Patient Doctor Relationship: Can We Teach Empathy at Med School?


No I don’t think so. For several reasons. Empathy is a process with different steps. Especially feeling what the patients feels is a quality not every doctor has. And if they do it is not always appropriate nor possible to be sensitive enough to use it. Moreover this process not only needs the quality it is also costs energy, depends on the relationship with the patient, and needs experience.

Along with their education medical students loose some of their humanistic attitudes such as empathy especially during their medical clerkship, often they become more cynical during their clinical training. Empathic feelings are difficult to generate when they have no experience or when the patient is difficult to know or communicate with, while further barriers include a stressful working environment and lack of time.

Empathy is somewhat beleaguered these days in an era in which “quick fixes” are encouraged by a managed care system driven by economic values. In The Netherlands we call it the DBC system.

Next post on Patient Doctor Relationship Series about self disclosure Friday 25th of July.
What can we clinicians teach them?
First of all good bedside manners:

  • Ask permission to enter the room; wait for an answer.
  • Introduce yourself, showing ID badge.
  • Shake hands (wear glove if needed).
  • Sit down. Smile if appropriate.
  • Briefly explain your role on the team.
  • Ask the patient how he or she is feeling about being in the hospital.

Teaching empathy is as argued before in this post not possible. But we can teach empathy to a cognitive level instead of an affective level. It is important to learn the students during their clerkship to conduct an interview in a way that encourages the patient to share their concerns. Instead of a disease centered interview teach them a patient centered interview.

Proposed methods for promoting the ability of medical students to elicit the patient’s feelings, distress, and concerns:

  • Ensure as much privacy as possible when interviewing the patient. “Break the ice” by expressing sustained respect and interest throughout the interview, e.g., maintain eye contact and a body posture slightly bent forward.
  • Listen carefully to the patient’s account of her history and do not interrupt her for at least two minutes. Encourage the patient’s spontaneous narrative by nodding and permit the patient to take control of the interview.
  • Watch for indirect verbal and nonverbal clues of the patient’s feelings. Respond with an accurate and explicit acknowledgment of the patient’s emotions, distress, and concerns. Encourage the patient to talk not only about his symptoms, but also about his personal and family situation, preferences, and feelings.
  • Toward the end of the interview, if appropriate, ask one or more of the following questions:
    • Of all your problems, which is the one that worries you most?
    • Do you have any preferences or suggestions about what your management should be?
    • Do you have any ideas regarding what caused your illness?
    • What are your plans for the future?
    • How does all this make you feel?
    • How did you/your family feel when you were told about your illness?
  • Encourage the patient to ask questions about his disease and his main concern(s) by asking Do you have any questions regarding your condition?

This last list is from a article published in Academic Medicine.

I like the comparison with acting. Real empathy is comparable to deep acting, engage in emotional labor, generating empathy consistent emotional and cognitive reactions before and during empathic interactions with the patient.(Deep acting is comparable to the method-acting tradition used by some stage and screen actors). What can be learned by all medical students is surface acting or forging empathic behaviors toward the patient, absent of consistent emotional and cognitive reactions, or both.

Although deep acting is preferred, physicians may rely on surface acting when immediate emotional and cognitive understanding of patients is impossible.

What do you think about empathy and doctors, can it be learned? Am I being to pessimistic?
Let me know in the comments.

Previous posts in this series about patient doctor relationship:
Consolation reduces stress
Benbassat, J., Baumal, R. (2004). What Is Empathy, and How Can It Be Promoted during Clinical Clerkships?. Academic Medicine, 79(9), 832-839.