April 17, 2019
Health care is more advanced than ever. Unfortunately, each technological advance takes health professionals further and further away from empathizing with patients. Drawing on examples from his provocative radio show, White Coat, Black Art, and his experience as the son of aging parents who were frequent users of modern health care, Dr. Goldman talked about the growing lack of empathy in health care, the causes, the impact, and how to put care back into health care.
Opening Remarks and Housekeeping Julie Arel, PMCQ VP Social, Iain Boomer, PMCQ Director
Introduction of Keynote Speaker Iain Boomer, PMCQ Director
The meeting featured our keynote speaker:
How Empathy Can Transform Health Care
As a veteran emergency room physician, Dr. Brian Goldman has a successful career setting broken bones, curing pneumonia, and otherwise pulling people back from the brink of medical emergency. He always believed that caring came naturally to physicians. But time, stress, errors, and heavy expectations left him wondering if he might not be the same caring doctor he thought he was at the beginning of his career. He started his presentation by talking about the two experiences in his life that led him to realize more empathy was needed in health care:
The first experience was during care that he provided to a woman who came to him at the emergency department. Although she had end-stage multiple sclerosis, she was not in need of any actual emergency care. As requested by the family, Dr. Goldman referred the patient to the internal medicine team, but because she wasn’t ill enough to be seen, she was triaged. The family repeatedly asked Dr. Goldman when the patient would be seen; each time they approached him he became increasingly defensive, until, at one point, a confrontation with the daughter of the patient led him to lose his patience. He realized afterward that he didn’t fully comprehend what the family was going through.
It wasn’t until his own parent’s passing that he experienced this difficult situation firsthand. The day of his father’s death, Dr. Goldman went to see his father in the hospital. The attending physician, who had been caring for his father for less than 12 hours, was anxious and worried about being reprimanded, but Dr. Goldman was grieving too much to deal with the attending physician’s anxiety.
Dr. Goldman then clarified the difference between sympathy and empathy. Sympathy, in our culture, is a superficial feeling because it focuses on the sympathizer’s own distress. In general, when extending sympathy, you don’t truly have a great desire to know what the other person is feeling because it is often too horrible to want to feel. Telling someone, “I don’t know what to say” hinders empathy. The best thing to do is just be there for the person. Empathy is different than sympathy; it is the capacity to have the same view as someone else and to be able to use this perspective to inform your actions.
There are 3 types of empathy: cognitive empathy, affective empathy, and emotional concern. Cognitive empathy is the ability to imagine what it must be like for someone else and to use that perspective to help inform your actions. This is the kind of empathy that is needed in health care. Affective empathy is feeling what the other person feels. It is the kind of empathy that mothers have, but we do NOT want health care professionals to have this form of empathy because it compromises objectivity and affects their abilities to do their jobs. We do, however, want health care professionals to have emotional concern, which is what motivates someone to solve a problem instead of running away from it.
Kindness is different than empathy; it is compassion. Compassion is doing something and empathy is thinking about something. Compassion is what you do with the wisdom of empathy.
We are all hardwired to be empathic and kind because these traits are pro-social and helped us build societies. Empathy, however, is a choice, not an obligation. It is impossible to be kind to everyone all the time. Dr. Goldman advised that we shouldn’t beat ourselves up for the times we are not kind.
Stress affects the ability to be kind. Studies have shown that empathy levels in doctors drop progressively with each year after medical school. The sources of stress for health care professionals are the medical culture (empathy is viewed as a soft skill to be used when clinical skills aren’t good enough or there is a fear of getting sued), time pressure (too many things to think about at the same time), technology (forces eyes to look at a screen and away from the patient), and increased specialization (doctors look after organs but not people, leading to fragmented care).
Empathy is important in health care but can cause physician burnout, so there is a delicate balance to maintain. Dr. Goldman discussed reasons why doctors may have a lower level of empathy than the general population, and while the evidence is not conclusive, it may be because doctors are simply exposed to more suffering and therefore may become desensitized over time as a way of self-preservation. He offered some solutions for the health care system, such as getting patients and family involved in the processes in place to take care of patients, as well as getting former patients to guide other patients through the system. Pharmaceutical companies can acknowledge that doctors are under stress and make a point to show appreciation when doctors take time to speak to reps. Sales pitches should be framed from an empathic point of view and explain how relationships with patients can improve, leading to doctors enjoying their jobs.
Empathy works both ways; health care needs more empathy for patients and people need to understand that doctors are under stress, too. Personally, Dr. Goldman manages his stress by practicing box breathing, mindfulness, gratitude, and running long distances. When he struggles to let go of bad feelings, he pretends he’s reviewing these feelings as characters in an ugly parade — he acknowledges their silliness as they pass by, and then allows them to walk away out of sight. He also said he embraces the things that embarrass him because we all have pain that we can share with others and this helps others go through similar challenges. Finally, it is easy to build rapport by finding something in common with everyone you meet.
Relationships can be re-established with kindness. When all else fails, unleash the power of unexpected kindness.
When choosing to be kind or to be right, choose being kind.