Can Doctors Learn Empathy?

My colleague loved performing surgery as much as anyone I had ever met. Every morning he
bounded into the hospital, full of energy and cheerful anticipation of the days surgical schedule,
his prominent mouth stretched into a broad grin.

Too bad his foot is always in it, another doctor whispered one day as our colleague passed by.

Doctor and Patient

Dr. Pauline Chen on medical care.

The sad truth was that despite his gusto, patients often complained about our colleague. He was
brusque when the moment required sensitivity, flip when the conversation was grave, and heavy-
handed when the situation called for a light touch. Just a few days earlier, we were shocked to
learn hed bluntly told an elderly war hero in the hospital for his diabetes, I need to cut off your
leg.

He sure doesnt lack enthusiasm, the other doctor continued as our colleague rounded the
corner, the bounce in his step unmistakable. Its just too bad you cant learn empathy.

Empathy has always been considered an essential component of compassionate care, and recent
research has shown that its benefits go far beyond the exam room. Greater physician empathy has
been associated with fewer medical errors, better patient outcomes and more satisfied patients. It
also results in fewer malpractice claims and happier doctors.

A growing number of professional accrediting and licensing agencies have taken these findings to
heart, developing requirements that make empathy a core value and an absolute learning
objective for all doctors. But even for the most enthusiastic supporters of such initiatives, the
vexing question remains: Can people learn to be empathetic?

A new study reveals that they can.

Building on research over the last decade that has shown that empathetic observers have brain
activity, heart rate and skin electrical conductance that mirror those of the person undergoing the
emotional experience observing a friends hand getting slammed in a car door, for example,
causes us to flinch because an image of the accident gets mapped onto the pain and threat
sensors in our own brain Dr. Helen Riess, director of the Empathy and Relational Science
Program in the department of psychiatry at the Massachusetts General Hospital in Boston, created
a series of empathy training modules for doctors. The tools are designed to teach methods for
recognizing key nonverbal cues and facial expressions in patients as well as strategies for dealing
with ones own physiologic responses to highly emotional encounters.

In one lesson, for example, doctors watch a video of a tense exam room interaction while a
striking graphic sidebar records the electrical skin conductance of both patient and doctor, the
mismatched spikes peaking as each persons frustration with the other escalates. Another lesson
walks doctors through a series of pictures of a patient whose face expresses anger, contempt,
happiness, fear, surprise, disgust or sadness.

To test the effectiveness of the lessons, Dr. Riess and several of her colleagues enrolled about 100
doctors-in-training and asked their patients to evaluate their empathy, based on the doctors
ability to make them feel at ease, show care and compassion and fully understand patient
concerns. Half of the doctors then took part in three one-hour empathy training sessions.

Two months later, the researchers asked a second group of patients to evaluate all the doctors
again. They found that the doctors who had taken the empathy classes showed significant
improvements in their empathetic behavior, while those who had not actually got worse at
empathizing with patients.

People tend to believe that you are either born with empathy or not, said Dr. Helen Riess, lead
author of the study. But empathy can be taught, and you can improve.

Compared with their peers, doctors who went through the empathy course interrupted their
patients less, maintained better eye contact and were better able to maintain their equanimity if
patients became angry, frustrated or upset. They also appeared to develop resistance to the
notorious dehumanizing effects of medical training. After the empathy classes, one physician
who had complained about being burned out said, I feel as though like I like my job again.

Responses to this study have so far been enthusiastic, in part because it is one of the first to rely
on patient evaluations of empathy rather than physician self-assessment. The holy grail of this
kind of research is whether patients think doctors are empathic, not whether the doctors think
they are, Dr. Riess said. She and her colleagues plan to expand their research and offer the
training to more doctors, as well as to nurses, physician assistants and others.

We are in a special place in the history of medicine, she said. We have the neurophysiology
data that validates and helps move medicine back to a real balance between the science and the
art.

Curious to know whether the empathy course worked, I decided to try out what I had learned in
researching this column. The next day at the hospital, I took extra care to sit down facing my
patients and not a computer screen, to observe the changing expressions on their faces and to
take note of the subtle gestures and voice modulations covered in the course. While I found it
challenging at first to incorporate the additional information when my mind was already juggling
possible diagnoses and treatment plans, eventually it became fun, a return to the kind of focused
one-on-one interaction that drew me to medicine in the first place.

Just before leaving, one of the patients pulled me aside. Thanks, Doc, he said. I have never felt
so listened to before.