Using Empathy in Communication: Difference between revisions

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== Introduction ==
Successful communication in healthcare leads to effective patient care and improving patients' satisfaction and independence.  In addition, effective communication can protect the patient from adverse health consequences resulting from poor communication such as medication errors or contraindications.  One way to effectively communicate with patients is to use emphatic communication.  Empathy allows healthcare workers to understand others and share thoughts, feelings and experiences. <ref name=":0">Babaii A, Mohammadi E, Sadooghiasl A. [https://journals.sagepub.com/doi/full/10.1177/23743735211056432 The meaning of the empathetic nurse–patient communication: A qualitative study. Journal of Patient Experience]. 2021 Nov;8:23743735211056432.</ref>. Provider-patient empathetic communication has shown to lead to better outcomes and treatment adherence. <ref name=":1">Haribhai-Thompson J, McBride-Henry K, Hales C, Rook H. [https://bmjopen.bmj.com/content/12/9/e063375 Understanding of empathetic communication in acute hospital settings: a scoping review.] BMJ open. 2022 Sep 1;12(9):e063375.</ref>


== Empathy ==
<div class="editorbox"> '''Original Editor '''- [[User:Robin Tacchetti|Robin Tacchetti]] based on the course by [https://members.physio-pedia.com/course_tutor/marissa-fourie/ Marissa Fourie]<br>
Empathy encompasses the ability to understand how someone thinks, feels and believes<ref name=":2" /> Furthermore, empathy can be further divided into two dimensions:
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>


# Cognitive empathy: ability to understand someone else's mental state
# Affective empathy: ability to respond to someone's mental state with an appropriate emotion<ref name=":1" />


== Introduction ==
Successful communication in medicine leads to favourable patient care and improves patient satisfaction and independence. In addition, effective communication can protect the patient from adverse health consequences resulting from poor communication such as medication errors or contraindications. One way to effectively communicate with patients is to use emphatic communication.<ref name=":0">Babaii A, Mohammadi E, Sadooghiasl A. [https://journals.sagepub.com/doi/full/10.1177/23743735211056432 The meaning of the empathetic nurse–patient communication: A qualitative study. Journal of Patient Experience]. 2021 Nov;8:23743735211056432.</ref>


== Empathic Communication ==
Empathic communication can be achieved with just a few steps. The Grossman Group has narrowed it down to 6 steps:<ref>The Grossman Group: 6 Steps To Be More Empathic, 2023.  Available from:https://www.yourthoughtpartner.com/blog/5-steps-to-be-more-empathetic</ref>
# Listen without interruption
# Pause and imagine how the other person feels
# Let them know you hear them by reflecting on what they have said: “What I hear you saying is…”
# Validate feelings: “I understand that you are feeling…”
# Offer support and then close the conversation
# Follow up on how they are going once an appropriate amount of time has passed
== Components of Empathy ==
Empathic communication is achieved by listening, understanding and experiencing another person's position.<ref name=":4">Petersen AC. Empathic listening: Empowering individuals as leaders. The Journal of Student Leadership. 2019;3(2):63-71.</ref> Empathy can be further divided into cognitive, affective, behavioral and moral empathy.<ref name=":1" />


dempathetic communication with patients through three main categories of: (1) having humanistic and unique behaviors with the patients; (2) providing a calm and happy environment for the patients; and (3) reducing the patients’ fear and consolation to them.
* Cognitive empathy refers to the ability to perceive a situation from another person's perspective beyond their own experience without judgement. This can include verbal and/or non-verbal skills and can be learned through observation and experience<ref name=":2" /><ref>Derksen F, Bensing J, Lagro-Janssen A. [https://bjgp.org/content/63/606/e76 Effectiveness of empathy in general practice: a systematic review]. British journal of general practice. 2013 Jan 1;63(606):e76-84.</ref>
{| class="wikitable"
|Friendly behavior with patients
|-
|The unique way of dealing with each patient
|-
|Maintaining patients’ dignity
|-
|Considering the patients’ beliefs and culture
|-
|Paying attention to changing patients’ behavior
|-
| rowspan="4" |Providing a calm and happy environment for the patients
|Creating a pleasant environment
|-
|Using jokes
|-
|Providing conditions for family meetings
|-
|Being neat and happy
|-
| rowspan="4" |Reducing the patients’ fear and consolation to them
|Giving hope to patients
|-
|Using distraction to reduce patients’ stress and suffering
|-
|Using spirituality to reduce patients’ pain and stress
|-
|Normalization of new conditions
|}
 
