At MGH, schooling doctors in the power of empathy

Center draws praise for a basic idea with huge effects

Dr. Helen Riess directs the Boston hospital’s Empathy and Relational Science Program. Evan McGlinn for The Boston Globe/File 2012

It was a classic mismatch: an angry, demanding woman and an impatient, brusque man. Time and again, they pushed each other’s buttons. It ended with a breakup.

But these weren’t lovers squabbling. He was a doctor, and she was his patient. She didn’t like his drug prescription for her high cholesterol. She loudly ticked off the side effects she’d read about and demanded a regime of diet and alternative medicine instead.

The doctor’s frown, his tone of voice, and his reply registered his impatience. If she wouldn’t take his advice, he said, he would refer her to another physician.

This videotape of a simulated encounter is more than just a vivid portrait of a doctor exasperated by a difficult patient. It’s part of a research and training program engineered to teach doctors empathy. Based at Massachusetts General Hospital, it’s the first such program in the nation offered by a hospital — and its tenets and approach have been catching fire, and gaining wider notice. It was, in May, the focus of a Madison Square Garden rally of 5,000 medical professionals.

Contrary to popular belief, empathy — or the ability to put yourself in another person’s shoes — isn’t necessarily something innate or acquired in upbringing. While some people seem naturally nicer than others, the Mass. General program has empirical evidence that empathy can be taught to adult professionals.

And should be, according to Dr. Helen Riess, a psychiatrist who directs the hospital’s Empathy and Relational Science Program. “Empathy training enhances relationships, increases job satisfaction and improves patient outcomes,” says Riess. And with 60 percent more doctors than a decade ago reporting burnout, today’s physicians and patients have more than ever to gain from the program.

Riess’s curiosity about empathy in medicine began 10 years ago, when she noticed a trend among her own patients: Many were upset over encounters with doctors. There was, for example, the overweight woman proud of her effort in losing 15 pounds.

Until she went into her doctor’s office. “When are you going to do something about that weight?” he asked her.

Or the woman who worried about her teenage son traveling overseas. “Is your mother always this anxious?” his pediatrician asked, in front of her.

Says Riess: “These are just not ways to treat people. It’s just frank disrespect.”

So Riess began to scientifically measure the physiological responses during doctor and patient interactions, using medical residents and patients at Massachusetts Eye and Ear as her subjects. With technology similar to lie detector tests, she and her team measured micro-perspiration of the skin, heart rate, and skin temperature of both doctor and patient.

When either participant in an encounter was upset, symptoms increased. But if people felt understood, the signs of stress abated. In fact, her research has shown that a positive doctor-patient relationship improves health outcomes in patients with diabetes, asthma, hypertension, obesity, and osteo-arthritis.

It makes doctors happier, too: High physician empathy has been linked to a decrease in malpractice claims. “Patients don’t sue doctors they like, with whom they have a meaningful relationship and whose intentions were good,” she says.

“Patients don’t sue doctors they like, with whom they have a meaningful relationship and whose intentions were good,” Helen Riess said. Bryan Karl Lathrop

Riess used her findings to establish empathy training courses, offering a perspective not readily found in most medical schools. In 2013, with a growing demand for her classes, Riess started Empathetics, an online, interactive course that trains health care professionals worldwide. The three one-hour sessions include tests at the end, and those who pass can get continuing education credits. Partners HealthCare, which operates MGH and Brigham and Women’s Hospital, now requires all residents at its teaching hospitals to take the course.

Jerry Rosenbaum, chief of psychiatry at Mass. General and Riess’s boss, says the program is “the right thing at the right time.” When he was in medical school in the 1960s, he says, no one mentioned empathy. But today? “I don’t think anyone would doubt this is an important part of being a caregiver in a health care institution.”

The poor people skills displayed by some doctors may stem in part from the rigors of medical school itself. “The field attracts altruistic, highly motivated people who want to help,” Riess says. “But studies show that by the third year, empathy starts to decline. It’s the first time they’re exposed to sick and dying people, and they have to develop a tough skin or be crying in the bathroom every day.”

Riess reinstills that sense of fellow feeling by focusing on practical nonverbal skills: making eye contact with patients, decoding their facial expression — are they scared, confused, disgusted? — sitting down and leaning toward them, nodding when listening, and adjusting tone of voice to match theirs.

Other advice: Don’t get defensive, no matter how annoying the patient is. “Sometimes, people just want to vent,” Riess tells physicians. Her tips for dealing with tricky patients include taking a “time out” by leaving the room briefly, consulting with a colleague, and doing breathing exercises.

She also counsels doctors on how to deliver bad news, such as telling an airline pilot he has macular degeneration and can no longer fly, or parents that their child has inoperable cancer. Deliver bad news at the end of the day, when interruptions are less likely, she counsels; prepare yourself to deliver such news; look at it from the patient’s viewpoint; provide support; balance hope with reality; and assure them that you will be there for them.

The Empathetics courses contrasts bad scenarios with better ones. In the case of the woman who refused to take cholesterol medication, the “better” encounter with her doctor featured him sitting down with her, leaning forward, nodding, making eye contact and telling her: “It’s perfectly reasonable to start with your diet.”

The woman smiled at him and left happy, and the physician, too, was more relaxed. And it took no more time than the adversarial encounter.

Dr. Stacey Gray is the residency program director at Mass. Eye and Ear and an otolaryngology surgeon. Her residents participated in Riess’s 2010 pilot study of the interactions between doctors and patients.

Gray is a big believer in empathy training. “In the past, it was much more of an apprenticeship model, with students observing someone who communicates well and is compassionate,” she says. “But as surgeons, we’re not very good at teaching that. We’re not psychiatrists or psychologists.”

The empathy workshops offer more concrete, hands-on lessons, she says. “If you specifically explain how you do these things, residents will understand better and faster.”

Is there hope for all doctors, even some surgeons who act like they think they’re God? “Not everyone is going to be Marcus Welby,” Riess says, referring to the 1970s TV series that featured Robert Young as a beloved family practitioner. “But in my experience, I think everyone can improve if they want to.”