Given the unprecedented impact of the coronavirus pandemic, accelerating steps needed to elevate empathetic behavior is especially important. A psychologically safe and just culture will assist staff and patients in coping more effectively when uncertainty and fear are so ubiquitous. There is no panacea, but each incremental effort will be worth the investment.
In her notable 2013 TED Talk, Harvard professor and psychiatrist Helen Riess, MD, provides several breathtaking examples of human empathy (see sidebar below). During the talk Riess says, “The good news about empathy is that when it declines, it can also be learned. Employers who want to have an engaged and productive workforce need to get tuned into the people. Patients who don’t
feel cared about have longer recovery rates and poor immune function.”
During an extended phone conversation I had with Riess early this year, she emphasized that the qualities of empathy are teachable and, eventually, lead to an improvement in staff attitudes and behavior.
More recently, she told me, “During the COVID-19 pandemic, empathy is needed more than ever at every level of healthcare organizations. Our patients need greater empathy because of the increased threats to their safety, and our colleagues need support and permission to ask for help that may be difficult for them.”
Riess created the acronym E-M-P-A-T-H-Y to help us remember the key pieces of how we connect to people. In the TED Talk, she describes:
- The “E” represents eye contact. Every human being, Riess says, “has a longing to be seen, understood and appreciated.”
- The “M” represents facial expression muscles. Riess suggests our faces are actually a road map of human emotion that can rarely be completely hidden.
- The “P” represents posture. Riess indicates “posture is another powerful conveyor of connection.” She cites a widely publicized study (Journal of Pain and Symptom Management, May 2005) in which researchers at MD Anderson Cancer Center in Houston found that physicians who were asked to sit down when making rounds in a patient’s room were rated as being much warmer and more caring and were estimated to have spent three to five times longer with their patients than doctors who remained standing, even though both sets of physicians spent the same amount of time with patients.
- The “A” represents affect. Physicians are trained to evaluate a patient’s affect as a way of assessing the person’s emotional state.
- The “T” represents tone of voice. According to Riess, the nuclei for tone of voice and facial expression reside in the same area of our brain stems. “This means that when we are emotionally activated, our tone of voice and our facial expressions change without our even trying,” Riess says. With practice, Riess notes, we can become more capable of hearing and seeing what these emotions are.
- The “H” represents hearing the whole person. “Far more than the words that people say, hearing the whole person means understanding the context in which other people live,” Riess says.
- The “Y” represents one’s response to others’ feelings. “We respond to other people’s feelings all the time,” Riess says. “We might think that we only experience our own emotions, but we’re constantly absorbing the feelings of others.”
The Importance of Unhurried Conversations
The article “Careful and Kind Care Requires Unhurried Conversations,” published in the Oct. 29, 2019, issue of NEJM Catalyst, highlights a similar theme. According to the authors, “To enable unhurried conversations, whether face-to-face, via telemedicine, asynchronous or virtual, participants need to make themselves cognitively and emotionally available.”
It is true that the term “unhurried conversations” implies that such discussions will take more time than perhaps is desired when there are intense pressures on clinicians to increase productivity, see more patients and become more efficient. However, reality and perception are not always aligned. This familiar adage was confirmed by five noteworthy articles: the previously cited 2005 issue of the Journal of Pain and Symptom Management; a 2011 issue of Patient Education and Counseling; a 2016 issue of the Patient Experience Journal; a 2016 issue of the Journal of Hospital Medicine; and a 2017 issue of the Journal of Nursing Care Quality. Each article reported the results of studies that consistently demonstrated that patients perceived doctors and nurses spending more time with them than other clinicians when the staff member simply sat down.
In an article I co-authored with Jeffrey Selberg in the January/February 2006 issue of Healthcare Executive, we recommended several steps that should be taken to promote a culture of empathy. At least three deserve re-emphasis:
- Establish objective performance indicators, standards and goals regarding patient-centered care; monitor results; and routinely report findings to senior management, medical staff leadership and board members.
- Create opportunities for patients and family members to promote quality healthcare and improve workflow processes by serving on hospital advisory committees.
- Insist that senior executives make regular patient rounds to remind them of the value of interacting directly with patients and staff on clinical units.
Given our experience with COVID-19, we know resources and time are going to be insufficient to meet the needs of every clinician. Consequently, any program that promotes empathy and benefits patients as well as staff by increasing their resiliency in the face of pandemics, illness, trauma or occupational stress should be pursued vigorously.
Paul B. Hofmann, DrPH, LFACHE, is president of the Hofmann Healthcare Group, Moraga, Calif., and co-editor of Management Mistakes in Healthcare: Identification, Correction and Prevention, published by Cambridge University Press and Managing Healthcare Ethically: An Executive’s Guide, published by Health Administration Press (firstname.lastname@example.org).
The Power of Empathy
Harvard professor and psychiatrist Helen Riess, MD, works at Massachusetts General Hospital and is the co-founder, chief scientist and chair of Empathetics Inc. Her remarkable 2013 TED Talk, “The Power of Empathy,” has been viewed over 500,000 times.
During the talk, Riess mentions having received a request from one of her students who wanted to determine if, when there is empathy between people, their heart rates and other physiological tracers become concordant. The student also wanted to recruit doctor-patient pairs who were willing to have their sessions videotaped and be hooked up to monitoring devices during those sessions. Riess approved the project, participated in it and, in the TED Talk, explains how she became a more effective therapist as a result of analyzing the videos. According to Riess, the familiar statement, “I feel your pain,” is actually validated by neuron studies of the brain.
This experience led her to learn everything she could about the neuroscience of empathy which, in turn, motivated her to develop empathy training grounded in the neurobiology of emotions and empathy. The training was evaluated in a randomized control trial where those doctors trained in empathy were reported by patients as being better listeners, showing more compassion and better understanding patient concerns.