=== <ref name=":0" /> ===


* Affective empathy refers to the involuntary, internal response to someone else's emotional state. Affective empathy is thought to be "built-in" from birth as part of personality and disposition<ref name=":2" />
* Behavioral empathy is what follows when we see the patient. It includes an ability to understand the patient's perspective, to communicate that understanding and to then act in a therapeutic way<ref name=":7">Fourie, M. Using Empathy in Communication. Plus. 2023</ref>
* Moral empathy is the internal motivation of concern for another with a desire to act to relieve their suffering by caring and driving acts of altruism<ref name=":7" />


== Empathy vs Sympathy ==
Empathy is the ability to understand how someone thinks and feels and what they believe and to respond appropriately.<ref name=":2">Fuller M, Kamans E, van Vuuren M, Wolfensberger M, de Jong MD. [https://journals.sagepub.com/doi/full/10.1177/10506519211001125 Conceptualizing empathy competence: a professional communication perspective]. Journal of business and technical communication. 2021 Jul;35(3):333-68.</ref> Empathy motivates an individual to act (help) on someone else's behalf. Empathy is a choice and it can be learned.<ref name=":4" />   


Sympathy refers to an immediate and uncontrolled emotional reaction when a person puts themself in another person’s position.<ref name=":3">Ahmed FR, Shalaby SA. [https://reader.elsevier.com/reader/sd/pii/S221413912200110X?token=D619ED17BD0B25793514374951760409E35FAF7EFBB141487D120527ABFA5119E1BEC7FB57392BD00A399AEA971967ED&originRegion=us-east-1&originCreation=20230421204439 Exploring empathy and self-efficacy in communication skills among nursing students: A cross-sectional study at two universities in the MENA region]. International Journal of Africa Nursing Sciences. 2022 Jan 1;17:100503.</ref> To sympathise with an individual is to "suffer with them".<ref name=":6">Hardee JT. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571783/ An overview of empathy]. The Permanente Journal. 2003;7(4):51.</ref>


In medicine, empathy creates a therapeutic relationship based on understanding another person and interacting accordingly. It allows the healthcare worker to make logical decisions and maintain professional objectivity regarding patient care. The clinician can "borrow" the patient's feelings to understand them but does not take the feelings on themselves. They can enter into the person's world, but are then able to remove themselves. Sympathy, on the other hand, may interfere with ethical decisions due to its emotional subjectivity. The clinician would be unable to help due to the sharing of their patient's plight.<ref name=":3" /><ref name=":6" /> 


''Cognitive empathy'' refers to the intellectual processes a person uses to ascertain another person’s emotional state. These processes help us to assign meaning to the information we receive from others and can be learned through observation and experience. One aspect of cognitive empathy is “perspective taking,” or the ability to perceive a situation from someone else’s viewpoint (Davis, 1983). Using perspective-taking skills, people are able to imagine beyond their own frame of reference or experience and do so without bias or judgment based on how they would see the situation themselves (Moore, 2005; Parker et al., 2008).
== Medical Empathic Care ==
In healthcare, empathic communication is often underused and misunderstood. Previously, it was referred to as "bedside manner". However, now empathetic communication is thought to be a learned, teachable skill that benefits both clinician and patient.<ref name=":6" /> Clinical empathy takes on the following characteristics:


