By Dr. Janani Krishnaswami
Today’s medical professionals face a number of challenges, from a systemic emphasis on treating symptoms over root causes of disease, to pervasive disillusionment and burnout that harms personal well-being. In this article, I’ll focus on the role of empathy in addressing two “real world” issues: distrustful patients and building a healthy organizational culture through teamwork.
Meeting Patient Distrust with Empathy
Due to a combination of misinformation and some unfortunate instances of bad medical practice, some patients oppose the treatment options they’re given or believe their doctors are hiding things from them. These encounters can be frustrating; however, it is essential to cultivate the skill of awareness and non-judgmental response. Awareness entails recognizing the natural emotional response (for example, a feeling of anger that arises when one’s skill and experience are unfairly challenged). Non-judgmental response entails harnessing a level of presence that allows for rising above the impulsive desire to become defensive or engage in an argument. The next step, however, can be even more challenging: cultivating patience and showing empathy for the patients who challenge us most.
Parents may already be familiar with these skills. For example, when a child is acting out, yelling and scolding rarely achieve beneficial results (and often escalate the situation). Rather, a more successful approach focuses on “responding” (coming from a more mature, aware, and controlled place) rather than “reacting” (coming from an impulsive, child-like, emotionally charged place). In addition, providing what the child really needs—usually, attention, an acknowledgment of the child’s frustration, and an attempt to build understanding—can work wonders in defusing the situation and finding common ground.
In many cases, patients may have been marginalized or treated unfairly in previous medical encounters. For example, they may have felt judged or “dismissed” by other doctors, or perhaps their behavior reflects frustration caused by persistent and painful chronic symptoms. When the physician truly attends to the patient and attempts to understand the reasons for their behavior or comments, an opportunity forms for establishing a common ground– from which empathy, trust, and health literacy can be strengthened. This approach also facilitates the dismantling of misconceptions surrounding patients’ conditions, and fosters a better patient understanding of root causes of illness or how a prescribed treatment can help.
I personally use this approach daily in my practice. Many times, even with patients who have been profoundly influenced by misinformation, the opportunity for establishing common ground emerges. In my experience, success comes from sincerely believing in what I’m doing, taking an extra few minutes to explain my findings in a clear manner (while paying full attention to the patient), and, fundamentally, caring about the patient’s welfare. In essence, making patients “feel better” comes down to feeling and evincing empathy. The sense of personal fulfillment from this type of practice is also quite uplifting—often, by the time the patient leaves the office, I can perceive a lightness in them that comes from connection and feeling heard, and experiencing insight into their condition. Quite simply, they feel better and they get better.
That being said, part of non-judgmental response is recognizing that the outcome will not always transpire the way I might want it. For example, some patients become entrenched in their misconceptions to a point where they may become blatantly offensive. No physician should be a martyr to inappropriate behavior or hateful speech. In these cases, it is absolutely appropriate to “let the patient go.” This can again be done in a nonjudgmental, empathetic way, such as by saying, “I perceive you may not be happy with your care here. While I am happy to try to help you, you may feel better seeking care elsewhere.”
The reward for showing empathy accrues to the physician as well—the fulfillment that comes from building a trust-centered, effective relationship with patients and the lower risk of burnout and fatigue that comes from realizing that lofty aim of “making a difference.” Increased patient trust starts a virtuous cycle, improving quality of care and even patient health outcomes.
To see how this can happen, think of the placebo effect where even inert medications take on an ability to heal when prescribed by a trusted physician. In other words, the way a treatment is administered to the patient can be vitally important to its practical effectiveness. For example, in one research study, diabetic patients who rated their physicians as empathetic and trustworthy had superior health outcomes compared to diabetic patients whose physicians had lower empathy and trust scores—despite having similar disease severity and being on similar treatments.
Building a Team with Your Colleagues
Empathy is also a cornerstone to improved systems of healthcare, a prerequisite to teamwork, which in turn improves health on a population level. Effective teamwork is linked to health care quality, safety, and optimizing systems to deliver the best care possible. Teamwork can shine a spotlight on wasteful and potentially harmful aspects of medical practice, such as overprescribing antibiotics or obtaining unnecessary radiographic imaging or tests that don’t offer value or benefits to patients.
Empathy can also be the first step in addressing burnout, an epidemic among health professionals. If you’re feeling stressed or burned out, chances are your colleagues are as well. The medical field is very demanding for doctors, but also for all healthcare professionals, who are integral to the everyday workings of the team. Fostering a true team environment built on trust and openness (rather than hierarchy and bureaucracy) is key to building a successful practice.
Finally, sometimes it is easy for the medical professional to be on “autopilot,” feeling burned out and fatigued without recognizing an important root cause: an unhealthy organizational culture. Learning from and interacting with peers is a continuous element of medical practice. Therefore, one of the keys to personal and professional fulfillment is to specifically seek out a collaborative, open culture that promotes such learning. Sometimes, employment opportunities offering this type of workplace culture may not necessarily be the most financially lucrative. However, for many physicians, the long-run tradeoff can be worth it, potentially promoting workplace success with a healthy level of personal well-being and fulfillment.
Janani Krishnaswami is a physician reviewer at UWorld and practicing internist at Academic Medical Associates. Triple board-certified in preventive medicine, internal medicine, and lifestyle medicine, she is the former director of wellness at the School of Medicine at UT University of Texas Rio Grande Valley. She can be reached at