Ask clinicians (doctors, nurses, PAs) what they find to be frustrating in their work with patients, and very quickly the discussion will focus on patient behavior – harmful behaviors like smoking, or patients not doing things that can help them: e.g. taking medications, exercising and getting enough sleep.
Ask patients what they find to be most frustrating about clinicians, and they will describe clinicians who are disengaged – not listening, paying more attention to the computer screen than to the patient and not caring about the patient’s life.
This is not a new problem. Dr. William Osler, the founder of modern medicine, wrote in the late 1800s that it was critical to teach physicians to talk to their patients and above all to listen. He stated, “Listen to your patient, he is telling you the diagnosis.” More recently, in his book, Being Mortal: Medicine and What Matters in the End, Dr. Atul Gawande describes his father’s doctor and how he took time to listen and understand him. He describes, “…he recognized that my father’s questions came from fear. So he took the time to answer them, even the annoying ones.”
Current research supports what these pioneers taught. A critical ingredient in healthcare is the establishment and maintenance of an empathic relationship between clinician and patient, for the sake of both the clinician who wants to help and the patient who is seeking help.
It is not easy. Large patient panels, hectic schedules and the explosion of medical knowledge have added complexity, and in some cases barriers, to establishing an empathic connection. Simply put, as in many aspects of medicine, we have to act smarter if we are to be successful.
The antidote is to engage the patient, as a person, in a dialog about their health. When that dialog is in a spirit of shared decision-making, patients are better able to “sign up” to action plans, seeing themselves as co-creators. Following are some examples of “doable” changes that will strengthen the empathic connection.
Patients often don’t get to ask the questions that are most important to them, both in the exam room and in the hospital. Since the clinician can’t anticipate the patient’s questions, or the clinician asks for questions at the end of the visit when it is clear that he or she is feeling time pressures, a simple modification can help ensure patients get the answers they need.
The better approach is for the clinician to invite the patient to ask questions at the beginning of the visit. What if a form were provided at check-in that invites patients, caregivers or trusted love ones to write out the questions that concern them? The message would be clear: “I want to know what’s on your mind.”
Software modifications and/or using what is there
A clinician with a large panel cannot be expected to remember all of the psycho-social details of a patient’s life anymore than they can remember the last blood pressure readings. The difference is that the BP gets entered into the medical record and the psycho-social details do not. If clinicians enter personal details, even in the notes section, it provides a frame of reference to use when talking to the patient – for example, “When you were here last, you mentioned you were concerned about your daughter. How is she doing?” Interest in a patient’s life beyond their disease and injury contributes to the empathic connection and thus to clinician influence.
Remember also that people have goals. They are used to talking about financial goals, educational goals and family goals. They are not as used to discussing health goals, and clinicians are not used to asking about them. However, when a clinician inquires about a patient’s health goals, it opens a rich discussion in which it is clear that the clinician is genuinely interested in working collaboratively with the patient. The empathic connection is strengthened and the clinician has more influence when viewed by the patient as a caring individual.
Use your words
As parents we tell children to “use your words.” Clinicians should also do this, as simple probes can lead to a stronger empathic connection. Some questions are especially powerful and provide the clinician with information that leads to empathy – if the answers are acknowledged with understanding and compassion.
- To a patient who is quite ill, or is living through a difficult family or work situation, ask: “How are you holding up?”
- When a patient reports a difficult or even a wonderful situation, ask: “What was that like for you?”
- At the end of the visit to make sure all bases have been covered, ask a final question: “Is there anything else that you have been thinking about or wondering about?”
These empathic strategies provide the clinician with opportunities to communicate understanding and compassion. They all convey interest in the patient. Clinicians gain in influence when the patient experiences the clinician as being interested in the patient as a person, not another chart. Both patient and clinician achieve greater results when the empathic connection is established and maintained. Simple things can make a difference.
Dr. Stacey Rubin is a psychologist and psychoanalyst. She has contributed to the development of unique software that brings the psychosocial elements of health care into the reality of the office and hospital setting. She has both a research and clinical interest in the use of empathic communication as an essential aspect of health care.