''Affective empathy'' refers to a person’s involuntary, internal responses to the emotional state of another person. Research suggests that many aspects of affective empathy are “built in” from birth as neurological functions (Rizzolatti & Craighero, 2005), aspects of personality (Baron-Cohen & Wheelwright, 2004; Eisenberg, 2007), biophysical reactions (Decety & Moriguchi, 2007; Iacoboni, 2005), biological dispositions (Hoffman, 1984), or motor skills (Blair, 2005).Both cognitive and affective aspects of empathy focus on individuals’ understanding of another person through their own internal experiences or assessments. But as a relational process, empathy also involves individuals’ behaviors in demonstrating this understanding to the other person (Hojat, 2009) and the interactions that influence this understanding (Zaki et al., 2008). Some conceptualize empathy as part of the communication process, for example, as an aspect of developing a connection to or feelings for another person (Miller, 2007; Rogers, 1975). But developing a connection with another person involves more than just empathy; it also involves, for example, compassion, congruence, resonance, and sympathy, traits that might or might not be appropriate to apply in professional situations. Schrooten and De Jong (2017) drew attention to a gap in the literature between the cognitive and affective aspects of empathy and the expression of empathy, arguing that empathy as a mental state does not automatically lead to empathetic communicative behaviors. They also argued that authors focusing on the expression of empathy sometimes seem to advocate tips and tricks for professionals to use in order to express empathy but that these tips do not necessarily help professionals to truly experience it.<ref name=":2">Fuller M, Kamans E, van Vuuren M, Wolfensberger M, de Jong MD. [https://journals.sagepub.com/doi/full/10.1177/10506519211001125 Conceptualizing empathy competence: a professional communication perspective]. Journal of business and technical communication. 2021 Jul;35(3):333-68.</ref>
# understanding the patients’ feelings, situation and perspectives and recognising the difficulties of putting oneself in their position
# communicating this understanding and confirming its accuracy
# helping the patient<ref name=":5" />
When these attributes are used in provider-patient communication, the patient receives a caring message. In addition, it impacts patients in a multitude of positive ways:<ref name=":3" /><ref>Wu Y. [https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00535-0 Empathy in nurse-patient interaction: a conversation analysis.] BMC nursing. 2021 Dec;20(1):1-6.</ref><ref name=":1">Haribhai-Thompson J, McBride-Henry K, Hales C, Rook H. [https://bmjopen.bmj.com/content/12/9/e063375 Understanding of empathetic communication in acute hospital settings: a scoping review.] BMJ open. 2022 Sep 1;12(9):e063375.</ref><ref name=":5">Albuquerque A, Howick J. [https://medcraveonline.com/IJFCM/the-moral-role-of-clinical-empathy-in-patient-healthcare.html The moral role of clinical empathy in patient healthcare]. Int J Fam Commun Med. 2023;7(1):11-4.</ref>


In
* Increases:
** positive responses from patients
** patient adherence
*** approximately half of all medical recommendations (including prescriptions) are not followed by patients
** patient outcomes
** emotional health
** symptom resolution
** accuracy of a diagnosis
*** patients feel more comfortable revealing embarrassing / personal information that might help with the diagnosis
** patient safety
** patient motivation and empowerment
* Decreases:
** anxiety
** stress
**[[depression]]
** heart disease
** mortality
** hospitalisation
** morbidity


the nursing context, empathy refers to the capability to understand the
In addition to the positive attributes seen in patients, empathic care can have favourable outcomes for healthcare workers. The list below details how empathic care benefits healthcare workers:


ideas, experiences, and feelings expressed by another person and then
* Increases:
** well-being
** job satisfaction
*** feeling more connected to the patient and thus decreasing dissatisfaction with the job and health system
** communication with patients
* Decreases:
** stress
** burnout
** litigation risks<ref name=":5" />


create a therapeutic relationship based on this understanding by interacting accordingly (Mercer & Reynolds, 2002). Therefore, empathy
== Empathic Communication ==
There are many different ways to display empathic communication in the provider-patient relationship. According to Babaii et al.,<ref name=":0" /> empathic communication with patients is achieved in three ways:


helps nurses to maintain professional objectivity and make rational
# having unique and humanistic behaviours with patients
#* maintain their dignity
#* consider their culture and beliefs
#* be friendly
#* adopt unique ways of dealing with each patient
# providing a happy and calm environment for patients
#* using jokes
#* being happy
#* making sure there is a pleasant environment
# decreasing a patient's fear and providing consolation to them
#* giving hope
#* normalise new conditions
#* use distraction and spirituality to reduce stress and anxiety<ref name=":0" />
Albuquerque et al.<ref name=":5" /> created the following steps for clinicians on how to provide empathic care:


