Physician Empathy: Improving Patient Experience through Listening and Understanding

By Jackie-Meyers Thompson

Question: “Doctor, my back is hurting. It started about two weeks ago and hasn’t let up. Do you know what could be causing this?”

Answer: “You know you’re overweight don’t you? That could cause the back pain you’re complaining about”

This patient portal exchange certainly leaves a lot to be desired when it comes to an empathetic physician response. Empathy is the ability to understand and share the feelings of another, in this case the patient who is concerned (not complaining) and looking to his/her physician to respond—appropriately. It’s not, generally speaking, arrogance, but a true misunderstanding of what it is to empathize with another person.

There is much being done in the area of training ‘AI’ in the art of empathy. But are our flesh-and-blood physicians missing the boat? Or has the boat already sailed without them?

Stephen Weber, M.D, Chief Medical Officer at The University of Chicago, thinks of this often, and his thoughts have spawned the “Clinical Learning for Empathetic and Remote Communications” (CLEAR) program which emphasizes the art of empathy between physician and patient. “Empathy is an art,” says Weber. “Most people have it or they don’t, but as we are moving along further in our teachings, we find it can be taught as well, as it is with AI responses.”

How do we teach empathy? It can be achieved through a series of exercises and best practices which we must request or demand of our physicians. With the example above, it means not just jumping to the physician’s conclusion but listening—really listening— to what the patient has on their mind and understanding that the patient is not complaining but merely stating their concerns in the best way they know how.

Patients may not be trained in empathy, but as physicians, we must lead by example. As physicians, we often jump to what we feel is the obvious solution but know that this solution may be masking any number of other conditions to which the patient has a better view. It means listening to how residents and attendings are responding to patients in person, on the phone, and through patient portals, pulling out the judgmental comments, be they real or imagined on behalf of the physician, and replacing them with how WE would want to be spoken to.

One can take the back pain comment and respond, “I understand you are having problems with your back. Let’s find out what is causing this and quell your concerns. Keep in mind that your weight is not helping the matter but is not likely the cause.” This method takes the ‘sting’ out of the initial comment, given that very few people go to their physician to feel worse than they did when they started out. In listening to and responding to patient’s assessments of how their physician responded to their concern, we can help the physician restructure their words and, perhaps, the diagnosis. Jumping to the most obvious ‘conclusion’ can often mean ignoring another issue going on.

In studies conducted regarding empathy as a whole, it has been divided into two related types: cognitive empathy and affective. Cognitive empathy (CE) is the accurate understanding and appropriate response to others’ thoughts, whereas affective empathy (AE) is the accurate understanding and appropriate response to others’ emotions. A majority of meta-analyses have shown that interventions are effective in increasing cognitive empathy to a moderate degree, while a smaller number have reported modest effect sizes on the training of emotional skills, including AE.

While both types of empathy are crucial to the workings of a strong physician (understanding and empathizing with the thoughts of others as well as the emotions), it is apparent that it is easier to read someone’s thoughts effectively as opposed to feelings. However, once thought is understood, there is a smaller chasm to the feelings that exist. And unfortunately, the teaching of this art has yet to be truly successful. Consider the number of patients with an axe to grind for not being heard, whether the situation was benign or dire.

This is the goal in the CLEAR program: to be understood and taught—not just to a computer program—but to the physicians themselves. It’s not easy; nothing about medical training truly is. But we believe that along with anatomy, microbiology, and pathology, there is room for the art and education of empathy. A doctor cannot be truly patient centered without it.

Dr. Stephen Weber is Associate Vice Chairman for Faculty Development in the Department of Medicine at the University of Chicago. He most recently served as  Executive Vice President and Chief Medical Officer for the University of Chicago Medicine Health System. In this capacity, he helped oversee multiple programs and priorities including physician quality and practice, population health, care coordination, informatics, simulation and innovation. He is Co-Founder of the University of Chicago Medicine Center for Digital Transformation. A Professor of Medicine in the Section of Infectious Diseases and Global Health, he continues to see patients in both the inpatient and ambulatory settings.  

Jackie Meyers-Thompson is a seasoned public relations professional in all aspects of digital communications, crisis communications, and special events management. She has also authored three books: Fertility for Dummies, Infertility for Dummies, and Getting Pregnant for Dummies with Wiley Publishing. Thompson blends her writing ability with her background in strategic thinking, effective communication, and adapting to changed needs in order to get the most results focused, well-written and reliable outcomes. She prides herself in consistently to deliver high quality products whatever the task at hand may be.