. At first it was a canned response. Over time it’s annoying me less and less, and now I really don’t care anymore.

      That’s just one example of a learned response to a social situation. Normally we learn these things growing up, but “Doctor-Patient Talk” isn’t something we learn growing up. By giving someone a phrase it gives them a starting point, and then they develop their own skills based on patient response as they grow as a Doctor.

      • guest

        Your reply is actually a wonderful illustration of the difficulties with the approach being described above.

        You are describing a single, very simple social convention which you found annoying. You had to take the time to research it and with many repetitions, over time, that one uncomplicated social response has begun to bother you less.

        Imagine a doctor and patient interacting: there are literally hundreds of nuances in each encounter and each encounter is different. It is a vastly more complex social situation than just learning the appropriate response to a “Bless you” when you sneeze–the mastery of which apparently took quite a bit of time and thought on your part.

        I would argue that there is no good way, short of providing doctors with more time with their patients (which we don’t as a society appear to want to pay for), for doctors to re-capture that caring, empathic approach which everyone misses. I feel that there is also no good way, contrary to what the author of this piece thinks, to teach doctors to fake it well enough that they will fool many of their patients.

        There is simply too much that a doctor is expected to do, and is expected to do in less and less time, for him or her to have a genuine relationship with their patients.

        • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

          With all due respect, you missed my point. I am not talking about “faking it.” I am talking about using a skill to connect with people. I have worked with many physicians who stated “we don’t have time for this …” However, once they learned to incorporate the skills, they saw significant changes. At first, it seems awkward, however with time it becomes natural. The skills work — and research proves it.

          • guest

            I would be very interested to see specific research studies on this topic. Again, just speaking as a patient, it is always quite obvious to me when a physican doesn’t really have a personal interest in me and is employing coached responses in order to create an artifical atmosphere of empathy or interest.

          • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

            I have worked some very resistant healthcare professionals. I do find most professionals can gain the
            skills. I have found, based on
            personality, their empathy may sound stiff, but they really do care. I have
            relatives who are very introverted. When they speak you may feel that their
            words are hollow; however, they really do care.

          • guest

            Just to clarify, in my own professional work, I am a psychiatrist, so I am very aware of empathy and how crucial it is to connect with patients. I also know that it’s critical to do it well, which is to say that it must be genuine, so that the patient experiences the connection as a genuine one. If the patient feels that the doctor is stiff, or hollow, or following a script, I think it is almost worse than if the doctor is entirely businesslike and sticks to addressing the patient’s medical issues.

            I think my point really is that it’s important to be aware that in the last two generations there has been an explosion in the technical knowledge that most doctors must have mastery over, at the same time that there has been relentless downward pressure on the amount of time that a doctor has to spend with a patient.

            Most doctors these days, if they are good at what they do, are highly skilled technicians. A few extraordinary ones can manage to connect emotionally with their patients while also efficiently deploying their technical skills to address the patient’s medical issues. Many doctors just have their hands full trying to do the technical side of their job well. Trying to add in catch phrases or tricks to appear empathic when you really don’t have time to genuinely connect will fool fewer patients than you think.

            I am sure that the research you cite proves that patients want a doctor who is empathic. We all do. But I would be interested to see research that demonstrates that doctors who have been through empathy coaching have patients who experience them differently after the coaching.

            I personally think patients would get more out of their encounters with doctors if their doctors were allowed to spend more time with them, and I wish I saw more “thought leaders” in the healthcare industry advocating for thoughtful, personalized, high-quality care for all of our patients, not just the ones who can afford a high-priced concierge practice.

          • DeceasedMD

            I would imagine for you, as a psychiatrist who has a lot more knowledge than this MA will ever have about how to treat and show empathy for pts, I find it amazing that he thinks he can teach MD’s. Hubris I think is the word.

          • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

            Hello. As a psychiatrist, I greatly value your opinion. I appreciate the time you took to write a very thought-provoking post. Two words come to mind — it’s complicated! I have worked in healthcare my entire life & have seen more changes in the past few years, then in the past 30 years. Oh my, that makes me sound old! I believe on a spiritual / philosophical level, it may be challenging to teach a person to empathize. However, what I am talking about is really basic & practical. I started my work decades ago teaching medical students how to communicate with patients. We taught them to listen for physical symptoms as well as feelings. During the practice sessions with actor patients, we asked the students what the people were feeling. Then we suggested reflecting back what the person is experiencing. It does work. Are we changing their intrinsic nature? Probably not, but we are getting them to think about how the patient is feeling. It’s a start. Thank you again for commenting.

      • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

        You make an excellent point. For some people, the use of empathy is a new skill. At first, it may seem unnatural and awkward. However, with time it becomes natural and spontaneous and real. I give people starting tools and suggest they “make it their own.”

        • JR DNR

          I think the real fear is that someone’s employer will give them a script and tell them not to deviate from that script. That of course is not healthy for the individual.

          Example script: “is there anything else I can do for you today?”

          This is a great question to ask when someone seems to be done with their conversation and questions are answered. It usually either jogs them to ask another question, or they’ll say “on no you answered my questions.”

          It’s not a great question to ask if someone has already said “great, thanks for your help, bye.” It’s not a great question to ask if someone is really angry.

          So that’s the power and the danger of learning phrases or scripts. If you don’t know what to say, they are absolutely empowering. But if you’re required to say things, even when the situation isn’t right, of course it will cause problems.

          Summary: Learning phrases to use with patients so they roll right off your tongue and seem natural? Win. Being forced to use phrases at inappropriate times by an employer? Fail. I think it’s the second part that worries people.

      • Patient Kit

        Whether we say it ourselves or not, it’s hard for me to get bothered by the social convention of saying “bless you” when somebody sneezes. Whenever anyone “blesses me”, I always just say “thank you” (and I mean it too) because I interpret “bless you” as a way of acknowledging that someone nearby sneezed and wishing them well. To me, “bless you”, in essence, means “I hope you don’t get sick”. I don’t find it meaningless or super meaningful. Just kind of nice. It beats “Get away from me! I don’t want your cold.” ;-)

        • JR DNR

          But it’s not a social convention to say “bless you” where I grew up. Instead, you get the occasional weirdo who says “Good Health” in German. I never heard “bless you” until I moved to a different state.

          I haven’t found a good distinction between who says it and who doesn’t, but it seems more common among certain branches of Christianity which are common here, but not common where I grew up.

          So some religions use it, other don’t. The people who I know who use it are all extremely religious. Therefore, it comes across as religious to me.

          • Patient Kit

            Bless you, Good Health, Gesundheit…..it’s pretty much all an expression of the same thing to me and all come from a good place. Intent means a lot and I don’t think there is any ulterior motive in saying “Bless you”.. Whether the sneezer or blesser is religious or not, I just don’t find the well-wishing to be awkward or uncomfortable. In some ways, ignoring a sneeze or, LOL!, glaring at a sneezer seems worse. I do understand where you’re coming from. I just don’t feel the same way. I live in a city of 8 million where it’s a very mixed bag, culturally, how people react to a sneeze. Just don’t sneeze right on me. That’s all I ask. ;-)

          • JR DNR

            It’s nice you aren’t offended and grew up with it as a polite thing to do.

            I grew up saying “excuse me” when I sneeze, and if you sneeze and don’t say excuse me, I think you’re rude.

      • Lisa

        Learnng ‘doctor patient talk’ maybe necessary for some, but if a doctor can’t develop their own skills beyond the formulaic, I am not impressed.

  • guest

    Speaking as a patient, this type of behavior on the part of my doctor always make me uncomfortable. I know that they have less than 15 minutes with me, and I also know that their making chit-chat “to get to know me better” is something that they are doing as a patient management strategy, not out of having any actual time in which they can develop a real relationship with their patients.

    Also, because they have very limited time, I feel self-conscious about the fact that I can’t relax and have a genuine conversation with them, since I have no idea how much time they have mentally allotted to this “conversation.”

    Then there’s the fact that if I am there for a problem of any complexity, I am conscious that every minute that they spend asking me about something personal that they’ve made a note about in my chart is a minute that we don’t get to spend trying to figure out why I have a nagging cough, or whatever.

    And finally, most doctors are not that socially skilled. We spend years in solitary study so we can get good test scores and get into medical school, then spend years in medical school competing with our classmates for good residency spots. Your typical doctor just does not have the social skills to make the approach recommended above seem anything but mechanical and insincere.

    Or, if it is sincere, they end up spending too much time on it and are chronically running very late in their practice.