decisions regarding patient care and improves their communication. In
# allow an acceptable amount of time to understand the patient's story
# discuss general issues
# provide encouragement
# provide verbal signals that you understand what the patient is telling you
# be physically engaged (e.g. eye contact, gestures, specific postures, appropriate touch)
# be welcoming throughout the session<ref name=":5" />


contrast, sympathy is defined as an immediate and uncontrolled
== Barriers to Empathic Listening ==
There are barriers that can hinder empathic communication. The following barriers can creep into conversation and should be avoided when providing an empathic ear:
* criticising
* challenging the legitimacy of the speaker’s feelings
* giving advice
* interrupting
* changing the subject<ref name=":4" />


emotional reaction that occurs when a person puts themself in another
=== Medical Barriers to Empathic Listening ===
There is a general misconception among practising clinicians on the amount of time that emphatic communication takes. Hardee et al.<ref name=":6" /> reported a range of concerns raised by clinicians:


person’s position. Sympathy represents emotional suubjectivity and may
* "There is not enough time during the visit to give empathy.”
* “It is not relevant, and I’m too busy focusing on the acute medical problem.”
* “Giving empathy is emotionally exhausting for me.”
* “I don’t want to open that Pandora’s box.”
* “I haven’t had enough training in empathetic communication.”
* “I’m concerned that if I use up all my empathy at work I won’t have anything left for my family."<ref name=":6" />


lead to abeyance of care or interfere with ethical actions
These statements highlight that clinicians feel empathic communication is time-consuming. However, unlike sympathy, empathy does not require emotional effort on the clinician's part, so it does not need to be emotionally exhausting or awkward. It only takes a moment to offer a gesture of empathy.<ref name=":6" />


urses’ empathic attitudes convey a caring message to their patients


and contribute to improved patient outcomes (e.g., increased physical
This video below by Roma Sharma explains empathic listening:   
 
{{#ev:youtube |IYkpnYzxz4k}}
and mental well-being, tension relief), recognition of patients’
 
emotional responses, increased harmony and cooperation among the
 
healthcare team, and increased patient satisfaction (Zeighami et al.,
 
2020). Moreover, nurses’ empathetic behaviors may improve patients’
 
hospital stay experience and contribute to adherence to care recom-
 
mendations, which may in turn reduce care errors, anxiety, and dissat-
 
isfaction
 
<ref>Ahmed FR, Shalaby SA. [https://reader.elsevier.com/reader/sd/pii/S221413912200110X?token=D619ED17BD0B25793514374951760409E35FAF7EFBB141487D120527ABFA5119E1BEC7FB57392BD00A399AEA971967ED&originRegion=us-east-1&originCreation=20230421204439 Exploring empathy and self-efficacy in communication skills among nursing students: A cross-sectional study at two universities in the MENA region]. International Journal of Africa Nursing Sciences. 2022 Jan 1;17:100503.</ref>
 
 
lSympathy is feeling pity for someone, while empathy motivates us to act on that person’s behalfwe want to understand where they are coming from and how we can help. We do this through listening to and feeling with them, experiencing and understanding them from their perspective (g empathy is a choice; it is something we can learn how to do, and we can begin simply by getting in the habit of asking people how they are and
 
