Part 1 of this article focused on defining empathy and its role in health care. In Part 2, I’m going to focus on the loss of empathy and how to regain it. Neumann’s systematic review (2011) showed that empathy is significantly decreased in medical students by their first interaction with patients and declines further as training continues. So, why is it that the more medical students practice, the less empathy they have?
Neumann believed that it is a protective mechanism for the practitioner to limit their own distress of human vulnerability by dehumanizing the patient into theory and parts. Also, Decety et al. (2010) demonstrated that medical expertise down-regulates sensory processing of the perception of pain in others. Pretty amazing: Maybe the more you know, the less you “feel”? The third reason is personal distress caused by burnout, decreased quality of life, and depression.
Which brings us to mirror neurons. Mirror neurons play a neurophysiological role in empathy that fire both during an action or sensation in the body and when the same action is observed in someone else. For example, watch your favorite football team play a real important playoff game. It’s the fourth quarter, game tied, last play with a 53-yard field goal attempt. The kicker is nervous, the coach is nervous, fans in the stadium are clenching their hands together and the next thing you know, so are you. Now, even if you don’t have money on the game, you can feel and understand what these players, coaches, and fans are going through. The distress theory hypothesized by Bauer (2005) states that increased distress such as burnout, decreased quality of life, and depression, may decrease or inhibit the ability for these mirror neurons to fire properly. Thus, undermining one’s capability to empathize. Following this logic it sounds like it’s possible for favorable outcomes to decrease as stress and productivity demands increase.
If this learned behavior is neurophysiologically diminished can we regain this ability and improve our patient’s outcome? Absolutely…Thank you neuroplasticity! Let’s start with stress: If stress diminishes the utility or effectiveness of mirror neurons, decreasing the ability to empathize, then it stands to reason that one may need to find constructive ways to decrease stress as a means to improve these connections. Easier said than done, I know. One simple way to de-stress is through breathing, and this is also helpful for your patients. Here is a link created by Harvard to get you and your patients all Zen-like.
Dr. Mohammadreza Hojat wrote a paper in 2009 titled, Ten Approaches for Enhancing Empathy in Health and Human Services Cultures, is well worth the read. If you don’t have time for the entire paper, here are three of Dr. Hojat’s ten that can be quickly actionable.
The first is improving your interpersonal skills. Suchman, Markakis, Beckman and Frankel (1997) developed an interpersonal model where three basic communication skills are needed for empathic communication: Recognition of a patient’s negative emotions and concerns, exploration of these emotions and concerns, and acknowledging that these emotions and concerns will create a feeling for the person in front of you.
The second is improving narrative skills. A practitioner’s ability to listen really comes into play here. This is where you can begin to grab hold of a patient’s trust and willingness–or lose it. When someone is ill or injured, they want to tell someone all about what they are dealing with. They are searching for both guidance and reassurance. The more you can listen–and quit all the interrogating–the more answers they will actually give you about how to help them. No one likes to reiterate the medical history form they should have already filled out, so question only when necessary and question with purpose. In essence, just have a friendly conversation.
The third and final approach is to enjoy literature and the arts. This doesn’t have to be Plato or Aristotle, it can be anything. You can watch movies, read a good book or poetry, listen to music, go to an art exhibit, or watch your favorite television show. All can provide these insights into meaningful human emotion– if you’re paying attention. An added bonus is that reading, watching movies, and listening to music are all pretty decent ways to help you de-stress.
All in all, empathy is a learned behavior that plays a gigantic role in optimal outcomes for increased patient satisfaction and health. Understandably, it is something that one person may find easier than the next, but that doesn’t mean it can’t be enhanced in all of us. Patient care is an ever-changing work in progress but the desire for kindness and caring from one person to the next is standard.