Dr. Kohli On Patient Empathy

Patient empathy – what is it? An Academic Medicine article defines empathy in a medical context as a “conscious, strenuous, mental effort to clarify a patient’s muddy expression of (their) experience using a soft interpretation of (their) story. Employing this empathic process, according to the article “involves 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 to that patient and her experience.”

Given this definition, it’s easy to see why patient empathy is a critical skill for a physician to possess, and yet possessing and practicing it might be hard to quantify. DocWire News Medical Lead Dr. Payal Kohli spoke in depth about what patient empathy means to her, how she demonstrates it, and what advice she would offer other health care professionals on this important, yet often under-discussed topic in the medical world.

DocWire News: What does patient empathy mean to you?

It’s so interesting to hear the word empathy, because we don’t really understand just how important it is in the medical encounter. But empathy is really the ability to put yourself in somebody else’s shoes without necessarily having an emotional connection with them. When I think of patient empathy, I actually think of three different spheres of empathy and how they relate to the patient. One is their emotional empathy, so do you relate to the patient’s emotions to what they’re experiencing? One is cognitive empathy, which is do you relate to their understanding, what their understanding of the disease is or the risks of a procedure, for example? And then the final one is behavioral empathy. Do you understand how the patient is behaving and as a manifestation probably of the other two spheres of empathy and how you could potentially alter that?

How important is patient empathy, specifically in cardiology? 

It’s incredibly important, in my opinion, and in fact, it’s not just my opinion, but scientific research tells us that it’s very important to the patient, particularly in fields that have social care with them. So, for example, me as a cardiologist, a lot of the things that I counsel patients about are behavioral changes and empathy is really important when it comes to really initiating social change amongst our patients. It’s incredibly important in a variety of different fields, but it doesn’t just make the patient feel good, it actually makes the providers feel good, as well, so providers that are empathetic or have patient empathy are have more job satisfaction and more engagement. But believe it or not, it actually also results in better patient outcomes, better medication adherence, and because of that better patient satisfaction, you’re actually less likely to have a medical malpractice lawsuit if you’re a provider that regularly practices empathy. I’ve really embraced the idea of empathy in every single one of my visits and I think it is key to how I interact with my patients.

What are some ways that a physician can demonstrate empathy? 

It seems like it would be hard at the surface, but it’s actually not so hard. Really, what I like to say is that we want to use our census when we’re talking about empathy. So, our first sense is our sense of sight, it’s vision, so eye contact is really important. I know we have a lot of administrative burdens with having to document and chart and we’re being pulled in different directions with our phone and our pagers and such, but looking at the patient, I think, really helps with empathy.

The second sense I like to use, my hearing. You want to listen to what the patient is saying. You want to look out for those cues that the patient is giving you, either verbal or non-verbal, as to what their emotional, cognitive, and behavioral understanding is of what exactly you’re talking about in the visit. And then the final sense that I like to use is a sense of touch. Appropriately, you want to your touch, use your interaction with the patient, your body language, leaning into them, touching them, whatever the situation might require to really show them that you’ve listened, you’ve looked at them, and you’ve heard and you’re empathizing with them.

Are there any challenges (e.g., physician burnout, stress) that make it difficult to externalize patient empathy?

Oh my gosh, there are so many challenges that make empathy one of the hardest things that we have to do as providers. As you pointed out, the biggest one of these, of course, is burn out and stress. We are pushed for time, we don’t have the luxury to sit there and necessarily engage with our patients or talk to them, and so often empathy is what ends up taking the backseat. Another, I would say, challenge that I’ve personally perceived is the lack of training around this. We spend a lot of time in medical school learning the technical parts of medicine, the scientific parts of medicine, but what we don’t necessarily learn about is the communication, the empathy, which is so critical to your patient interaction.

And then I think some of it is also cultural. I think it depends a little bit on what type of environment you’re operating in. But in some of the very large academic centers, if there’s a big team of people, for example, so let’s say you’re rounding in the hospital and it’s not just a doctor, but it’s medical students and pharmacists and nurses and 10 people standing in the room, sometimes those may pose logistical challenges to really connecting with the patient, trying to understand them, and trying to express all of that empathy. But I think the nice thing about the challenges is that if we recognize them, we can surmount them and we can figure out solutions for how we could potentially work around them to really try to empathize with our patients.

What advice would you offer to other physicians to help them improve in showing patient empathy?

There’s no RVUs or productivity bonus or anything like that when it comes to empathy. But if you take a step back and ask yourself, “Why are we doing this? Why did we even go into the field of medicine, which is arguably one of the hardest fields out there?” I think at the end of the day, most of us would say that we went into this field to make people’s lives better, to leave people better than we found them, to really make an impact on disease and patient outcomes. If that really is your answer, then I think empathy is one of the key ways in which you’re really going to implement that. Because what I’ve realized as a physician, as a cardiologist, even as a patient, that sometimes it’s not what we do that matters as much as how we’re doing it that matters for the patient and for their ability to stick with whatever plan it is that we might make.

I implore all of us to look in, reflect, think about our challenges with empathy, think about how much empathy is part of each of our patient visits, and really rise up to the challenge of trying to incorporate it into each and every single one of our patient visits so that we can, again, take the patient not just from what we’re doing, but about how we’re doing it, and give them a better quality of life, really help to meet them where they are, and help to change their disease outcomes as a result.