Barriers to Active Empathic Listening (AEL) A common problem with listening is that we tend to overemphasize the physical aspect of it; we assume that if we are hearing what they are saying Empathic Listening 65 then we are being a good listener. In reality, listening is so much more than nodding our heads, not interrupting, and being a blank slate at whom they can throw their words (McClelland, 2017; Shrivastava, 2014). If basic listening is a difficult process, then it can be assumed that active empathic listening (AEL) is even harder. Knowing this, the necessity of education, especially for leaders, on common barriers to AEL is crucial. Having this knowledge will better prepare leaders and future leaders to recognize AEL barriers in their own lives and navigate a course to more empathic listening. Speaking Rate Versus Listening Rate One logistical barrier to AEL is the fact that we process words much quicker than a speaker can speak them. A 1992 study found that the average speaking rate is 120–180 words per minute whereas the average listening capacity of the brain is 500–800 words per minute (Shrivastava, 2014). This gap naturally results in excess time for our brain to wander in the listening process. In a perfect world we would use this extra time to tap into empathy, perhaps by dialing in to what the speaker’s nonverbal communication is telling us about how they are feeling. Instead, it often becomes a time where we get off track; we rehearse in our head how we will respond or become distracted by a memory their story reminds us of (Salem, 2003). Defensiveness and Shame In conflict especially, defensiveness and shame are toxic habits that fuel the conflict cycle and directly halt the empathic process. While empathy draws us to another person and allows us to accept and understand their pain, defensiveness repels us from one another, undermining any hopes of connection. When we are focused on protecting ourselves and guarding our position, listening to and validating the other side of the story is most likely not the first item on our agenda (Beckenbach, Patrick, & Sells, 2010). Shame also prevents us from exploring the other’s perspective. Note that there is a difference between shame and guilt. Guilt originates when we recognize we have caused another person distress through a particular action; we see how reparative acts, like apologizing, may restore our relationship with them. Guilt is linked to perspective taking (the goal of empathy) and motivates us to do so. Shame, on the other hand, 66 The Journal of Student Leadership condemns the whole self, resulting in personal distress. Shame tells us that the affliction we have caused another person is not because of a particular action but because we ourselves are inherently bad. Why then would we want to hear the other’s perspective and further recognize the problem that we believe we are? When shame envelops us, we don’t listen with empathy; instead, we resort to more damaging behaviors such as ignoring the problem or the person, denying responsibility, or even lashing out at the very person who needs our empathy (Leith & Baumeister, 1998). Other Barriers There are other barriers to empathy, including: criticizing, challenging the legitimacy of the speaker’s feelings, giving advice, interrupting, and changing the subject (Salem, 2003). In the vulnerability of sharing one’s story, perhaps the worst response one can receive is that of criticism. Critical phrases such as “Why did you do that?” can staunch the open flow of information sharing and may result in feelings of shame if the speaker feels that the listener is negatively judging their character and actions. Likewise, the speaker should not feel like the purpose of sharing their story is to convince the listener of the truthfulness of their feelings; they want to be trusted and validated. Furthermore, if we are interrupting, giving advice, or changing the subject, the listener may feel that we are there to listen minimally and then get our point across. These responses may communicate that we want to change them and how they do things instead of communicating understanding and support (Jones, Bodie, & Hughes, 2016; Serbin, 2013). Enablers of AEL Admittedly, we are all human, and because of this we give in to behaviors that hinder AEL. We get distracted, become defensive, shame ourselves or others, interrupt, criticize, and give advice even when we have good intentions in our listening. But, as leaders, we can do better than this. We can become agents of change in our lives and in the lives of others by learning how to overcome these barriers. The solutions to these barriers are contained within the AEL process, the steps of active listening with empathic habits woven throughout them. When acted upon, these are the habits that have the potential to transform communication, relationships, and leadership. Empathic Listening 67 Active Listening The active listening process is composed of three steps: sensing, processing, and responding. Sensing involves an active awareness of both the verbal and nonverbal, explicit and implicit information the speaker is communicating. Processing comprises synthesizing the information gained during the sensing stage into a narrative whole. The final step, responding, is the listener’s way of letting the speaker know that they hear and understand what is being communicated. This is done through verbal and nonverbal cues such as nodding one’s head, asking questions, and paraphrasing (Jones et al., 2016; Shrivastava, 2014). Together, the combination of sensing, processing, and responding contribute to the listener’s efforts to communicate empathy to the speaker. Mindfulness in the Sensing Stage In the active listening process, leaders can utilize the following empathic concepts to encourage a more compassionate flow of communication. David Sauvage, a corporation consultant, states that, “The basis of empathy is emotional self-awareness” (as cited in Manning-Schaffel, 2018). This means we have to sense and accept our own thoughts and emotions before we can do the same in our communication with others. In support of this claim, research shows that individuals who score high on mindfulness also score high on empathy and that vulnerable (empathic) listening is dependent on the listener’s understanding of what is happening internally for them (Jones et al., 2016; McClelland, 2017). In summary, if we are to accurately interpret and articulate someone’s emotions back to them, we must first be able to internalize and comprehend our own emotions. Part of this emotional intelligence is being able to differentiate when we are feeling guilt versus shame. In leadership, identifying shameful thoughts is an important step in correcting our thinking. Rather than resorting to defensiveness or retreating from a situation (which are common side-effects of shame), we can instead engage in reparative acts (i.e. apologizing, listening to the other person’s narrative) that produce empathic results in our relationships. 68 The Journal of Student Leadership Self-Exper<ref>Petersen AC. Empathic listening: Empowering individuals as leaders. The Journal of Student Leadership. 2019;3(2):63-71.</ref>
 
