As medical professionals we often see people at their worst: battered and broken, bothered and in pain, no make-up, bad hair day, naked and too ill to even care about modesty. At those critical moments, in our patients’ hour of desperation, they hand over their lives to us … and the lives of their family. All that they are — they willingly place at our mercy. At times, burnout, and the day to day hustle of our profession – at no fault of our patients – may cause us to be somewhat apathetic, and minimize what the patient is feeling. We move on from room to room, call to call, then home to our loved ones; while our patients and their families are left reeling from the circumstances of their harsh reality. Where did empathy go in medicine? Are our patients merely a number, an insurance claim, a conversation over dinner, one too many charts we have to complete, or a cluster of diagnostic codes to us? A lack of empathy can negatively affect patient outcomes and quality of care. Our jaded persona could be the reason we miss important pieces of our patient’s clinical puzzle.
I remember an incident as told to me by a former colleague, Pam. She had been a seasoned emergency room nurse for years. Pam and I had worked in the ER together for a couple of years before she went back to school to become an Advanced Practice Nurse. Inspired by her, I would later go back to school and complete the same program. After completing graduate school, Pam went back to the love of her life, the ER. She had fallen in love all over again. But her honeymoon phase had been short-lived. She had begun to grumble and complain about the oh so familiar “frequent flyers” who visited the ER on a regular basis.
“They come in for the same thing day after day,” she had stated. “You can’t refuse to see them. Even if you did, they know what to say to get your attention,” she continued. I knew exactly what Pam was speaking of. The emergency room was full of primary care suitable patients. It had pretty much become a revolving door of the same patients with the same conditions.
Forty-eight-year-old Lisa Jackson was one of those patients. She’d visited the ER at least one to two times a week with complaints of migraines. The staff knew her on a first name basis. They’d give her the normal concoction and send her on her way. But this time, Lisa complained that her headache felt different. Pam remembered Lisa saying her headache was so bad it had made her throw up. But Lisa had been manipulative in the past in order to get more pain medication, so Pam didn’t trust her. She gave Lisa exactly what she thought she wanted — two of morphine and twenty-five of Phenergan — and discharged her almost as fast as she had come. Lisa was back within a couple hours, this time by ambulance. A cat scan of Lisa’s head had confirmed a subarachnoid hemorrhage, which is a bleed in the brain from a small vessel. Pam’s loss of zeal had allowed Lisa’s behavior of “crying wolf” cloud her clinical judgment. But luckily for both, Lisa survived the ordeal with very little complications.
To make sure empathy is incorporated into everyday practice, I utilize five tactics to help remind me that, before anything else, my patients have needs as human beings.
1. Listen to your patients to get a full understanding of what’s going on with them. Don’t try and minimize what they are feeling. Our patients know their bodies and what they are experiencing better than we do. Each patient is different, and the more information we have concerning our patient will further help us find out what’s going on with them.
2. Treat your patients the way you would want your family to be treated. How could we go wrong tailoring our care on the empathy we want shown to our elderly mothers and grandmother or our children? When my mother was once a patient, I remember how cold she’d get in her hospital room. So I made sure the nurse brought extra blankets. I keep this same thought close when I’m caring for other elderly patients. I make every attempt to preserve my patient’s dignity, knock before entering their room, address them accordingly — not inappropriate names as “sweetie or sweetheart,” keep them covered as much as possible and involve them in their plan of care.
3. Walk a mile in your patients’ shoes. Try to imagine how you would feel if in the patient’s predicament. Often we are on the other end of the spectrum — the one administering services. We often forget what it feels like to be a hopeless patient or a confused family member. I remind myself daily how easily the roles could be reversed.
4. Place yourself at the patient’s level. Standing above the patient and having him or her look up at you may paint a lofty picture. This could make the patient uncomfortable, and hinder the rapport of the provider-patient relationship. Since sitting on the patient’s bed may break infection control measures or policies; grab a chair and place it at the patient’s bedside so you can be eye level.
5. Learn the culture of your patient populations. Knowing this increases your cultural awareness and sensitivity toward others. A lot of elderly patients lack formal education. Many of them had to quit school to help with family expenses or care for younger siblings while their parents worked, so their vocabulary and comprehension might be limited. Be mindful of the medical lingo you use with them. Some African Americans may be intimidated by doctors, or because of the tainted history with medical professionals, may have a mistrust of the health care system altogether. When treating teenagers, remember at times they are afraid of the process and worried about confidentiality. Privacy is very important with this age group.
Practicing empathy is a skill set that takes time to master. We should constantly strive to include it in our day to day practice. Empathy is crucial to improving patient outcomes, decreasing burn out, and enhancing the provider-patient relationship. It is also the missing piece of the puzzle that could save our patient’s life.
Jennifer Bradley is a nurse practitioner.
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