Can you fake empathy until it becomes real?

Studies show over and over again that empathy is the key to physician-patient communication and is directly related to patient satisfaction, adherence to medical treatment, lawsuits, and clinical outcomes. Yet despite its importance, many doctors still struggle with showing empathy.

The reality is that while most medical students start school with high levels of empathy, it doesn’t take long before that empathy is beaten out of us.  Studies show that a drop in empathy begins soon after the start of our clinical experience, with third year rotations having a particularly catastrophic effect on levels of empathy.

Why?  Theories for this decrease in empathy abound, including the psychological need for medical students to emotionally detach themselves from the amount of pain and suffering witnessed in the hospital setting, to the stress and barriers caused by time pressures, and even to neurotransmitter changes that seem to be required when switching between emotional and analytical thinking.

And as we enter into clinical practice, physicians face the burdens of documentation and regulatory requirements that eat into the time that we should be spending on building relationships with our patients, which contributes to an ongoing erosion of our compassion.

So if we know that empathy is critically important, but we just don’t feel empathetic, what are we to do?  Maybe we’ve just had to give bad news to a patient after being up all night with a sick child, and oh, a hospital administrator just waltzed into the office to discuss those “patient satisfaction” scores.  And now we walk into an exam room, not feeling our best, and face a particularly challenging patient.

Let’s be realistic for a minute.  None of us feel truly empathetic all the time.  The rates of physician burnout and compassion fatigue are through the roof.  But the public has no idea about any of this; remember much of what they know comes from the latest episode of Scrubs or Grey’s Anatomy.

It’s time to fake it ‘til you make it, and learn how to act empathetic.

Empathy is the ability to give the impression that you understand and care.  It means making a person feel like they are the most important part of your day.  You don’t actually have to feel it, you just have to show it.

The good news is that just acting empathetic actually leads to true empathy, with studies showing that teaching role-playing (or acting) to medical students helped them to not only appear empathetic, but actually created feelings of true empathy,  and that teaching naturally introverted people to act extroverted led to increased happiness.

And it’s not that difficult to show empathy.  Step 1:  Smile when you walk in the door.  Step 2:  Look your patient in the eyes.  Step 3:  Touch your patient — even a mere handshake increases a patient’s perception of physician empathy.  Step 4:  Listen actively.  Continue the eye contact, lean forward as your patient talks, make sounds of acknowledgment and head movements to show that you are actually listening.

The trick to showing empathy when you’re feeling less-than-compassionate is to be convincing.   So take a clue from Hollywood television drama and incorporate a bit of acting into our exam rooms.  Instead of: “I’m not a doctor but I play one on TV,” how about: “I’m a doctor who plays a television doctor.”

I’m firmly convinced that the most important class I took in preparing to become a physician had nothing to do with the hard sciences.  High school drama club taught me more interpersonal technique than anything I learned in my clinical skills med school course.

Listen, I’m no Meryl Streep.  The most acting experience I have comes from small-town high school productions of Fiddler on the Roof and corny vaudeville skits more than 20 years ago.  Doesn’t matter.  In those small roles, I learned how to portray a character that wasn’t me.  Like those annoying celebrities on Inside the Actors Studio, I could ask myself: “Who is this character?  What does she think?  Why does she do the things she does?”

No one expects you to win an Oscar — just put your own personal feelings and behaviors to the side for a little while and pretend to be someone else — someone caring, someone competent, compassionate; whatever qualities you would want in your own physician.  It’s not so much “faking it” as it is embodying the characteristics that create a good bedside manner.

So, when you’re having a tough day, before you open the exam room door click your brain into acting mode and practice showing empathy.  It works.

Rebekah Bernard is a family physician and the author of How to Be a Rock Star Doctor:  The Complete Guide to Taking Back Control of Your Life and Your Profession.  She can be reached at How to Be a Rock Star Doctor.

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