What makes a good doctor or, for that matter, a great one? Most patients want physicians who are excellent clinicians and diagnosticians. But we also want doctors who are caring, empathetic and maybe even telepathic — doctors who seem to know intuitively what we need without any awkward discussion of sensitive issues.
After all, patients may not want or know how to talk about substance abuse, domestic violence, sexually transmitted disease or a host of other issues in their background that can have a profound impact on their diagnosis or treatment. Opening the door to such a conversation begins with empathy and sensitivity on the part of the physician. It’s a critical step in building trust with a patient.
But not all doctors are born with these qualities. Certainly, not everyone comes hardwired that way.
The literature suggests that learning empathy is not only possible but also productive. There’s even some evidence that the rigors of medical school actually decrease empathy among students. So, the question is a pertinent one for would-be physicians and their patients: Can empathy be taught?
Social worker and psychotherapist Franca Posner says, “There is increasing evidence that empathy and compassion can be developed and taught.” As students see results of what they’ve learned, she says, the practice becomes more rewarding. Some studies show that empathy — whether innate or learned — can increase patient satisfaction, lead to better clinical outcomes, reduce physician burnout and lower the risk of medical errors.
Medical schools are getting onboard, incorporating programs to teach their students how to develop the skills and put them into action. Posner, who has her own private practice in the Washington, DC, suburbs, works with George Washington University Medical School’s Professional Development Program.
The school pairs physicians with mental health professionals to coach small groups of students, generally 8-10 at a time, over the course of their first three years in training. To help them learn to develop the skills of empathy and compassion that they need, the George Washington University Medical School engages actors from the local Washington community to play the part of patients. They present with symptoms that students must assess, diagnose and track. Students also practice communicating clearly and compassionately with their “patients” at each step of the process.
One of the things the students learn is how to deliver bad news. Doctors, of course, are trained to identify and, if possible, cure illness. As a result, they are more inclined to focus on diseases and particular organs, rather than the whole person.
In other words, as Sir William Osler famously said, “The good physician treats the disease; the great physician treats the patient who has the disease.” To add further context, a great physician appreciates the illness in the context of the whole person.
So what do students learn? At the George Washington program, one of the things they are taught is to enter a patient’s room with their electronic devices closed or turned off, to sit down and engage at eye level with the patient in the bed and begin with an open-ended question such as, “How are you feeling today?”
Students also practice the art of delivering unwelcome news in a caring, sensitive way. For example, they might say, “Unfortunately, the news is not what we hoped for,” instead of saying “I am sorry that I have bad news.”
The distinction may seem insignificant, but Posner points out that the former focuses on the patient, while the latter emphasizes the doctor who is delivering the bad news.
Programs such as George Washington’s also teach cultural and social awareness which involves developing sensitivities to such issues as how people want to be addressed or even touched. Veterans with post-traumatic stress disorder, elderly patients with dementia and victims of violence or abuse may also have special needs that the good — no, make that great — doctor needs to learn to handle with care and compassion.
The list of individual patient needs might seem endless, and no program can develop a protocol for all possibilities. Instead, Posner says, students need to develop their “Spidey senses,” that is a sixth sense — like Spider-Man — to sniff out the unspoken danger that is lurking.
In other words, we patients want doctors with finely-tuned antennas so they can intuitively sense when we have special considerations or needs. And, for the most part, it doesn’t matter if they are naturally empathetic or learn the skill in medical school. We just want them to take great care of us.
Bonnie Friedman is the author of Hospital Warrior: How to Get the Best Care for Your Loved One and can be reached at Hospital Warrior.
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