When things go wrong, doctors are encouraged to be open with patients, show compassion and communicate effectively. But is there room for empathy, or even emotion, in the clinical setting?
Traditionally, empathy in clinical practice was bound up with the vague term “bedside manner” – you either had it, or you didn’t. It couldn’t be taught or improved. Now, however, empathic communication is seen more as a taught skill, and one that is essential in order to fully understand a patient’s condition.
“I don’t think I would be able to do my job properly without being able to empathise with my patients,” says Dr Ayesha Rahim, former Deputy Chair of the UK’s BMA Junior Doctor Committee. As a junior doctor in psychiatry, she explains: “It’s a huge thing for patients to tell you something extremely personal about themselves. It’s important to be attuned to what they are saying, and how they are saying it, by looking out for non-verbal clues.”
Clinical empathy is about understanding a patient’s symptoms and feelings, and communicating that fact to the patient. It is important to check back with the patient when taking a history to show you fully understand, for example, “Let me see if I have this right.” Verbalising the patient’s emotion, eg, “You seem anxious about your chest pains,” demonstrates active listening.
Stop, look and listen
Empathy is difficult to express unless it is truly felt. Although there are stock phrases that doctors use to empathise with patients, it is important that these are not repeated with little regard for the individual situation. Empathy as a taught skill can soon become formulaic emotion – something patients do not buy.
Dr Pauline Leonard, a consultant medical oncologist, led a national programme, Connected, teaching doctors how to break bad news. She says: “There should be templates around empathy, but doctors should be encouraged to move the template to fit the patient – that is the art.
“Doctors like templates because they are nervous. Ultimately, doctors are scared that when they empathise really well, so much emotion is unlocked in the room that they don’t feel equipped to cope with the situation and put the patient back together again.”
If you empathise well, however, all you need to be equipped to do is sit and listen. Patients need to know that you are there to answer any questions, that you are not frightened of strong emotions. Tempting though it may be to bring an awkward conversation to a quick end, try not to brush off fear, uncertainty or anger with “Don’t worry, everything will be okay,” or “I know how you must feel”.
Dealing with emotion
Sometimes, it is important to know when to step back from a situation. An excess of emotion can blur boundaries. There are a wide range of opinions on what is professionally appropriate.
. Advice can at best only be general, because of the huge number of differing reactions to a doctor’s behaviour by patients. How doctors react and support patients will depend on the previous relationship they have had, and the knowledge that a doctor has of the patient’s personality.
The GMC stresses that to fulfil your role in the doctor–patient partnership you must be polite, considerate and honest, treat patients with dignity and treat each patient as an individual, but warns against establishing or pursuing “a sexual or improper emotional relationship with a patient”.
In providing competent and compassionate care, emotion does sometimes creep in – after all, doctors are human too. However, the empathic doctor should not be willing to indulge idle emotion or self-absorbed sympathy; empathy should be given with a strong clinical purpose.
Above all, empathy allows the patient to see the person behind the professional, and the doctor to see the person, and the suffering, behind the patient.
Our advice – steps to effective empathy
- Pause to imagine how the patient might be feeling
- State how you see the patient’s feelings (eg, “It sounds like you’re upset about...”)
- Legitimise the feeling
- Respect the patient’s effort to cope
- Offer support (eg “Let’s see what we can do together”)
- Be sensitive about physical boundaries.