An Empathy-Based Approach to Practice

For all the focus on the challenges facing physicians in health care, it’s easy to forget a simple truth: Patients have it harder still. They battle insurance companies that deny their claims, surrender a growing portion of their budget to copays and deductibles, and confront waiting room delays on a regular basis. When they do get the doctor’s ear, they often are sick, scared, or in pain. It’s no wonder they often fail to follow treatment regimens or lash out in frustration.

To better connect with patients and meet their spiritual, emotional, and physical needs, clinicians need a different set of tools—empathy and compassion.

“Empathy is extremely important, but not just for the physician—for the entire team, too,” says Heidi White, MD, a geriatric specialist with Duke Medicine. “From the front desk to the billing department to the physician, everyone who comes into contact with that patient needs to be willing to listen to what that patient is going through, not only his or her symptoms and diagnosis, but how long he or she had to wait and how he or she is navigating through the health care system.” For example, a receptionist who notices that a patient has been kept waiting longer than expected might offer an apology and offer the patient something to drink.

In a clinical encounter, empathy is an attempt to walk in a patient's shoes. Studies have found that clinicians who practice empathy-based care produce better health outcomes, in part because their patients are more likely to follow treatment regimens and view themselves as a partner in their own health care. Empathy-based care has also been linked to higher rates of patient satisfaction, fewer malpractice claims, and even an improvement in the emotional well being of the health care team.

Potential Challenges
Yet, incorporating empathy into clinical care doesn’t always come easily to health care professionals trained to remain objective and, increasingly, to balance productivity with efficiency. It may also be challenging to empathize with patients who constantly complain, are argumentative, or are generally unpleasant.

“It can be very difficult in the fast-paced medical environment,” says White, who notes she sometimes struggles with the need to take notes during patient examinations. “It means we’re not always looking at our patients directly when they’re talking, and that can be a hindrance when creating an empathetic relationship.” Her strategy? She explains to patients that she’s taking notes so it can be part of their record, apologizes for not making eye contact, and reassures them that she’s listening while they speak.

Teaching Empathy
The good news is that empathy can be learned. Teaching methods include reading facial expressions for emotions, recognizing body language and other nonverbal cues, and improving empathetic communication, emotional self-awareness, and strategies for dealing with challenging patients or delivering bad medical news.

Ask Open-Ended Questions
For her part, White says much can be gleaned from patient encounters by asking open-ended questions and building in a few extra minutes to let patients talk. “A lot of empathy can be built through the very simple act of listening,” she explains, noting physicians can demonstrate they’ve heard by repeating back what the patient has said or having a resident, nurse, or medical assistant summarize the patients’ concern when the doctor comes in. “That way, patients get the opportunity to speak up if they feel that something was left out or underemphasized,” White adds.

Opportunities for Empathy
Medical practices must also look for opportunities to express empathy, which requires the entire team. Is that patient skipping check-ups, not taking medication, or behind on payment due? A simple question and an offer to help can yield plenty.

Perhaps there’s a language barrier, for which your office can provide a translator, or an access issue for older patients who no longer drive. Maybe economics are to blame, for which your office can create payment plans. By gently probing for information and being present during patient encounters, physicians and their staff are better positioned to meet their patients’ needs.

“What patients really want is to know is that their provider understands their concerns and recognizes not only their illness, but the impact it is having on their relationships, their finances, and their role in the family,” describes White, noting a diagnosis of dementia, for example, can be a devastating blow to the family matriarch and her children.

White points out that patients who feel they’ve been heard are more likely to disclose relevant health information during clinical examinations and may be more receptive to interventions that go beyond just taking a pill. “We don’t always have a cure, but, even when we can’t do anything more medically, we can still listen, empathize, find them support groups, and research community resources. We can still say, ‘Okay, how are we going to walk this road together?’”