    And finally, as a patient, I really don’t care for “empathic responses.” The actual purpose of an empathic response is to get the patient to open up and talk about their feelings. This cannot be accomplished in the scope of a 12 minute visit, so what you are talking about then is an empathic response that hangs there awkwardly as a savvy patient like me tries to figure out a graceful, but brief way to respond, or a patient opening up emotionally, only to have to be cut off sixty seconds later when it turns out that the doctor didn’t actually have time to get into anything emotional.

    However, these are all things that it’s difficult to understand unless you are a doctor yourself, which definitely makes it easier to write long blog posts optimistically telling doctors how they can improve interactions with their patients.

    • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

      Hello: Thank you for your comment. I have been working with physicians for 20 plus years. I have a masters degree in health education and next year will begin my doctoral studies. I have also interviewed thousands of patients about their experiences with healthcare professionals. One of the biggest issues patients discuss is the lack of emotional connection. I also have a great of experience as a patient. I am a 15-year survivor of Stage III Colon Cancer. It was the nearly complete lack of empathy from my healthcare team that led to my interest in emotionally connecting with patients. I don’t want a mechanical robot taking care of me — I want a highly-skilled professional with an empathic approach. Best wishes, Edward Leigh, MA, Founder & Director, Center for Healthcare Communication

    • JR DNR

      So I was at the doctor’s office and it was really hot so the door was open… the doctor snuck over, peaked out the office, closed the door, and related a personal story to me. Obviously he didn’t want his staff to hear.

      That is the one of the reasons I like my doctor.

      • guest

        Aw! That’s cute! And probably one of the best ways that a doctor can truly bond with their patients—by being natural, and recognizing that they are both people…

        • JR DNR

          “Cute” strikes me as a condescending response… like you’re talking down to me like I’m a small child or a puppy.

          What if someone was taught to not show emotions (many men are), to be professionally distant, and is coming across as really cold. And they don’t want to be that way. They want to change.

          That is when “learning” comes in.

          When I first became a manager, and I had an employee who’s family member died, I was polite and courteous. But I came across as cold, when I was trying to be respectful. Luckily I had great role models who coached me on how to be different.

          Many older doctors (and some residents still today) don’t have anyone to really model after with these skills, they instead learn to shut down emotionally, push it all away, and be cold. So this kind of article can help them if they are seeking that out.

    • Patient Kit

      Do you think that’s really true — that most doctors lack social skills? Or is that a stereotype that’s not nearly as common as you think? I can understand the dynamic that you mentioned of spending a lot of solitary time studying and competing. So, I can see how some social skills might be delayed. I can see how some docs might be late bloomers in the social skills area. But there is no reason to never get there, especially if you’ve chosen a career that, to say the least, involves working with people. Also, I’d hope that many docs go into medicine in the first place because they are a “people person” who cares about people and has the impulse to want to help people.

      As a patient, I do want genuine empathy from my docs. It doesn’t have to be smooth and perfect. It just has to be genuine and human. And we all know that time is an issue, so short and sweet is fine. I’m not looking for a therapy session from my docs. Just a genuine human connection. Just make good eye contact with me and let me know — somehow — that you know me and care about me. If a doc has no people skills, no empathy, no communications skills — that doc better have some extraordinary special skills that I can’t get elsewhere from other docs.

      • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

        Thank you for your comment. You bring up so many wonderful points. You use the key word, genuine. When I coach physicians, they will sometimes initially say, “This feels awkward, unnatural.” I tell them to work on it and it will feel very natural and wonderful. Any new skill feels uncomfortable when starting out, such as riding a bicycle. People can learn empathic communication. It may take more work for some people, but everyone can learn these skills. Also, you don’t have to be prefect. Physicians will sometimes say to me, “What if I use the wrong feeling word?” The important point is that patients will know you are trying to understand their experiences — that is the beauty of these skills.

        • Patient Kit

          I think we all agree that empathy should not be faked. But assuming that empathy is actually there and felt, I wonder whether some docs resist expressing it because they are uncomfy doing things that don’t make them feel perfect, in control and excellent. Nobody likes doing things that we feel inadequate at. But pushing through that is the only way we get better at things we’re currently not great at. Like expressing empathy. It’s worth breaking through that wall though. Nobody likes or trusts a cold doctor.

      • rbthe4th2

        I dont know. The doc I had like this, I’ve done without his skills. I may be suffering but at least I dont have snide, condescending, egotistical spoiled brat Dr. Ego on top of it.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Why do we have to teach the most communications driven species how to communicate? Or are we teaching them how to substitute “quality” communications, for “quantity” communications, which is the natural way people relate to each other, build relationships and eventually trust?
    This reminds me of those parenting books that teach how to communicate with your children, e.g. active listening, repeating things back, empathy, etc. I think those books came into vogue about the time parents became too busy with work and careers to have proper time for their kids.

