Empathy in Medical Education: Can Kindness Be Taught?

Effective communicator. Attentive listener. Emotionally intelligent. When you think of a doctor, are these the traits that come to mind?

Probably not. As many patients know, the stereotype of the emotionally distant doctor scrawling on a clipboard or tapping at a keyboard while spouting confusing diagnoses can be rooted in reality.

This is because, for centuries, medical education here in the United States and across the world has focused solely on the hard facts. Emphasis is placed on doctors obtaining scientific knowledge, expertise in diagnosis, and excellent technique. As a result, many “soft skills” often end up on the back burner.

While medical education has long been primarily focused on academic rigor and gaining clinical experience, doctors have been encouraged to possess some level of good “bedside manner.” However, this standard for how doctors should interact with patients appears to set the bar quite low in terms of fostering a beneficial doctor-patient relationship.

Identifying the Problem

In recent years, healthcare reform restrictions have caused shorter, more impersonal visits with doctors to become the new norm. This apparent lack of physician empathy and the absence of essential social skills within the practice of medicine has become a large concern for many within the field and in the general public.

A 2017 survey from the Schwartz Center for Compassionate Care showed that 63% of physicians and nurses and 42% of patients believe that over the past five years, there has been a significant decline in communication and emotional support from healthcare professionals.

The decline of medical students’ empathy throughout their education has been well-documented and, over the past few decades, there have been several studies detailing the various reasons that have propelled this increase in physician cynicism. These factors include the sense of elitism that develops among medical students at prestigious schools, the emphasis that current medical education places on detachment and objective clinical neutrality, the focus on research at the expense of teaching and learning at many universities, and the practice of defensive medicine.

Some healthcare educators believe that medical school admission processes are at fault, as they traditionally prioritize high test scores over interpersonal skills. Others believe the physically and emotionally taxing nature of training and long hours in the hospital result in dehumanized physicians. Whatever the reason may be, it is imperative that something be done to improve physicians’ level of empathy. This is essential for a healthcare environment that is conducive to open communication and trust between healthcare providers and patients.

Why Empathy Matters

Many researchers define clinical empathy differently. One way to define it is an interest in, and understanding of, patients’ experiences, concerns, and perspectives associated with personal illness, combined with an ability to provide care and an intention to help.

Using empathy in a clinical setting helps put patients at ease and sets the foundation for a trusting and positive patient-doctor relationship. It can also aid doctors in honing in on a patient’s specific concern, which can save time and frustration for everyone involved.

Research has also shown that there is a positive association between increased empathy in a clinical setting and a number of advantages, including diagnostic accuracy, psychological and pharmacological interventions in psychiatry, and “patient enablement,” or the extent to which a patient is capable of understanding and coping with his or her health issues.

When empathy is present in patient-doctor relationships, better health outcomes have been reported. According to a study recently published in the online journal PLOS ONE, additional efforts that were made to establish rapport with a patient and build a trusting and communicative relationship had statistically significant effects on “hard health outcomes” such as obesity, diabetes, pulmonary infections, hypertension, asthma, and osteoarthritis pain.

Both patients and doctors can benefit from clinical empathy.

The practice of empathy in healthcare settings doesn’t just benefit patients — it has been shown to be advantageous for physicians as well. When doctors engage with their patients in a way that is approachable and portrays a level of understanding of the patient’s personal background, they receive positive feedback from patients, which can be rewarding.

Moreover, improved communication and trust in clinical settings has been associated with lower risk of malpractice suits as well as higher rates of patient compliance with treatment regimens. The increased patient satisfaction has tangible benefits for physicians and hospitals, as patient satisfaction scores are frequently used to calculate Medicare reimbursement rates under the Affordable Healthcare Act and are also featured in many online hospital rating platforms.

Additionally, the appreciation that doctors receive from patients by practicing empathy has been shown to reduce physician burnout and keep doctors motivated throughout their career.

Ultimately, the use of clinical empathy in healthcare is a win-win strategy for all involved, as it both promotes a sense of comfort within patients while also helping improve physicians’ mental health.

Teaching Empathy

To combat the current lack of empathy amongst healthcare professionals, many medical schools are implementing required academic programs. The hope is that training doctors on how to cultivate relationships, use sensitive language, and develop a deeper understanding of their patients will foster a higher level of empathy among physicians across the board.

One such program is the Narrative Medicine program at Columbia University. The course is designed to emphasize the importance of patients’ personal stories when it comes to delivering comprehensive care. It teaches physicians how to recognize, interpret, and incorporate the patients’ various plights and circumstances when it comes to designing a unique care plan.

Another noteworthy program that is aiming to promote empathy in doctors is VitalTalk, which is a required course in clinical empathy for oncology fellows at Duke University. In this program, seemingly simple advice is offered, such as maintaining eye contact or making sure that appointments where bad news will be delivered are scheduled at the end of the day. But these practices can have profound effects on whether or not a patient is satisfied with their overall treatment and whether the patients’ emotional needs are met.

Stanford University takes it one step further by having paid actors, called “standardized patients,” interact with medical students in a simulated clinical environment. The program is designed to assess the students on their communication skills, diagnosis accuracy, social and cultural awareness, and overall level of compassion.

Elias Escobedo, the Standardized Patient Program trainer at Stanford University School of Medicine, noted that the program is especially effective at teaching and assessing interpersonal skills in its students. “It provides the students with the perspective of the patient from day one,” Escobedo said.

Student physicians at Stanford begin interacting with standardized patients as early as their first quarter in medical school. This allows students to begin learning how to create these crucial connections with their patients early in their career.

“Physicians may not be aware of their certain habits, or the fact that the specific way that they answer questions can have a lasting impact on their patients,” Escobedo said.

The goal of the Standardized Patients Program is to to provide students with realistic scenarios that expose them situations they will need to navigate as physicians, such as sexuality, language barriers, and age-related dynamics.

The actors give the students detailed feedback stressing how the interaction made them feel. They also offer specific observations about the student’s behavior in certain moments, which allows the student to make the necessary changes in the future.

Throughout the Standardized Patient Program, physicians are encouraged to actively listen, pick up on non-verbal cues presented by the actor, and be mindful and present throughout the interaction. “It’s all about the act of listening and acknowledging and validating the patient and their experience,” Escobedo said.

In the future, we can expect to see more medical schools dedicating courses to clinical empathy and a shift in focus toward cultivating positive patient relationships. These improvements in clinical empathy have the potential to promote more personalized care and overall better health outcomes.