Empathy, Patients, and Caregivers

Empathy—the feeling that you understand and share another person’s experiences and emotions: the ability to share someone else’s feelings.

—Merriam-Webster

By the time I became a third-year medical resident, I had mastered the repertoire of “don’t tread on me” behaviors that seemed essential to survive as a senior level trainee. I emulated my supervisors, mostly residents, as they advocated for themselves in the face of an onslaught of demand from other departments and from patients. I remember one occasion when, in front of my intern, I firmly “told off” a patient who was obviously poor and possibly homeless and who I thought was faking pain in order to get admitted to the hospital and receive analgesics. I was pleased with myself when I informed the ED staff that I would not accept the patient onto the medical service.

In retrospect, I wonder how and why I had become a “tough guy”? What had happened to my desire to “be there” for patients in their hour of need? Had I lost my aspiration to care for others, fueled by role models like my father, an internist and pillar in the community?

Does Empathy Decrease over Time?

A number of studies support my personal observation that physician empathy decreases during the training years and later persists at lower levels.¹

Yet, perhaps ironically, increased empathy is associated with fewer medical errors, increased patient satisfaction, fewer malpractice claims, and improved clinical outcomes.¹

Can We Increase Empathy?

In a 2012 study, Helen Reiss and colleagues randomized residents from several specialties into two groups, one receiving standard post-graduate education and a second whose education included three 60-minute empathy training modules. The empathy training consisted of the following elements:

1. Neurobiology of empathy;
2. Approaches to increase awareness of the physiology of emotions during patient encounters;
3. Skills involved in interpreting the meaning of facial expressions; and
4. Breathing exercises and mindfulness practices to enhance empathic responses to patients.

Using a validated instrument to measure empathy as rated by patients, the study reported increased empathy scores for the residents who participated in the empathy training program. An important skill the residents learned in the training was the ability to read/decode the facial expressions of patients and use that information to alter their behavior, thereby increasing patient-reported empathy.¹

The authors point to the need for more studies to learn if, and to what extent, empathy training can improve performance in key areas like patient outcomes, malpractice claims, physician well-being, and patient satisfaction. Furthermore, they concluded that “long-lasting improvements in empathic clinical care cannot be sustained without organizational changes at all levels of healthcare. Such cultural changes require a commitment from clinical and administrative leaders to place empathic care at the forefront of institutional missions.”

Committing to Enhancing Physician Empathy

The Cleveland Clinic has addressed empathy as an important element of its institutional mission. Consider the following initiatives and interventions:

• The health system’s CEO publicly prioritizes empathy as a path to better patient experience and caregiver well-being.
• There is a chief experience officer position.
• All employees receive specialized H.E.A.R.T. (Hear, Empathize, Apologize, Respond, Thank) training; embedded approaches and practices support ongoing prioritization of empathy.
• All employees are trained to see themselves as caregivers.
• Physicians and trainees receive training in communication with patients.
• The health system holds an annual national summit on empathy and patient experience.