 
Empathy has an important role to play in establishing a positive nurse-patient relationship and offering favourable nursing care [4]. Nurses who show understanding of their patients’ illness experiences will find their relationship enhanced [5]. and Scott (2000) reported that nursing empathy could contribute to patient’s positive responses such as relief from pain, improved pulse, and emotional self-disclosure [12]. Williams (1979) found that the elderly patients received nursing empathy would experience a statistically significant improvement of self-concept [13]. It has also been found that nurse empathy could reduce the cancer patient’s anxiety, depression, and hostility significantly [14].<ref>Wu Y. [https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00535-0 Empathy in nurse-patient interaction: a conversation analysis.] BMC nursing. 2021 Dec;20(1):1-6.</ref>
 
Competency can be subdivided into empathic skill, a communication skill, and the skill to build up a relationship with a patient based on mutual trust. Empathic skill is the approach by which the physician can elicit the inner world of the patient and get as much information as possible from the patient, while at the same time recognising the patient’s problem.2,30,31 Communication skill is used to check, clarify, support, understand, reconstruct, and reflect on the perception of a patient’s thoughts and feelings.15,23 The skill to build up a trusting and long-standing patient–physician relationship encourages physicians to resonate with the patient emotionally. These long-term relationships are important for telling and listening to the stories of illness.32,33
 
Behaviour has a cognitive and an affective part. The cognitive part includes verbal and/or non-verbal skills.14,15,22,25,26 The affective part includes recognition of the emotional state or situation of the patient, being moved, and recognising a feeling of identification with someone who suffers with anger, grief, and disappointment. After this recognition, the physician, in their behaviour, reflects on and communicates their understanding to the patient (Figure 1).20,23here is a relationship between empathy in patient–physician communication and patient satisfaction and adherence, patients’ anxiety and distress, better diagnostic and clinical outcomes, and strengthening of patients’ enablement.<ref>Derksen F, Bensing J, Lagro-Janssen A. [https://bjgp.org/content/63/606/e76 Effectiveness of empathy in general practice: a systematic review]. British journal of general practice. 2013 Jan 1;63(606):e76-84.</ref>
 
# Listen without interruption
# Pause and imagine how your employee is feeling
# Show you hear them by reflecting back what they are saying: “What I hear you saying is…”
# Validate their feelings: “I understand you’re feeling…”
# Offer support and close the conversation
# Follow up to see how the person is doing after a little time has passed<ref>https://www.yourthoughtpartner.com/blog/5-steps-to-be-more-empathetic</ref>


== Resources ==


https://www.youtube.com/watch?v=IYkpnYzxz4k&t=5s
* [[Communication Skills]]


== References ==
== References ==
<references />
[[Category:Communication]]
[[Category:Rehabilitation]]
[[Category:ReLAB-HS Course Page]]
[[Category:Course Pages]]

Latest revision as of 23:15, 8 May 2023

Original Editor - Robin Tacchetti based on the course by Marissa Fourie
Top Contributors - Robin Tacchetti and Jess Bell


Introduction[edit | edit source]

