Using Empathy in Communication

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

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.

Empathic Communication

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

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

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

• 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

• 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
• 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
• 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

Empathy vs Sympathy

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

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

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.

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. 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

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:

• 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

Empathic Communication

There are many different ways to display empathic communication in the provider-patient relationship. According to Babaii et al., 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

Albuquerque et al. 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

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

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. 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."

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.

This video below by Roma Sharma explains empathic listening:

Resources

• Communication Skills