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Julia Ward and her colleagues ask the questions:
Are there significant changes in empathy over time in undergraduate nursing students? Does the extent of exposure to clinical experiences affect changes in empathy among undergraduate nursing students? A similar study amongst medical students2 suggested several reasons for this erosion of empathy including: - lack of strong role models
-negative attitudes from clinical faculty
-an intimidating educational environment
-perception of belittleness
-heavy educational assignment or clinical duties
- patients’ negativity 8 Strategies to seal the empathy leak:
So when someone at the second day of the Patient Experience Summit asked Cleveland Clinic CEO Toby Cosgrove where in his institution he's found the greatest resistance to creating empathically engaged connections with patients, he gave a quick and candid answer. "The docs," he said. "The biggest problem is the docs.".... It was all part of a theme conveyed by many at yesterday's gathering, the third annual Patient Experience Summit, which focused on empathy and innovation in patient care... "Entering a patient's room with a positive attitude, a caregiver can choose to be present with patients, and connect with them," Lyons said. "Patients are people: interesting, complicated, wonderful people.
"Listen to them." By Evelyn Theiss Cleveland Clinic Empathy Program
...Don't you see me making eye contact, striking an open posture, leaning towards you and nodding empathetically?'
Compassion fatigue starts in medical school. A recent study by Daniel Chen et al found that students with higher empathy scores tended to choose more people-oriented specialties, such as primary care and psychiatry, over more technical specialties like surgery or pathology. .. At present, the battle to sustain doctors’ empathy in the face of compassion fatigue is already being lost during training. If we want more doctors at the front-line of patient care, then schools need to provide a learning environment that develops and sustains empathy during medical training, especially in the clinical years. By Gillian Ragsdale
Nurses need to understand that the profession is now more about caring than curing and should be recruited for their "compassion", the head of their their training will say today.
It turns out you can teach someone how to be empathic. Resident physicians who participated in three 60-minute empathy training sessions significantly improved their interactions with patients, according to a study published online in the Journal of General Internal Medicine. The training sessions teach recognition of facial expressions and other non-verbal emotional cues, emotional self-awareness, strategies for dealing with challenging patients or delivering bad clinical news, as well as techniques for recognizing and regulating personal stress.
Resident physicians' participation in a brief training program designed to increase empathy with their patients produced significant improvement in how patients perceived their interactions with the residents. This contrasts with several studies showing that empathy with patients usually drops during medical school and residency training. The report from a team of Massachusetts General Hospital (MGH) researchers will appear in the Journal of General Internal Medicine and has been released online. "The most exciting message from this study is that empathy can be taught and, most importantly, that improved empathy can be perceived by our patients. Many medical educators have thought that you are either born with this trait or you aren't," says Helen Riess, MD, of the MGH Department of Psychiatry, who led the study. "We are also very happy to see that participating residents liked the training and found it interesting and helpful." An associate clinical professor of Psychiatry at Harvard Medical School, Riess directs the Empathy and Relational Science Program in the MGH Department of Psychiatry (http://www.massgeneral.org/psychiatry/services/empathy_home.aspx) img http://bit.ly/hZGXA5
The following references may help therapists, counselors, and other clinicians who wish to keep abreast of the research, theory, and related literature on empathy. Although there is a massive literature on empathy, I've focused mainly on works concerned with empathy in clinical training and practice, and in other clinical contexts. This literature addresses such issues as: whether clinicians become less empathetic during their training Kenneth S. Pope, Ph.D.,
The 3rd Annual Patient Experience: Empathy and Innovation Summit Patient experience has emerged as a dynamic issue for healthcare CEOs, physicians, and industry leaders. No provider can afford to offer anything less than the best clinical, physical and emotional experience to patients and families. As patients become savvier, they judge healthcare providers not only on clinical outcomes, but also on their ability to be compassionate and deliver excellent, patient-centered care. The Essence of Compassionate Care: The Skilled Use of Empathy Cleveland Clinic Empathy Program
Purpose: Empathy is a key element of patient–physician communication; it is relevant to and positively influences patients' health. The authors systematically reviewed the literature to investigate changes in trainee empathy and reasons for those changes during medical school and residency. Conclusions: The results of the reviewed studies, especially those with longitudinal data, suggest that empathy decline during medical school and residency compromises striving toward professionalism and may threaten health care quality. Theory-based investigations of the factors that contribute to empathy decline among trainees and improvement of the validity of self-assessment methods are necessary for further research.
Physicians recognize the importance of patients' emotions in healing yet believe their own emotional responses represent lapses in objectivity. Patients complain that physicians are too detached. Halpern argues that by empathizing with patients, rather than detaching, physicians can best help them. Yet there is no consistent view of what, precisely, clinical empathy involves. This book challenges the traditional assumption that empathy is either purely intellectual or an expression of sympathy. Sympathy, according to many physicians, involves over-identifying with patients, threatening objectivity and respect for patient autonomy.
When dealing with patients and families coping with life threatening illness, one of a physician’s greatest interventions may be that of empathy. Defined simply, empathy is the responsiveness to the emotional state of another person—we try to understand another’s experience. It is a process that requires effort and intention. Sympathy is an awareness of another person’s situation and is an almost “autonomic” type response. Sympathy is important and is part of what humanizes a caregiver but empathy is integral to a successful doctor-patient relationship. Many studies of medical students have indicated that empathy is lacking.
