In medical school, I was taught to sit at eye level when speaking to patients, ask how they would prefer to be addressed, and ask open-ended questions to allow them to express themselves. I learned to interject with “That must be really difficult for you,” or “I can only imagine how that makes you feel,” as a way to show empathy and foster better connection with patients. This worked for some patients during my medical school clinical rotations.
However, I’ve seen some patients become impervious to such an approach, sometimes becoming upset or emotionally closed-off. In residency, I’ve encountered many patients who do not respond to the empathic methods I was trained to use. During these times, I’ve learned to abandon the script and speak to these patients from a perspective of dignity and respect, and I have rarely ever had trouble connecting even with the most “difficult” patient.
Some of my colleagues have asked me how being empathetic comes so naturally to me. How did I learn to connect so well with my patients? “Even the most cantankerous, bellicose and unreasonable patients calm down and become agreeable after speaking with you!” I’m not quite sure, either.
I see patients as people first. They need to know you care, that you really value and respect them, despite meeting you at the most vulnerable and worst times of their lives. The patients who get admitted every couple of weeks for alcohol withdrawal or heroin overdose need to know that you still respect their dignity (however little they feel it is). They need you to understand that their diseases or struggles do not define them as a person, and that they have value in the eyes of their family and loved ones.
Questions I ask include: Do you know why you’re in the hospital? What do you think is your current medical problem that we’re treating? What have we done for you so far? Have you seen all the labs and imaging results yet? Would you like to me to explain them to you? What are you most concerned about right now? It doesn’t have to be about the disease we’re treating. Is there anything else I can do to help you or make you feel more comfortable? Is there somebody you’d like me to call? By the way, my name is Dr. Anochie. “It’s like Spanish for last night,” if the patient is Hispanic. I’ll do my best to take care of you.
These are simple conversations, but they are also very meaningful to patients. It shows them that you care about their understanding of their disease processes, and that you’re also providing emotional support to help them cope. They perceive you as their ally and advocate. Frequently checking on patients inadvertently causes them to pull down their walls and trust you as their physician. This is essential because physician-patient trust significantly increases compliance with recommendations, prescriptions and clinic appointments after hospital discharge.
This still begs the question: Can empathy be taught? Can’t I just memorize some sentences that project empathy, say them to a patient while holding their hands and staring into their eyes, and then check it off my list?
It doesn’t work that way. Patients know when doctors are “acting.” It’s like a customer service rep telling you, “Thank you so much for calling, we really value your membership.” You know it’s a memorized line spoken perfunctorily.
My personal belief is that empathy comes naturally to people who have had some background experience to draw from when attempting to connect with a patient. A physician who has had friends or relatives suffer through drug addiction might be better able to connect with a patient struggling with addiction. This underscores the importance of admitting students into medical schools with diverse personal life experiences, social economic classes and family upbringing. Future doctors from such varied backgrounds are vital to the field of medicine. They will make a positive impact toward improving the health care experience for our diverse and complicated patient population.
A quote from the late Maya Angelou says, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” This perfectly encapsulates the theme of this opinion piece. It is common knowledge that empathetic physicians are less likely to get a malpractice lawsuit, even after admitting an error or mistake to a patient or their family. It is also important to acknowledge that we learn from our patients’ stories and experiences beyond their presenting chief complaint or working diagnosis. I’ve learned so much from the diverse patient population for whom I care. I’ve gone home in tears sometimes thinking about how the health care system is failing them. I’ve also been inspired when patients voluntarily share their personal triumphs, regaling me with how they’ve overcome impossible circumstances, and are still persevering to get through the next day.
This is why I love medicine. This is also why I advocate for my patients and treat everyone with equal dignity, whether they struggle with addiction or are the CEO of a Fortune 500 company. Death and disease do not respect class or age, neither should physicians give preferential treatments to them.