Successful communication in medicine leads to favourable patient care and improves patient satisfaction and independence. In addition, effective communication can protect the patient from adverse health consequences resulting from poor communication such as medication errors or contraindications. One way to effectively communicate with patients is to use emphatic communication.[1]

Empathic Communication[edit | edit source]

Empathic communication can be achieved with just a few steps. The Grossman Group has narrowed it down to 6 steps:[2]

  1. Listen without interruption
  2. Pause and imagine how the other person feels
  3. Let them know you hear them by reflecting on what they have said: “What I hear you saying is…”
  4. Validate feelings: “I understand that you are feeling…”
  5. Offer support and then close the conversation
  6. Follow up on how they are going once an appropriate amount of time has passed

Components of Empathy[edit | edit source]

Empathic communication is achieved by listening, understanding and experiencing another person's position.[3] Empathy can be further divided into cognitive, affective, behavioral and moral empathy.[4]

  • Cognitive empathy refers to the ability to perceive a situation from another person's perspective beyond their own experience without judgement. This can include verbal and/or non-verbal skills and can be learned through observation and experience[5][6]
  • Affective empathy refers to the involuntary, internal response to someone else's emotional state. Affective empathy is thought to be "built-in" from birth as part of personality and disposition[5]
  • Behavioral empathy is what follows when we see the patient. It includes an ability to understand the patient's perspective, to communicate that understanding and to then act in a therapeutic way[7]
  • Moral empathy is the internal motivation of concern for another with a desire to act to relieve their suffering by caring and driving acts of altruism[7]

Empathy vs Sympathy[edit | edit source]

Empathy is the ability to understand how someone thinks and feels and what they believe and to respond appropriately.[5] Empathy motivates an individual to act (help) on someone else's behalf. Empathy is a choice and it can be learned.[3]

Sympathy refers to an immediate and uncontrolled emotional reaction when a person puts themself in another person’s position.[8] To sympathise with an individual is to "suffer with them".[9]

In medicine, empathy creates a therapeutic relationship based on understanding another person and interacting accordingly. It allows the healthcare worker to make logical decisions and maintain professional objectivity regarding patient care. The clinician can "borrow" the patient's feelings to understand them but does not take the feelings on themselves. They can enter into the person's world, but are then able to remove themselves. Sympathy, on the other hand, may interfere with ethical decisions due to its emotional subjectivity. The clinician would be unable to help due to the sharing of their patient's plight.[8][9]

Medical Empathic Care[edit | edit source]

In healthcare, empathic communication is often underused and misunderstood. Previously, it was referred to as "bedside manner". However, now empathetic communication is thought to be a learned, teachable skill that benefits both clinician and patient.[9] Clinical empathy takes on the following characteristics:

  1. understanding the patients’ feelings, situation and perspectives and recognising the difficulties of putting oneself in their position
  2. communicating this understanding and confirming its accuracy
  3. helping the patient[10]

When these attributes are used in provider-patient communication, the patient receives a caring message. In addition, it impacts patients in a multitude of positive ways:[8][11][4][10]

  • Increases:
    • positive responses from patients
    • patient adherence
      • approximately half of all medical recommendations (including prescriptions) are not followed by patients
    • patient outcomes
    • emotional health
    • symptom resolution
    • accuracy of a diagnosis
      • patients feel more comfortable revealing embarrassing / personal information that might help with the diagnosis
    • patient safety
    • patient motivation and empowerment
  • Decreases:
    • anxiety
    • stress
    • depression
    • heart disease
    • mortality
    • hospitalisation
    • morbidity

In addition to the positive attributes seen in patients, empathic care can have favourable outcomes for healthcare workers. The list below details how empathic care benefits healthcare workers:

  • Increases:
    • well-being
    • job satisfaction
      • feeling more connected to the patient and thus decreasing dissatisfaction with the job and health system
    • communication with patients
  • Decreases:
    • stress
    • burnout
    • litigation risks[10]

Empathic Communication[edit | edit source]

There are many different ways to display empathic communication in the provider-patient relationship. According to Babaii et al.,[1] empathic communication with patients is achieved in three ways:

