Dr. Helen Riess
Riess, director of the Empathy and Relational Science Program in the Department of Psychiatry at Massachusetts General Hospital, and associate clinical professor of psychiatry at Harvard Medical School, recently published a study showing that explicitly teaching empathy to doctorsin- training improves their interactions with patients.
Q. It seems like everyone complains about the lack of understanding in doctors and other medical personnel.
A. Contemporary physicians are facing tremendous pressures in terms of the number of patients they're expected to see, the short amount of time in which they have to see them, the complexity of the health problems, and the increasingly burdensome documentation requirements. I firmly believe that empathy is challenged and to some extent driven down by many of the factors that are beleaguering health care today.
Q. Do we actually drum empathy out of people as we teach them to be doctors?
‘We’re trying to not have empathy and compassion feel like one extra thing you have to do. One way to actually help you cope . . . is to connect with people and feel this thrill of helping them.’
A. There are many studies that have documented this decline [in empathy] throughout medical training. It seems to start in the third year of medical training, and it persists during residency. Whereas it used to bounce back after the rigors of training were over, now that the pressures just continue, and continue to mount, at least 60 percent of practicing physicians are showing signs of burnout today.
Q. And teaching doctors empathy helps counteract physician burnout?
A. Some doctors after getting empathy training come back and say I feel my job is really rewarding again. By connecting with people more fully, I feel like I want to go to work again.
Q. You are talking about all types of health care professionals, not just doctors, right?
A. When there’s this much pressure and burnout in one segment, it invariably trickles down to the others.
Q. One of the concerns is that being empathetic will add even more time and stress to a busy doctor’s day.
A. We’re trying to not have empathy and compassion feel like one extra thing you have to do. One way to actually help you cope with all these things is to connect with people and feel this thrill of helping them.
Q. And we could actually save money on medical care if caregivers were more empathetic?
A. The number of health dollars we can save just altering the relationship and making people less anxious and afraid could be truly phenomenal.
Q. What are doctors most often missing by not being empathetic enough?
A. Reading nonverbal signs of communication which account for 75 to 80 percent of communications. Since patients often don’t feel free to express their negative feelings, if you don’t look for more subtle signs that they don’t like what you’re saying, you can miss an opportunity to explain yourself better or understand what their resistance is all about.
Q. How should doctors and health professionals deal with patients who are rude or difficult?
A. When they run into emotional obstacles like anger, or manipulation, or even rudeness, those are just surface behaviors that are covering up for tremendous vulnerability and fear. We try to train our doctors to not get defensive when they run up against these things, but slow down and try to find out “where are you really hurting,” or “why are you so afraid,’’ instead of labeling people as difficult or hard to deal with.
Q. What responsibility do patients have in helping their caregivers become more empathetic?
A. Patients need to help doctors know when they don’t understand, when they’re feeling that they’re not being listened to. They need to develop more courage to ask questions so that it really can be about a relationship rather than just receiving information.