Empathy and the Impact on Clinical Outcomes

By Mike Nelson, MD

This Insight discusses the importance of empathy in patient encounters and how tools such as AIDET® can help deliver a consistent message.

Incorporating empathy into physician/patient interactions and relationships is proven to produce a number of positive outcomes. Through the use of direct measurement of individual physician empathy (Jefferson Scale of Physician Empathy), as well as patient perceptions of physician communication and empathy, some of the positive outcomes include:

  • Reduced metabolic complications in diabetic patients cared for by physicians with higher empathy ratings1
  • Improved glucose and LDL-C control in diabetic patients cared for by physicians with higher empathy ratings2
  • Patient assessment of physician communication associated with Improved patient medication adherence3
  • Reduced incidence of malpractice claims4
  • Physician well-being

When we talk about empathy, we are referring to the capacity to understand another person’s experience from within that person’s frame of reference. Sigmund Freud commented that “Empathy does not involve identifying with the other person per se, but with what that person is experiencing”. In other words, it is about recognizing and validating a patient’s anxiety, fear, pain, worries and situation.  Our patients need to know that we are seeing, listening and relating to them.

Empathy has proven to have a positive influence on healthcare outcomes, yet research shows physicians ignore 75 – 90 percent of opportunities to be empathic with their patients5. A number of possibilities have been identified including:

  • Gradual desensitization through medical education and subsequent professional experience
  • A mistaken perception that being empathic will increase the time required for patient visits
  • Knowledge gap on how to recognize empathic opportunities and how to respond to them
  • Misperception that deployment of empathy might lead to loss of objectivity

Fortunately the barriers can be mitigated. Most healthcare providers have some capacity to be empathetic. For those who have become desensitized over time, a re-commitment to be “in the moment” and look for verbal and nonverbal cues from patients is a first step. 

For those that are less empathetic, there are learning resources available to recognize cues from patients and to respond to them in empathic ways.6 Utilization of Key Words at Key Times (KWKT) and AIDET®, Studer Group’s communication framework, are proven to improve patient perception of care and ensure care givers are delivering consistent measures of empathy, concern and appreciation. Additionally, empathic responses to patients during a clinically encounter have actually been shown to shorten the patient visit.7

Below are some tips for physicians and providers when interacting with patients and families:

  • Acknowledge (A of AIDET®)  not only their presence but patient concerns, challenges and anxieties
  • Listen intently using reinforcing cues like a forward nod or expression like “I see”
  • Utilize Key Words which reinforce your empathic stance: 
    • “I can understand your frustration with this challenging illness. We are here for you and will continue to do everything we can to help you through this”
    • “I so admire how you have maintained a positive attitude and never given up since the stroke and rehab process.”

Empathy is as important to providing good clinical care as technical competence. Increasingly third party payers and malpractice insurers are factoring in the patient experience outcomes to determine premiums and copays. The journey to being more empathic with patients is as simple or as hard as individual physicians and providers want to make it.

Additional Resources:

  • Learn more about the impact of AIDET® and gain tips from practicing physicians at each of our Studer Conferences.  
  • The revised and updated HCAHPS Handbook lays out the strategy and tactics that enable organizations to consistently provide the exceptional quality of care their patients expect and deserve. 
  • Additionally, The CG CAHPS Handbook provides tools and tactics to improve patient experiences and clinical outcomes. 

References:

  1. Canale, Stefano Del, MD, PhD, Louis Daniel Z., MS, Maio Vittorio, PharmD, MS, MSPH, et al, The Relationship Between Physician Empathy and Disease Complications: An Empirical Study of Primary Care Physicians and Their Diabetic Patients in Parma, Italy, Academic Medicine, Vol. 87, No. 9 / September 2012
  2. Hojat Mohammadreza, PhD, Louis Daniel Z., MS, Markham Fred W., MD, et al; Physicians’ Empathy and Clinical Outcomes for Diabetic Patients, Academic Medicine, Vol. 86, No. 3 / March 2011
  3.  Ratanawongsa N1, Karter AJ, Parker MM, Communication and medication refill adherence: the Diabetes Study of Northern California. JAMA Internal Medicine 2013; 173 (3): 210-218
  4. Stelfox HT, et al, The American Journal of Medicine 2005; 118: 1126 – 1133
  5. Morse DS, Edwardsen EA, Gordon HS.  Missed opportunities for interval empathy in lung cancer communication, Arch Intern Med 2008; 168:1853-8
  6. www.empathetics.com
  7. Suchman AL, Markakis K, Beckman HB, Frankel R, A model of empathic communication in the medical interview,  JAMA 1997;277;678-82

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