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 healthcare leads to favourable patient care and improves 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. Provider-patient empathetic communication has shown to lead to better outcomes and treatment adherence.

Empathy vs. Smpathy

Empathy involves the ability to understand how someone thinks, feels and believes and respond appropriately Sympathy, in contrast refers to an immediate and uncontrolled emotional reaction when a person puts themself in another person’s position. Empathy motivates one to act on someone else's behalf understanding their perspective and knowing how to help. Sympathy is feeling sorry for someone. Empathy can be learned and is a choice. Empathy is accomplished by Understanding someone else's listening, understanding and experiencing from another persons' position.

In healthcare, 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. Sympathy on the other hand may interfere with ethical decisions due to its emotional subjectivity. Empathic care sends a caring message to patients, increases patient's positive responses, decreases anxiety and contributes to improved patient outcome.

Empathic healthcare positively impacts patient stress and anxiety, decreases pain and depression, and even reduces the risk of heart disease.25 In addition, it improves emotional health, symptom resolution, and psychological measures.26 Empathy improves diagnosis accuracy27 because patients feel more comfortable revealing embarrassing personal information.28 Patient adherence is one of the main factors for better health outcomes, and nearly half of the medical recommendations, including prescriptions, are not followed by patients. Indeed, empathy contributes to increased adherence and self-efficacy.29 A high number of trials have shown that increased professional empathy can reduce pain and anxiety and contribute to the quality of healthcare.30 Likewise, empathic care positively impacts patient safety and decreases mortality. According to observational studies, there is a 50% decrease in patients with diabetes.31 In sum, it is noted that when patients perceive a high level of clinical empathy, they experience better long-term results and feel more motivated and empowered.32 This provides an improvement in psychological response, a decrease in hospitalization, and increased therapeutic effectiveness.33 Empathic care increases patient satisfaction, better outcomes such as proper management of chronic conditions, and less post-traumatic stress after severe medical emergencies.34 Also, empathic care reduces morbidity35 and may benefit many patients with multimorbid conditions.36

Concerning health professionals, empathy in care increases their well-being while reducing stress and burnout,37 and litigation risks.38 Thus, evidence shows that empathic care increases job satisfaction,39 which provides better communication with patients.40 It is also important to highlight that, commonly, physicians perceive those empathic relationships with patients are significant interpersonal connections, which is a mechanism to diminish dissatisfaction with both the job and the health system, as well as burnout.41 Considering that clinical empathy benefits patients and health providers, it has a moral value42 in the light of a consequentialist perspective and because the doctors’ duty of beneficence requires it. Clinical empathy is a capacity that contributes to increasing the well-being of the patient and health providers, so it is morally right because of its good consequences in the healthcare field.

Cognitive and Affective Empathy

Empathy can be further divided into two cognitive empathy and affective empathy (responding to someone's mental state with an appropriate emotion) Cognitive empathy refers to the ability to perceive a situation from another persons perspective beyond their own experience without judgement. Cognitive empathy 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.

Empathic Communication

According to Babaii et al., 2021, empathic communication with patients is achieved through three categories:

1. having unique and humanistic behaviors with the patients
   • maintaining their dignity
   • consider their culture and beliefts
   • friendly behaviour
   • unique way of dealing with each patient
2. providing a happy and calm and environment for the patients
   • using jokes
   • being happy
   • pleasant environment
3. decreasing the patients’ fear and consolation to them
   • giving hope
   • normalisation of new conditions
   • use of distraction and spirituality to reduce stress and anxiety

Steps to 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 they feel
3. Let them know you hear them by reflecting back what they have said: “What I hear you saying is…”
4. Validate their feelings: “I understand you’re feeling…”
5. Offer support and close the conversation
6. Follow up after a little time has passed

o this end, studies on the subject indicate that health professionals must display the following behaviors as guides of empathic care: (a) set aside sufficient time to understand the patient’s story; (b) talk about general issues; (c) offer encouragement; (d) give verbal signals that the patient is being understood (hmm, ahh, etc.); (e) be physically engaged (adopting specific postures, gestures, eye contact, appropriate touch, and others); (f) be welcoming during the consultation, from the beginning until the end

Barriers to Empathic Listening

The following are barriers needed to overcome to be a good empathic listener:

• criticizing
• challenging the legitimacy of the speaker’s feelings
• giving advice
• interrupting
• changing the subject

Active Empathic Listening

Empathic listening involves more than not interrupting, nodding our heads and staring at the person talking. There are three steps in the active listening proces:

1. sensing: awareness of nonverbal, verbal, implicit and explicit information the speaker is communicating
2. processing: integrating the information obtained in the sensing stage
3. responding: verbal and nonverbal cues such as asking questions and paraphrasing; letting the speaker know you have heard what they said

This video below by Roma Sharma explains empathic listening:

Resources

• Communication Skills