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 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

Empathic communication is accomplished by listening, understanding and experiencing another persons' position.. Empathy can be further divided into cognitive empathy and affective empathy. Cognitive empathy refers to the ability to perceive a situation from another persons 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.

Empathy vs. Smpathy

Empathy entails the ability to understand how someone thinks, feels and believes and to respond appropriately Empathy motivates one to act (help) on someone else's behalf. Empathy is a choice and 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 is able to "borrow" the patient's feelings to understand them but does not take the feelings on theirselves. The are able to enter into the persons world, but then able to remove themself. 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 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 leaned, teachable skill that benefits both clinician and patient. Clinical empathy takes on the following characteristics:

1. understanding the patients’ feelings, situation and perspectives and recognizing 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 aspects:

• Increases:
  • patients positive responses
  • patients adherences
    • approximately half of medical recommendations (including prescriptions) are not followed by patients
  • patients outcome
  • emotional health
  • symptom resolution
  • diagnosis accuracy
    • patients feel more comfortable revealing embarrasing information that might help with diagnosis
  • patient safety
  • patient motivation and empowerment
• Decreases:
  • anxiety
  • stress
  • depression
  • heart disease
  • mortality
  • hospitilisation
  • morbidity

In addition to the positive attributes seen in patients, empathic care can result in 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., 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 beliefs
   • 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

Providing Empathic Care

There are ways that healthcare workers can provide empathic care to their patients. The following steps provided by Albuquerque et al., 2023 guide the way to empathic care:

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

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

Barriers to Empathic Listening

Hardee et al., 2003 reported on misconceptions from practicing clinicians on empathic communication. Their concerns regarding using empathic communication included:

• 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.

Since empathy does not require emotional effort for the clinician, unlike sympathy, it does not need to be emotional exhausting or awkward. It only takes a moment to offer a gesture of empathy.

Other barriers that hinder empathic communication can occur while communication with another individual. These following barriers can creep into conversation and should be avoided when providing an empathic ear:

• 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