Can empathy be taught, or is it innate?

In medical school, I was taught to sit down at eye-level when speaking to a patient, ask them how they’d prefer to be addressed, make sure to ask questions in an open-ended manner to allow patients to express themselves, and interject with “that must be really difficult for you” or “I can only imagine how that makes you feel,” as a way to show empathy and foster better connection with patients during the interview process of acquiring the patient’s history of present illness.

This worked for some patients during my medical school clinical rotations; however, I’ve seen some patients become impervious to such an approach, sometimes becoming upset or emotionally closed-off.

In residency, I’ve encountered many patients who do not respond to the empathic methods I was trained to use during the history-taking process. During these times, I’ve learned to abandon the script and speak to these patients from a perspective of dignity and respect and have rarely ever had trouble connecting even with the most “difficult” patient.

Some of my colleagues have asked me how being empathetic comes so naturally to me, or how did I learn to connect so well with my patients?

“Even the most cantankerous, bellicose, and unreasonable patients calm down and become agreeable after speaking with you!”

I’m not quite sure either. I see patients as people first.

They need to know you care; that you really value and respect them, despite meeting you at the most vulnerable and worst times of their life. That patient who gets admitted every two weeks like clockwork for alcohol withdrawal or heroin overdose needs to know that you, as a physician, still respect their dignity (however little it is). They need us to understand that their diseases or struggles do not define them as a person and that they have value in the eyes of their family and loved ones.

Questions such as: do you know why you’re in the hospital? What do you think is your current diagnosis is or what medical problem do you think you currently have that we’re treating? What have we done for you so far? Have you seen all the labs and imaging results yet? Would you like me to explain them to you? What are you most concerned about right now? It doesn’t have to be about the disease we’re treating. Is there anything else I can do to help you or make you feel more comfortable? Is there somebody you’d like me to call on your behalf? By the way, my name is Dr. Anochie (“It’s like Spanish for last night,” if the patient is Hispanic). I’ll do my best to take care of you.

These are simple conversations to have with a patient, but they are also very meaningful to them. It informs the patient that you care about their understanding of their disease process, and that you’re also providing emotional support to help them deal with it. They perceive you as their ally and advocate. Frequently checking in on patients inadvertently causes them to pull down their walls and trust you as their physician. This is essential because the physician-patient trust significantly increases compliance with recommendations, prescriptions, and clinic appointments after the inpatient discharge process.

This still begs the question: Can empathy be taught?

Can’t I just memorize some sentences that project empathy and say them to a patient while holding their hands and staring into their eyes, and check it off my list?

It doesn’t work that way.

Patients know when doctors are “acting.”

It’s like listening to customer service rep tell you “thank you so much for calling, we really value your membership,” you know it’s a memorized line spoken perfunctorily. My personal belief is that empathy comes naturally to people who have had some background experience to draw from when attempting to connect with a patient.

A physician who’s had friends or relatives suffer through drug addiction will easily know how to connect with a “frequent flyer” drug addict, etc. This underscores the importance of admitting students into medical schools with diverse personal life experiences, social-economic classes, and family upbringing. Future doctors from such varied backgrounds are vital to the field of medicine, and they will make a positive impact toward improving the health care experience for our diverse and complicated patient population.

A quote from the late Maya Angelou, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel,” perfectly encapsulates the theme of this opinion piece.

It is also common knowledge that empathetic physicians are less likely to get a malpractice lawsuit even after admitting an error or mistake to a patient or their family. It is also important to acknowledge that we, as physicians, also learn from our patients’ stories and experiences beyond their presenting chief complaint or working diagnosis. I’ve learned so much from the diverse patient population I care for.

I’ve gone home in tears, sometimes thinking about how the health care system is failing them. I’ve also been inspired when patients voluntarily share their personal triumphs, regaling how they’ve overcome impossible circumstances, and are still persevering to get through the next day. This is why I love medicine. This is also why I advocate for my patients and treat everyone with equal dignity, whether they’re a drug addict or CEO of a Fortune 500 company. Death and disease do not respect class or age; neither should physicians give preferential treatments to them.

Okechukwu Anochie is an internal medicine resident.

Image credit: Shutterstock.com

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