“When you show deep empathy toward others, their defensive energy goes down, and positive energy replaces it. That’s when you can get more creative in solving problems.”
– Stephen Covey
Empathy has always been the root of human connection, and in that, stems the foundation of our capacity to help others—whether family, friend, or patient—it all comes down to the same core values. And yet, it is the humanistic domain that many question including as part of the DO licensure exam. How important is it?
Having worked in osteopathic medical education and licensing for over 25 years, I am frequently posed the question, what makes DOs different? My answer is always the same, it’s about patient empathy. This isn’t to say that MDs don’t possess this trait; they do. However, there’s a heightened sense of empathy and patient understanding that seems to steer certain candidates toward osteopathic medicine.
The DO approach is based on the unique connection between mind, body, and spirit as it relates to patient care. It’s this holistic, 360-degree assessment and desire for enhanced understanding that fuels empathy and a different shade of patient care. It also involves empathic inquiry, developing understanding beyond just the problem at hand, but also what other life factors are impacting the patient. As a doctor, understanding how these many dimensions interact and intersect on a deeper level is the basis of the DO approach.
To clarify, empathic doctors are not internalizing or ‘taking on’ a patient’s pain or discomfort in a therapeutic way. Rather, they’re attempting to understand the patient’s illness experience. A patient once told me, “I don’t need my doctor to love me, but I do need them to understand me.” That deeper level of understanding is what brings humanistic values back into the medical encounter, allowing for the establishment of a knowing relationship. Research has shown that empathy helps to build trust, is linked to better diagnoses, improves patient outcomes, and decreases malpractice lawsuits.
Now that we have better understanding of the importance of empathy, how do we measure it in a clinical setting? The COMLEX-USA Level 2-Performance Evaluation has been assessing interpersonal and communication skills and professionalism of candidates for the past 15 years. And empathy is one of six dimensions assessed. Based on evidence that patients place great value on their human connection to their doctor, there are several guiding principles that support the role empathy plays in patient care:
Empathy is connection.
Attend to the patient both verbally and non-verbally. Listen to them. Make eye contact. Actively respond to their condition or pain. Avoid giving patients the ‘clinical cold shoulder’ by focusing only on their symptoms.
Empathy is curiosity.
This is especially important for young doctors who don’t have a lot of patient experience. Learn from the patient. Explore their illness experience. Discuss their lifestyle, their belief system, their stress levels, what motivates them. Give patients the feeling of being understood.
Empathy is compassion.
This is the ability to imagine what a patient is experiencing without being overwhelmed by their pain or distress. Research has shown that people are selective when expressing empathy towards others. It’s hard to feel compassion, for example, when a patient is difficult, unlikeable, or struggling with unhealthy behaviors that put them at risk. But it’s these patients who are most deserving and in need of our compassion and understanding.
Empathy is not stress.
Stress is in opposition to empathy. It’s difficult to connect to a patient, or anyone for that matter, when we feel anxious and overwhelmed. Likewise, physicians who have difficulty managing their feelings towards patients are themselves at risk. Although the stress of working with patients is an unavoidable part of a physician’s work life, one goal of medical education should be to equip students with the skills to manage stress in healthy ways.
A generation ago, few were talking about the role of empathy in healthcare. But today, cognitive neuroscience has enabled us to look critically at what ignites and motivates our behaviors, including the empathic ones. This new knowledge and learning, coupled with a heightened focus on developing higher quality patient care, shines a bright light on the need and desire for greater empathic engagement. That said, empathy is not what makes good doctors; it’s what makes good doctors even better.
Demonstrating empathy is important to becoming a DO, and since 2004, passing this assessment has been required to obtain the DO degree, move into residency training, and obtain a license to practice osteopathic medicine.
Contributed by Tony Errichetti, PhD | Director of Doctor-Patient Assessment | NBOME
