Monday, July 6, 2015


Ofri knows first-hand that empathy is easily lost in the chaos of a hospital.

A self-described "people person" who loves hearing her patients' stories, Ofri still goes entire shifts without asking anything beyond, "How are you feeling?"

"The last time I worked in the clinic, I was so busy that I hardly had time to renew medication, let alone ask questions about people's lives," said Ofri, whose book, "What Doctors Feel: How Emotions Affect the Practice of Medicine," was published in 2013.

After shifts like that, she regroups, reminding herself that being empathetic can be as simple as putting her hand on a patient's shoulder or referencing a note she made during their last visit about a family member or a knitting hobby.

"I wish I had an hour with each patient, but even just noticing if they had a haircut, got a new job or lost a few pounds is money in the bank for when you have to face bigger, harder issues," she said, adding, "It's about recognizing their life outside of the hospital. … Three or four times a year for 15 minutes they're a patient, but they're always a person."...

"(Burnout) makes it very hard for people to show empathy and muster the energy to care as much about what the patient is feeling," he said. "When you're working 80 hours a week, listening to all of a patient's concerns takes a lot of effort."...

In 2004, Boyle, then 18, was in a serious car accident that put him in a coma for more than two months. During his recovery he worked with a wide variety of care providers, connecting with some while trying to ignore others who coldly used words like "vegetable."

"When you come into a room, the patient is engaged with your presence and body language," he said, noting how unsettling it is when a doctor seems distracted or uncomfortable. "You have to create a positive energy around the patient."...

At the University of Utah, Wanner combats the potential awkwardness of trying to be more empathetic by encouraging each doctor to do what feels natural for them.

"You have to use a style that works for you," he said. "Some clinicians use humor a lot, but others aren't good at that and would get in trouble if they tried. Some people are more comfortable holding the patient's hand or putting a hand on his or her shoulder.

"One of the things I tell people is that if you don't feel comfortable (using a particular strategy), you probably shouldn't be doing it," Wanner added.

Beyond his focus on being a good listener, Wanner said his empathy style involves "finding little opportunities to connect with people." He comments on a patient's shirt if it advertises a sports team he likes, or asks about "Get Well" flowers...

"Burnout is a major problem in health professions. The hours are long and the pace is fast," he said. "Regardless of how important you think (empathy) is for the sake of the patient, it's really important for you."

Emphasizing empathy helps a doctor do his or her job better, which enables patients to thrive, Wanner said, noting that his own effort to stay quiet and let his patients ask questions isn't revolutionary, but makes a big difference in the long run.

"It's very important for patients to feel they are listened to, respected and valued as individuals," he said. "And I think that if we don't do that as health care professionals, we're not giving patients the care they want and deserve."

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  1. The patient was dying and she knew it. In her mid-50s, she had been battling breast cancer for years, but it had spread to her bones, causing unrelenting pain that required hospitalization. Jeremy Force, a first-year oncology fellow at Duke University Medical Center who had never met the woman, was assigned to stop by her room last November to discuss her decision to enter hospice.

    Employing the skills he had just learned in a day-long course, Force sat at the end of her bed and listened intently. The woman wept, telling him she was exhausted and worried about the impact her death would have on her two daughters.

    “I acknowledged how hard what she was going through was,” Force said of their 15-minute conversation, “and told her I had two children, too” and that hospice was designed to provide her additional support.

    A few days later, he ran into the woman in the hall. “You’re the best physician I’ve ever worked with,” Force remembers her telling him. “I was blown away,” he says. “It was such an honor.”

    Force credits “Oncotalk,” a course required of Duke’s oncology fellows, for the unexpected accolade. Developed by medical faculty at Duke, the University of Pittsburgh and several other medical schools, “Oncotalk” is part of a burgeoning effort to teach doctors an essential but often overlooked skill: clinical empathy. Unlike sympathy, which is defined as feeling sorry for another person, clinical empathy is the ability to stand in a patient’s shoes and to convey an understanding of the patient’s situation as well as the desire to help.

    Clinical empathy was once dismissively known as “good bedside manner” and traditionally regarded as far less important than technical acumen. But a spate of studies in the past decade has found that it is no mere frill. Increasingly, empathy is considered essential to establishing trust, the foundation of a good doctor-patient relationship...

    While some people are naturally better at being empathic, said Mohammadreza Hojat, a research professor of psychiatry at Jefferson Medical College in Philadelphia, empathy can be taught. “Empathy is a cognitive attribute, not a personality trait,” said Hojat, who developed the Jefferson Scale of Empathy, a tool used by researchers to measure it...

    While the curricula differ, most focus on self-monitoring by doctors to reduce defensiveness, improve listening skills (one study found that, on average, doctors interrupt patients within 18 seconds) and decode facial expressions and body language. Some programs use actors as simulated patients and provide feedback to individual doctors.