    • JR DNR

      I think some people communication skills come naturally. Not so for others. I’m one of those “learned” communicators. I’m very grateful to have had opportunities, for example, to take workshops on effective email correspondence.

      - Never forward an email and expect someone to read the full chain of emails to understand the problem.
      - Make sure your email includes a clear statement indicating the action you want the recipient to take.

      Simple things like that have made me a better communicator. Sure, I don’t learn 100% of what they teach but I pick up a few things and incorporate it into what I do.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Sure, but these things are different, because this is a technical communication mode, mediated by inanimate objects and driven by protocols.
        Building trust through verbal communications is a natural result of human interactions conducted in good faith.
        There is something not quite right when one side begins using artificial protocols with the express purpose of inducing the other side to trust them, like in the TV commercials selling insurance. This is in my opinion does not qualify as a “relationship”. Why not just encourage people to verbalize what they feel in the moment? If it’s not empathy, then don’t fake it. Don’t say thank you unless you feel gratitude, and don’t say sorry unless you feel remorse, because if you do say it all day long to all people, I have no idea when you are truly grateful or truly remorseful, and I will assume that you never are.
        In your own example (saying bless you all the time), do you thing your coworkers could be conditioned to say pink butterfly instead, and mean the exact same thing, which is absolutely nothing?

        • JR DNR

          I watched this really great video about someone with high-functioning autism. He talked about how he had to be taught social skills as an adult by friends, co-workers and family. At first, it was awkward and artificial, but now, it’s a part of who he is as a person in society and he functions more fully.

          Seeing that made me realize that I too, didn’t just “know” these things, rather, I’ve learned them. Some I learned as a child, some I learned as an adult. But it’s “learned” not “natural”.

          • http://onhealthtech.blogspot.com Margalit Gur-Arie

            If by learned you mean learned through a normal process of growing up as a human being, then I would agree. I guess, when people have problems, they could learn how to, for example, express their feelings better.
            What I object to is the teaching of techniques to elicit trust from unsuspecting people who are pretty vulnerable during the time when those techniques are being applied to them. Even more disturbing to me is the fact that the goal is to make people more “receptive to suggestions”.
            What is wrong with just being honest and call it as you see it? I had a physician yell at me for half an hour straight one time (many years ago). Half an hour, no kidding. I think he cared a lot…. and I appreciated that.

          • JR DNR

            So there is a couple that is having problems. Should they try out couples therapy? Should they resolve the problems on their own?

            Everytime someone moves into a new type of relationship, there is a learning curve for the right social behavior in that relationship.Having a child-parent relationship is different from a parent-child relationship which is different from a teacher-student relationship which is different from a marriage which is different from an employee-boss relationship which is different from a boss-employee relationship…

            Being a child doesn’t automatically make you a great parent. Being a parent has a learning curve.

            Teachers learn about how children learn so they can be better teachers. Trainers learn how adults learn (different than children do) so they can be better Trainers.

            The thing is, many people are out there learning how people work. I’m not going to say it can’t be used for evil, but it definitely can help an individual in their career to study effective communication.

    • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

      Thank you for your comment. My area of expertise is patient-professional communication. I look at the research very carefully. Our goal is to help patients understand their medical situations. The research verifies that these skills help people feel less anxious and more open. The patients are then more receptive to our suggestions.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Why do you strive to make patients more receptive to your suggestions?

        • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

          Hello. Everything I do is patient driven. I have interviewed thousands of patients. I listen to their comments very carefully. Common themes always arise, such as the strong desire to have healthcare professionals who care about them as people not just diseased entities. The topic of empathy is always brought up — patients tell me they want professionals who are empathic — professionals who are trying to understand their experiences. My article was not really my opinions, but rather the article is based on the research and what patients tell me they want from their their professionals.

          • http://onhealthtech.blogspot.com Margalit Gur-Arie

            Don’t we all want that from all other people we interact with? I don’t think we want the studied appearance of care and empathy. We want the real thing. I would also venture a guess that the last thing people really want is to be manipulated in their doctor’s office in a similar way they are psychologically manipulated by marketers on TV.
            That said, it is probably going to work well for a while, but I can assure you that if these tactics become common in medicine, eventually nobody is going to trust doctors anymore, and rightfully so.

          • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

            Hello. With all due respect, I am puzzled by your resistance to this topic. The research suggests certain activities work to help patients feel more at ease. Patients tell me through years of focus groups that they want empathic healthcare professionals. The point of the TV insurance example is that we need to connect first on an emotional level. This has nothing to do with manipulation, but has everything to do with showing compassion.

          • Patient Kit

            With all due respect, if I was your editor (and rest assured that I know I am not), I would have suggested not opening your piece with an insurance commercial as an illustration of the points you then want to make. We all know that insurance commercials are very manipulative, so why make a connection between that and good genuine human doctor-patient communication? I think some of the mixed reactions you’re getting are, in part, a reaction to your starting with that insurance ad. I want genuine empathy from my docs, not manipulative emotion in order to make me more receptive to info. That does sound like manipulative marketing. And now I can’t get the image of an adorable gekko in a white coat and stethoscope buttering me up before he goes in for the kill. ;-)

          • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

            Thank you for your note. You make an excellent point. I always have other people review my articles and
            no one noticed the potential problem with first story. The point of the story
            is that we need to connect first through emotion so people would be more
            receptive to our information. Of course, I would never suggest manipulative
            marketing. However, I could see how people may have that impression. Once
            again, many thanks for your comment. My best to you.

          • Patient Kit

            I just happen to have my editor hat on right now since I’m currently doing some freelance editing work after a long bout of unemployment during my recent ovarian cancer odyssey. (Not sure if you know my story from other posts here at KMD. But I’m happy to hear that you’re a 15-year cancer survivor. I’m just past my 1-year cancerversary).

            I think the intent of your OP was good at heart. I basically read it as a plea for docs to learn to express the empathy that they do feel, not fake the empathy that they don’t feel. Unfortunately, I think your insurance reference has, ironically, resulted in a little miscommunication. On the bright side, your OP has sparked some good discussion, which is always a good thing.

          • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

            I am happy to read your cancer was caught early and you are now cancer free. I wish you continued good health. After my stage III colon cancer, I joined a listserv on acor.org. The listserv was a Godsend — my miracle! They have multiple listservs for a variety of cancers. Check out the ovarian cancer list. I see your screen name is “patient kit.” Are you a patient advocate? In addition to my work as a professional, I also have another hat — cancer patient advocate. I am on many national committees. My focus is on screening & early detection. Blessings to you. Be well. PS. I know some people had issues with this article, which came a surprise to me. I do my best – do what I can to help other people. I never get “worked up” about things. Based on my medical history — I shouldn’t even be alive now! Every day is a gift — why spend your time being upset?

          • http://onhealthtech.blogspot.com Margalit Gur-Arie

            Resistance? I like it, but is this really the correct term?
            Physicians are not flight attendants, or customer service representatives. They need not show anything they don’t actually feel.
            And if the system is blunting their ability to feel or express feelings (see Dr. Wible’s comment), I don’t think that a patina of comments about vegetable gardens, dogs and weddings, is an appropriate substitute.

          • Patient Kit

            Speaking of resistance, you’re one of the leaders of The Resistance, aren’t you, Margalit? ;-)

          • http://onhealthtech.blogspot.com Margalit Gur-Arie

            Ha ha… mine is Résistance :-)

          • rbthe4th2

            One of the reasons why people dont trust doctors now. Maybe I should say that the trust is starting to drop rather than not trust. I have some great docs but all it takes is one problem child … and like docs who learn from the sue happy, we learn what they do too.

  • rtpinfla

    Wow there seems to be a lot of controversy on what seems to be a well written and insightful post. I think, for a guy like me, there is a lot of good advice in there.
    We all believe we are empathic and caring physicians. Probably most of us are. But if the patient perceives that we are uncaring then it really doesn’t matter how empathic or even how competent you are.
    I believe that I am a caring and empathic physician but also know that sometimes it doesn’t come across well since I tend to like my distance. it’s not that I’m rude or brusque- I’m told I’m mostly pleasant and courteous. But I’m one of those that find it difficult to “chat a patient up” to ask about a trip or other things regarding their personal life. When I do manage to stumble into those conversations, I always find them interesting if not insightful and it definitely, without exception, improves the give and take needed to provide better care. I learn more about the patient and feel that the patient comes to trust my recommendations a bit more. Plus I learn stuff like why certain goat meat tastes better than others (like I did yesterday).
    So for me, it’s not so much pretending to care- I do. It’s more about demonstrating that empathy in a way the patient can perceive. For me it’s a work in progress- I’ll probably never be the doc that shares recipes or swaps fishing stories with my patients, but I’ll keep inching that way.