"An exercise on the challenges of aging helps students feel more compassion for patients, but researchers say repetition is needed for lasting results. The link of outcomes and empathy
Previous research has shown a positive relationship between physician empathy and patient outcomes. In a March 2011 Academic Medicine study, Hojat and his colleagues found that physicians with high empathy had patients with significantly greater control over their diabetes than patients of physicians with low empathy The studies used the Jefferson Scale of Empathy, which Hojat and his colleagues developed to assess how empathetic physicians are to patients. The test is now used throughout the world, Hojat said." img http://bit.ly/dP1O76
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Enhancing the patient experience has been a long-term vision of Cleveland Clinic CEO and President Delos M. “Toby” Cosgrove, MD Cleveland Clinic was one of the first major academic medical centers in the country to establish an Office of Patient Experience and appoint a Chief Experience Officer, as well as the first major academic medical center to host a summit focused solely on patient experience. “Delivering high quality healthcare requires not only skilled medical expertise, but an environment that promotes healing,” Dr. Cosgrove said. “We strongly believe every dimension of patient care should be measured in order to have the greatest impact. Offering compassion, showing empathy and providing patients with the responsiveness they deserve can improve outcomes and speed recovery.” Cleveland Clinic Empathy Program
I think you'll find I'm one of the most empathic doctors around.
Medical residents lose their empathy for patients over time according to an article in the Journal of General Internal Medicine. However, they can regain some of this by taking a short course in empathy that rescusitates this feeling that they had when they went into medicine. Part of this is because of the "scientific" emphasis of their training and some because their teachers don't teach it very well. The neurobiological basis for empathy was taught via specialized brain imaging as well as from patient feedback.
A local hospital is teaching others empathy for the elderly with a suit designed to imitate what it's like to age. By 2030, researchers say California will experience an explosive growth in retirement-age residents. By then, about 9 million people will be over the age of 65. So the Center for Optimal Aging in San Pedro is using empathy to educate the public about what the aging process can be like using a suit that imitates an elderly person's body. by Denise Dador
See what faculty and staff of OSU Wexner Medical Center have to say about how others in the organization demonstrate empathy and compassion in everything the...
Helen Reiss, M.D., of hospital’s Department of Psychiatry, who led the study (she is also chief technology officer of Empathetics LLC, which was formed to bring the training to a wider audience), says the most exciting finding of the study is that empathy can be taught and that improved empathy can be perceived by the patients. According to MGH, some studies have found that medical training is often accompanied by a drop in empathy, and some have pinpointed the third year of medical school. According to Reiss, possible reasons are self-protection by medical trainees against their own emotional distress and a desensitization that occurs from performing potentially painful procedures. by John DeGaspari
The Prince of Wales has urged medical professionals to prioritise "empathy and compassion" in their treatment of patients.
In a speech at the College of Medicine's annual conference, the Prince said greater effort needs to be made to put patients at the heart of the healthcare process.
He said: "Some commentators and observers have spoken of the need to restore urgently a climate of care and compassion at the heart of our health services. I find it quite extraordinary that there appears to some at least to be a gap here, especially when we are told that these so called 'soft skills' of caring can have a significant impact on the quality and pace of recovery amongst patients."
While nothing replaces meeting with a patient, reading another physician’s description of interviewing a patient can provide insights into physician-patient interactions that we cannot get when we ourselves are involved. In my view, “A Case of Baffling Fatigue with a Spectral Twist” illustrates clinical empathy in action. Often confused with compassion, sympathy, and other benevolent emotions, clinical empathy involves emotional resonance, but is distinguished by curiosity. Whereas sympathy involves feeling as if one were “in the same boat” with another, empathy involves curiosity about another’s distinct experience. Vividly and specifically imagining another’s distinct world becomes possible with careful, attuned listening. by Jodi Halpern, M.D., Ph.D.
If you’ve misplaced the user manual for your brain, The Compassionate Brain: How Empathy Creates Intelligence by Gerald Huther is the ultimate guide for all who think. The chapters move through the brain’s structures, from worm brains to the human psyche, then moves to discuss the hardware already installed in the brain and how to repair that hardware, also how to service the equipment and what to do when malfunctions occur. If you’ve ever wondered what the differences are between a mole brain and human brain, this is a good place to look. And the last twenty pages, how to fix malfunctions in the brain, are high quality indeed.
In the August 2011 issue of Academic Medicine, Neumann et al1 systematically reviewed the literature to explore the reported potential causes for changes in the empathic capacity of medical students and residents during the course of their training. Varying theories or explanations were proposed. It is striking that, in none of the reported studies, parallel studies of the empathic capacity of the medical faculty were undertaken.In a number of the studies reported, reference is made to the impact on trainees of the hidden curriculum, including an unsuitable learning environment and inadequate role models as factors influencing the decline in trainees' empathic capacity.
Despite a lot of study, especially in the past decade or so, there remain many questions about how best to foster empathy in students who will be spending the rest of their working years in patient care. It matters because patients are more likely to comply, more likely to receive an accurate diagnosis and more likely to be satisfied with the clinician-patient relationship when empathy is present, the pharmacy journal authors wrote. “Empathy is an important component of the healthcare provider-patient relationship that has been linked to optimal patient outcomes.” by Anne Polta
In part eight of the Future Learning series, Catherine Lucey of the UCSF School of Medicine shows how technology helps faculty train caring doctors. For Catherine Lucey, Vice Dean of Education at the School of Medicine, integrating technology aids the faculty in teaching students to become compassionate, skillful physicians. Click on the video to learn more about UCSF's approach to learning.
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