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HealthJanuary 28, 2020

How to show empathy to patients — even when you're stressed

By: Melissa Welby, MD

It's been a long, busy day, and charts are piling up. The patient you see next says they're feeling lousy and want an antibiotic. This is the fourth person today to whom you will need to explain that antibiotics aren't effective in viral illness. The previous three all left unhappy about their visit.

You're feeling rushed and frustrated. You know taking the time to listen to this patient is important, but you aren't sure how to show empathy to patients when you're feeling so stressed yourself.

We've all been there. Here's a look at what empathy looks like in a clinical setting and how to express it, even on your off days.

What is clinical empathy?

An Academic Medicine article defines empathy as "the distilling or connecting of feelings and meanings that are associated with a patient's experience while simultaneously identifying, isolating, and withholding one's own reactions."

Put more simply, empathy is the ability to understand and share the feelings of another person emotionally. It is a necessary part of any doctor-patient relationship, and its expression creates an alliance between you and the patient, assuring them that you care about them.

Sometimes this communication comes easily, but other times it can be quite challenging. However, it's a skill worth mastering. Research shows that there are numerous benefits of expressing empathy. It can result in improved doctor-patient relationships and patient satisfaction, according to study results published in PLoS One, as well as increased adherence to medications, according to a study published in the Journal of Research in Medical Sciences. It can also lead to decreased malpractice claims, according to an article in Emergency Medicine Journal.

Empathy in physician communication

How should a physician respond to the above patient who wants antibiotics? Here's an example of how to show empathy to patients — or not.

Expressing empathy

It sounds like you feel terrible! There are some awful viruses going around, and it looks like you caught one of them. Unfortunately, antibiotics aren't going to work here. I would give you an antibiotic if I thought it would do anything other than give you a stomachache and diarrhea. Being ill is so frustrating, I know, but I have some ideas that could be helpful and may reduce your symptoms while we wait for the virus to clear.

Lacking empathy

You have a virus, and antibiotics don't cure viruses. We can't give out antibiotics unless we know it's a bacterial infection because unneeded antibiotics contribute to resistance and other physical problems. You can take a decongestant and anti-inflammatory, and you should get some extra rest while you wait it out.

Neither of these responses is clinically wrong. However, they will produce different outcomes. The first acknowledges and validates the patient's discomfort, while the second robotically expresses facts. Expressing empathy will do more to build trust with the patient, even if they're frustrated. If you were sick, which response would you prefer to hear?

What's more, without empathy, the patient may leave angry, still convinced that they need an antibiotic because they don't think you listened when they were saying how bad they felt.

7 tips for showing clinical empathy to patients

Some have suggested that empathy shortfalls may result from physicians not understanding — or growing hardened to — what it's like to be in their patients' shoes. That's why one Florida doctor had his emergency medicine residents "become patients," entering the system and interacting with staff, as Emergency Medicine News reported.

Other medical professionals have looked to their own experience as patients, or even in patient-like situations, to regain access to the patient point of view. For example, one physician assistant wrote in the Journal of the American Academy of PAs about how the parallels between being a patient and getting a tattoo — from setting up the appointment to experiencing vulnerability — prompted her to reflect on "the many chances [she] had missed to communicate the empathy [she] felt for someone and allow them to be vulnerable, to ease their burden."

Indeed, sometimes it's the realities of a practice and the pressures of our personal lives — more than an overarching failure of empathy — that get in the way of making that essential human connection with a patient. If you are physically and mentally depleted, sleep-deprived and stressed, it becomes challenging to meet the needs of others.

But even if you are rushed with a patient, a few simple communication strategies and cues can help your patients feel heard.

Try to integrate these pointers into even the busiest of your clinical days. 

Start the appointment by making eye contact

Eye contact is essential for establishing a connection, yet the use of electronic medical records have made this increasingly difficult. Look up when you ask questions. When you look down at the computer, continue commenting to show that you're not distracted — or better yet, explain to first-time patients why you're using the computer during their visit.

Let your patient know you're listening

Give a nod or paraphrase what you hear them saying to demonstrate that you hear and understand them.

Be aware of your body language

Are you asking questions with your hand on the doorknob or your arms folded across your body? Are you standing? Sitting down doesn't take extra time, and it shows you aren't rushed.

Be curious about your patient

Ask questions so you understand more than just your patient's presenting issue. Ask how their symptoms are affecting their lives. This makes them feel heard and cared for while allowing you to see the whole picture.

Record details that humanize your patient

This means going beyond checking off boxes on the electronic medical record. What's impacting their life right now? A sick mother? An impending move? Not only will your patient feel connected when you remember to ask them about this next time, but the more you know about their life, the easier it is to feel empathy.

Show support to your patient

Recognize how a patient feels and acknowledge their fears and anger. Support them by responding to both their emotional and medical needs.

Look deeper for ways to empathize with your patient

This is especially important if you find yourself being judgmental. Find out a patient's story and identify common ground.

Medical training focuses on the technical skills that make us great diagnosticians, but it can often fall short on teaching us how to connect with patients. Human connection is an essential component of health care delivery, and the improved outcomes that accompany it benefit us all.

Melissa Welby, MD
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