    • Patient Kit

      I think you’re right. Assuming a doctor does actually genuinely feel empathy for his patients, it’s about learning to express what you feel. It is not about learning to fake what you don’t feel. Doctors shouldn’t feel alone in this. I think, when it comes to good interpersonal communication skills, we are all lifelong works in progress.

    • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

      Hello. Thank you for your note. Based on the research, my coaching of physicians and interviewing thousands of patients, these skills do work. It is simply about connecting with people. I was very surprised the article generated so much controversy. There are so many controversial topics in healthcare — I never dreamed an article on empathy would generate so much notice. I was worried the topic would be considered boring & no one would even bother to comment! Maybe the controversy is a good thing? Get people talking about the subject. Thank you again for your kind words. I wish you all the best. Edward Leigh, MA, Founder & Director, Center for Healthcare Communication

    • Anne-Marie

      As a lifelong introvert, I appreciate doctors who are a little more introverted. Your style would probably suit me fine. Just because someone isn’t chatty and brimming over with bonhomie, it doesn’t mean they’re uncaring or lacking in skill.

      I think American culture is biased in favor of extroversion, and it spills over into what we see as desirable and not-so-desirable ways of behaving. I sometimes get the feeling patients are being conditioned to expect doctors to display a communication style that’s at the extroverted end of the spectrum, and doctors are being demanded to produce it – whether it comes naturally or not, and whether it’s best for a particular patient or not.

      Quiet docs may have to turn up the volume sometimes to demonstrate their empathy, but loud, talky, touchy-feely docs might also need to tone it down so their expressions of empathy don’t get lost.

  • http://www.idealmedicalcare.org PamelaWibleMD

    Great reminder. I think assembly-line medicine and the abuse docs suffer in their training disrupts our natural tendency to express empathy.

    • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

      Hi Pamela: I agree — the system works against the natural
      flow of empathy. I have read articles
      that physician empathy deceases as they go through med school, residency,
      etc. By the time they have completed their
      education / training, much of the empathy is depleted. They need to be-charged! As an FYI, I LOVE LOVE LOVE your articles!
      Keep up the amazing work! Best, Eddie

  • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

    I sincerely believe that healthcare professionals do feel empathy. The point I am making is that they need to verbalize their feelings of empathy. The empathy needs to move from their minds to their mouths. Also, for professionals who don’t feel the empathy — they can learn. Learning to ride a bicycle feels awkward and unnatural at first. However, with training & practice it becomes second nature.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      If that’s the point you are making, then we are in agreement. However I am not sure how most of the statements in the article pertain to this otherwise very good point.

      For example:
      “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.”

      What does this have to do with “empathy”?

      • SarahJ89

        Margalit,
        I couldn’t make it all the way through the article. I find the example you quote pretty appalling. It’s manipulative and patronizing and downright contemptuous of patients. Ugh. Thank you for pointing it out.

      • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

        The article’s original title upon submission did not have word “empathy” in it. I use the words, “emotionally connecting.” The editors altered the title, which they have every right to do. The original tile reflected the fact that entire article was not about empathy. My best to you.

    • Suzi Q 38

      Not all healthcare professionals feel empathy.
      Some are jaded jerks….

      • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

        Hello. I am the eternal optimist and do believe that most healthcare professionals are caring people. However, there is a minority of people in healthcare who should not be seeing patients. They are angry, burned out and unhappy individuals. I am a healthcare professional, but have had extensive experience as a patient. In the mid 1990s, while I was struggling to determine the cause of my chronic physical issues, a doctor noticed I had abnormal liver function tests – she then accused me of being a drug addict. She insisted I “confess.” When I told her over & over I do not use drugs, she said I was lying. The actual cause of my symptoms? Advanced cancer. Miraculously, I am well today. My best to you.

        • Suzi Q 38

          I agree.
          Two of my doctors (specialists at that!) did not believe me either. They thought I was making it all up.
          My diagnosis was a tough one to accept, but I was relieved that someone believed me for once.
          I even diagnosed myself and gave MS, PAD, and spine injury as possibles.

          • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

            I am sorry to read of your bad experiences. It is tough to be ill & have others write you off. Sadly, I even had on dr who told me it was stress & that I just needed to learn to relax …

  • PoliticallyIncorrectMD

    em·pa·thy – ˈempəTHē/ -noun- the ability to understand and share the feelings of another.

    The ABILITY ! You either possess the ability or you do not. You can fake it but you cannot learn it.

    • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

      With all due respect — I completely disagree with you. It is a learned skill, like riding a bicycle. It may take some people longer to pick it up, but nearly everyone can learn it! It is not like a musical talent where either you have or you don’t.

      • PoliticallyIncorrectMD

        Again… You can teach somebody to appear caring but you cannot teach them to feel what others feel, similarly to not being able to teach love or any other complex emotion.

        http://m.ptjournal.apta.org/content/70/11/707.short

        • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

          Hello. I believe on a spiritual / philosophical level, it may be challenging to teach a person to empathize. However, what I am talking about is really basic & practical. I started my work decades ago teaching medical students how to communicate with patients. We taught them to listen for physical symptoms as well as feelings. During the practice sessions with actor patients, we asked the students what the people were feeling. Then we suggested reflecting back on what the person is experiencing. It does work. Are we changing their intrinsic nature? Probably not, but we are getting them to think about how the patient is feeling. It’s a start. Thank you again for commenting.

  • Chiked

    I am surprised no one has talked about the obvious. Appointments are now 10 mins with my doctor, most of that time spent typing on a computer. Even the pope couldn’t show empathy under those conditions.

    • guest

      Well, I mentioned it above, only to be chided by Mr. Leigh about how many years of experience he has and how a truly motivated doctor can, with proper coaching, learn to do anything regardless of the barriers/challenges.

      • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

        Hello. I never meant to sound harsh.
        In my experience, people tend to think showing empathy is a long process.
        However, it could be done in literally seconds. How many seconds does it take
        to say, “Sounds like you have having a rough time?” I have worked with many skeptical physicians
        who did not think highly of this “touchy feely” stuff. However, they
        later told that their patient meetings are significantly enhanced. I have even
        had Drs that told the patient visits were shortened since people felt at ease
        and got right to the issues. Once again,
        never meant to sound harsh. My best to you.

        • DeceasedMD

          You are an MA. You are not a psychiatrist who has a lot more knowledge than you will ever have about how to treat and show empathy for pts. Your words are hollow.

          • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

            Hello. I respectfully
            disagree. I do have an MA and next year
            I begin work on my doctorate. I have had
            20 plus years of experience working with patients. For over a decade I have been intensely studying
            the role of empathy in healthcare. If
            you don’t mind me asking, I see your screen name is “DeceasedMD.” I assume you
            are a physician. What area? What does the
            “Deceased” part mean? Just curious.

          • PoliticallyIncorrectMD

            Are you trying to be “empathetic” to DMD ?

        • Patient Kit

          I’m curious about how skeptical doctors come to end up with you? Why do they come to you for “empathy training” if they feel skeptical about it and resistant to you? Do these docs come to you of their own free will or are their employers forcing them into this training?

        • Karen Ronk

          Sometimes it does not even take words. You can see empathy in your doctor’s eyes or facial expressions if they really feel it.

          • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

            Hi Karen: Yes, the nonverbals are so very powerful. So much can be communicated without words. Thank you for your comment.

  • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

    Hello. Thank you for your comment. Very insightful. Yes, there is risk and a degree of vulnerability. It is a risk I wish more people would take. The receiver benefits from from empathic communication, but so does the sender. When I engage in empathic communication with others I see how the receiver benefits — I also feel good that I have helped another person.

  • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

    Thank you for commenting on my article. Since the article was not on a
    BIG healthcare topic, I wasn’t sure if many people would read it, let alone
    comment on it. I didn’t think my little article on empathy would even appear on
    the radar screen. The intense discussion
    shows strong interest in the subject, which is good. Yes, there are lots of opinions. That’s good too! Now it is time to find a way
    to make it work for patients. Thank you again for taking the time to comment
    and I wish you all the best.

  • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

    I have been in healthcare for 25 years and next year begin my doctoral studies. I have a strong academic / research background. However, the catalyst for this article was my experiences as a patient. In 1999, the tables were turned on me when I went from professional to patient. I was diagnosed with Stage III Colon Cancer. As you could imagine, I was devastated. My healthcare team was very nice, but something was missing. Then one day, one of my chemo nurses said something to me that changed everything; I found the missing link. The nurse said to me, “I know you’re going through a rough time. We’re here for you.” Her words had a huge impact on me — everything changed. She used an empathic statement. I was having a very rough time & she acknowledged that. I actually got a bit teary eyed and then hugged her and told her how much her words meant to me. (Gosh, I’m getting a little teary eyed right now thinking about the experience!) That was the day I began my intense study of the role of empathy in patient communication. As an FYI, it has been 15 years since my cancer diagnosis and I continue to be well.

    • JR DNR

      Unfortunately you’re fighting a hard battle here. There are many doctors here who believe it doesn’t matter at all how their interactions make a patient feel, even if it makes their condition worse, discourages the patient from following a treatment plan, or leaves them with PTSD. They believe they are only there to diagnose a small subset of human suffering they identify as “disease” or “pathology” – relieving suffering is beneath them.

      It gets really discouraging sometimes.

      • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

        Hello. Thank you for your comment. I do believe most healthcare professionals are very caring people. However, unfortunately, there is a minority of people in healthcare who should not being seeing patients — they are angry, unhappy and burned out. Sadly, many of these professionals have significant emotional issues, chemical dependency, etc. I have several colleagues who work with impaired physicians — they have many success stories of helping these individuals. Hurting people hut people.

        • JR DNR

          I think there are those who feel empathy and don’t know how to show it (what you addressed in your article). And then there are those who are hurting who are in denial, and refuse to see that hurt in their patients because it means acknowledging that they are hurting too. Unfortunately it seems our system is designed to burn physicians out before they enter practice.

  • Karen Ronk

    I don’t know what kind of surgery you had, but I had a similar situation with a surgeon and took too long to find another doctor instead of listening to my inner doubts. The results of that waiting have been very damaging to me and I would urge you to find someone else if you have any doubts at all.

  • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

    Hello: It sounds like you are having a challenging time with
    your surgeon. There appears to be a significant communication issue. When finding a surgeon or any physician for
    that matter, I always recommend starting with family & friends. Who have
    they had good experiences with – who would they recommend? I also highly recommend you visit the patient section
    of the website of the American College of Surgeons. The site even has a section
    on finding a surgeon. http://www.facs.org/patienteducation/index.html The site has excellent information. I wish
    you all the best.

  • Doug Capra

    Good article — but it’s sad that the medical industry has to be remind of something like this. It’s a basic element of good communication. One more thing — You write: “…empathy needs to come out in words. Patients are not mind readers.” No. Words are important, but most communication is in body language, facial expressions, tone of voice, and, of course, action. Words are just words. Their real meaning is revealed in contexts, and those contexts include the elements I mentioned above. You can say anything, use any words you want, but what you really mean is not contained in the words but in those other elements.

    • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

      Hello Doug: Thank you for commenting. I completely agree with you — the nonverbals speak volumes. In additional to having excellent nonverbals, my colleagues & I also encourage professionals to verbally state their thought / feelings. I have interviewed thousands of patients about their experiences — they always say they want their professionals to directly state they care about about them. My best to you.

  • Maddie D

    Out of curiosity, do the majority of physicians seek your services on their own, or are they referred by administrators?

    • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

      Hi Maddie: Thanks for your note. I have a good mix of physicians who directly request my coaching services and administrators who want their physicians coached. The coaching does cover psychosocial topics, like empathic communication, however a bulk of the coaching focuses on interviewing and educating skills. I wish you all the best.

  • rbthe4th2

    Yes a surgeon did me in. With all due respect, maybe they should stop promoting Hawkeye Pierce as a typical surgeon because the ones I’ve seen (and a few others) have been more like Charles Emerson Winchester in the first season.

  • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

    Thank you for commenting on my article. I appreciate the time you took to write a very well-thought-out note. I could see you are very passionate about the topic. Earlier in the comment section, I mentioned one big regret about the article – the first example. I simply meant to illustrate that we need to first connect with people emotionally. One patient advocate describes this as “rapport before report.” Also, I would never want imply the use of empathy is meant to manipulate people. From my years of research and healthcare experience, I have seen that raising awareness of a patients’ emotional experience is vitally important. I have interviewed thousands of patients who tell me this very thing. I am a healthcare professional, but I am also a person who survived two different cancer diagnoses. Outside of my work as a healthcare professional, I volunteer my time as an advocate for people with cancer. I help people with cancer navigate the system. Thank you again for writing. My best to you.