  1. having unique and humanistic behaviours with patients
    • maintain their dignity
    • consider their culture and beliefs
    • be friendly
    • adopt unique ways of dealing with each patient
  2. providing a happy and calm environment for patients
    • using jokes
    • being happy
    • making sure there is a pleasant environment
  3. decreasing a patient's fear and providing consolation to them
    • giving hope
    • normalise new conditions
    • use distraction and spirituality to reduce stress and anxiety[1]

Albuquerque et al.[10] created the following steps for clinicians on how to provide empathic care:

  1. allow an acceptable amount of time to understand the patient's story
  2. discuss general issues
  3. provide encouragement
  4. provide verbal signals that you understand what the patient is telling you
  5. be physically engaged (e.g. eye contact, gestures, specific postures, appropriate touch)
  6. be welcoming throughout the session[10]

Barriers to Empathic Listening[edit | edit source]

There are barriers that can hinder empathic communication. The following barriers can creep into conversation and should be avoided when providing an empathic ear:

  • criticising
  • challenging the legitimacy of the speaker’s feelings
  • giving advice
  • interrupting
  • changing the subject[3]

Medical Barriers to Empathic Listening[edit | edit source]

There is a general misconception among practising clinicians on the amount of time that emphatic communication takes. Hardee et al.[9] reported a range of concerns raised by clinicians:

  • "There is not enough time during the visit to give empathy.”
  • “It is not relevant, and I’m too busy focusing on the acute medical problem.”
  • “Giving empathy is emotionally exhausting for me.”
  • “I don’t want to open that Pandora’s box.”
  • “I haven’t had enough training in empathetic communication.”
  • “I’m concerned that if I use up all my empathy at work I won’t have anything left for my family."[9]

These statements highlight that clinicians feel empathic communication is time-consuming. However, unlike sympathy, empathy does not require emotional effort on the clinician's part, so it does not need to be emotionally exhausting or awkward. It only takes a moment to offer a gesture of empathy.[9]


This video below by Roma Sharma explains empathic listening:

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Babaii A, Mohammadi E, Sadooghiasl A. The meaning of the empathetic nurse–patient communication: A qualitative study. Journal of Patient Experience. 2021 Nov;8:23743735211056432.
  2. ↑ The Grossman Group: 6 Steps To Be More Empathic, 2023. Available from:https://www.yourthoughtpartner.com/blog/5-steps-to-be-more-empathetic
  3. ↑ 3.0 3.1 3.2 Petersen AC. Empathic listening: Empowering individuals as leaders. The Journal of Student Leadership. 2019;3(2):63-71.
  4. ↑ 4.0 4.1 Haribhai-Thompson J, McBride-Henry K, Hales C, Rook H. Understanding of empathetic communication in acute hospital settings: a scoping review. BMJ open. 2022 Sep 1;12(9):e063375.
  5. ↑ 5.0 5.1 5.2 Fuller M, Kamans E, van Vuuren M, Wolfensberger M, de Jong MD. Conceptualizing empathy competence: a professional communication perspective. Journal of business and technical communication. 2021 Jul;35(3):333-68.
  6. ↑ Derksen F, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: a systematic review. British journal of general practice. 2013 Jan 1;63(606):e76-84.
  7. ↑ 7.0 7.1 Fourie, M. Using Empathy in Communication. Plus. 2023
  8. ↑ 8.0 8.1 8.2 Ahmed FR, Shalaby SA. Exploring empathy and self-efficacy in communication skills among nursing students: A cross-sectional study at two universities in the MENA region. International Journal of Africa Nursing Sciences. 2022 Jan 1;17:100503.
  9. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 Hardee JT. An overview of empathy. The Permanente Journal. 2003;7(4):51.
  10. ↑ 10.0 10.1 10.2 10.3 10.4 Albuquerque A, Howick J. The moral role of clinical empathy in patient healthcare. Int J Fam Commun Med. 2023;7(1):11-4.
  11. ↑ Wu Y. Empathy in nurse-patient interaction: a conversation analysis. BMC nursing. 2021 Dec;20(1):1-6.
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