By Larry Laveman and Evan Laveman
Medicine is a plurality of science and humanitarian principles measured by scientific research. Unfortunately, there is very little scientific research on the effects of our humanity on medical outcomes. Since the idea of empathy in medicine is vague and open to interpretation, the Jefferson Scale of Physician Empathy was established to create an objective rating scale of physician empathy. The scale, however, tries to reduce “empathy” to a research variable, which is like trying to measure self-esteem with a thermometer. One simply cannot be used to measure the other. Empathy is not empirical; it is personal, which is why there is widespread disagreement on its definition.
Regardless, there is general agreement among educators that empathy is important to patient care. Doctors, however, may be tempted to shy away from being empathic, thinking it may lead to emotional fatigue, take too much time, or complicate their approach to the patient’s healthcare needs. There is also a prevalent and preconceived notion that detachment can serve as an essential protective mechanism to help them remain objective, analytic, and useful. Studies have shown that student empathy erodes in medical school as the initial idealistic desire to “help” is replaced by a more hardened de-idealized need to survive the constant exposure to illness and suffering. Ironically, research also seems to indicate a correlation between emotionally inclusive care shown to patients and successful outcomes. As a result, medical schools across the nation are starting to develop curriculum and admissions criteria based on compassion, communication, and empathy.
Arguably, the most important part of creating a therapeutic relationship with a patient is the ability to be empathically engaged. Showing interest, which is more than just a demonstration of sympathy, has been found to be at the core of all therapeutic alliances and has recently been directly linked to positive patient outcomes in medicine. The distinction between sympathy and empathy is important, since one carries more of an emotional relevance and the other a cognitive grasping of the emotional component. When you feel for a patient’s condition, you are sympathetic. When you have an understanding of a patient’s condition, not just by mere identification through your own experience, you are empathic.
To make the concept of empathy clearer, I use the term “empathic curiosity” to demonstrate the genuine sense of connecting with a patient through interest, understanding and compassion. Curiosity is conveyed by asking questions. When I am curious I’ll ask questions that elicit more information, but when I am merely sympathetic, I make statements such as, “I feel for what you’re going through.” The difference between curiosity and sympathy is a key element to building strong, trusting relationships. Empathic Curiosity draws no conclusions, makes no statements, is free of assumptions, has no implied identification with the patient and most importantly, and does not attempt to interpret behavior. To have empathic curiosity is to ask open-ended questions that cause the patient to think differently about how they perceive their situation and to problem-solve in more effective ways. In other words, it engages the patient. It’s more than just “putting yourself in their shoes”, it’s the desire to know, combined with an interest in understanding, complimented by a direct action that is clearly articulated to the patient.
Empathic Curiosity allows patients to convey their story and to clarify relevant points so the patient feels “heard.” It provides a space for interaction, and not just a question and answer assessment. It’s more than just ordering a battery of tests because you’re interested in confirming or rejecting your diagnosis. It’s a validation of the patient’s symptoms by taking a genuine interest in the patient through a compassionate, caring and genuine concern for their well-being. In the absence of curiosity, the healthcare provider fails to properly understand the patient. Starting with a question such as, “tell me about your history with tobacco” can open up a very productive and informative conversation, followed by “how do you view your association with tobacco”, rather than just asking the standard question, “Do you smoke?”
Jon Kabat-Zinn first used the term “participatory medicine” to describe the doctor/patient collaboration around treatment strategies. Subsequent studies have shown that by participating in their own care, patients have been able to reduce their symptomology. Zinn’s particular form of participatory medicine, Mindfulness Based Stress Reduction, reduces chronic stress reactions in the body that cause all sorts of symptoms from internal ailments to pain, indigestion, fatigue and chronic illness. Researchers have also shown that by changing the body’s response mechanism to stress through mindful movement, eating, meditation and awareness patients are able to become more resilient and better able to regulate their own bodies producing greater overall health.
When a patient visits a doctor or an emergency room the tone is set once the patient is greeted by the receptionist in the lobby. If the environment is cold and alienating the patient will exhibit a greater stress response. As fear and uncertainty set in the patient can become alienated from the healing process. Empathic Curiosity can set the tone for positive engagement. As research has begun to show, once the physician exhibits empathy and curiosity about their patient’s disposition a collaborative relationship is formed that enhances healing. This goes far beyond a physician’s ability to assess and treat on a medical level. Empathic Curiosity evokes a healing response from the patient that is not completely understood at this time. But one thing is clear; the more empathy being shown by a physician to a patient, the greater the likelihood of a positive outcome.