Empathy and Compassion: The “Soft” Studies

Maybe you’ve heard the term “soft studies.” I learned of it after reading an online 2007 essay, written by a (at the time) medical student, Elliot M. Hirsch, MD, referring to studies focused around cultural education and professionalism.¹ According to Dr. Hirsch, these studies did not appear to be taken too seriously in medical school and were not seen as being very relevant. Further research pointed out that in students’ preclinical years, there is a decline in empathy instruction, followed by a more prominent drop in it once students enter their clinical work.² More specifically, according to a third article printed in the Medical Science Educator, it is said that while medical education is committed to teaching patient-centered communication and empathy, quantitative research suggests empathy scores tend to decline as students progress through medical school.³

How discouraging. Isn’t building patient relations part of the effectiveness and success of doctoring?

With that in mind, let’s turn this conversation around and speak pragmatically on the importance (or lack thereof) of these essential characteristics in medicine, empathy and compassion. What is their impact on the success of a practice, on patient acceptance and care, and that valuable patient-clinician connection.

I recall speaking with a DPM friend of mine years ago who taught a practice management course at one of our respected podiatry schools. He knew how intently focused his students were on their clinical studies and thought he could also integrate some equally important social skills. This, he concluded, could help them become more well-rounded physicians. The end game was certainly not to detract from their clinical studies, but to add a very meaningful human quality to them.

His first order of business was to define what empathy and compassion were. He characterized empathy as the ability to identify with and emotionally join in a patient’s situation, perspective, feelings, and sufferings. Compassion, as I recall he explained, is an extension of the empathetic understanding of a person’s feeling and suffering along with the desire to help alleviate or prevent it. Simply, a caring response to someone else’s distress.

The instructor felt that all physicians are faced with these emotions on a daily basis. The best way to drive these attributes home in a classroom setting was to present various scenarios and have students take an active role as the physician in playing each one out. It would help, he said, to put themselves in the other person’s (supposed patient’s) shoes and listen—really listen to how and what was being presented to them. Were they able to comprehend what the “patient” communicated to them? Could they personally relate in some way to their patient’s circumstances, thoughts, and feelings? As a doctor, were they able to detect fear, frustration, confusion? Did they respond in such a way that was caring, supportive and helpful? These sessions proved to be powerful lessons in humanity.

Of course, the clinical element is critical to care, the very reason a patient appears in your office. Yet the clinical approach alone, without also engaging in and understanding a patient’s emotional state, can be considered to many as treatment deficiency. For example, if doctors enter a treatment room and decide to only stick to their intended clinical protocol with little regard for that person’s circumstances, a huge opportunity to deliver comprehensive care is being overlooked.

Don’t misunderstand. From a practice management standpoint, I recognize and support the use of structured protocols. In fact, management protocols can help a practice stay organized and run efficiently and purposely, as if on autopilot. Clinical treatment protocols are equally effective; however, they are not intended to lock the physician into just one treatment plan per condition. A thorough examination will reveal objective and subjective findings, the patient’s medical history, and the response to previous treatment. These factors combined with the doctor’s expertise and the patient’s acceptance will determine if taking a clinical treatment plan in a different direction is the right path towards achieving an optimal result. This decision is not only an option, but also an obligation.

Keeping this in mind, read how Dr. Aiken handled his patient, Mrs. Jones. When she returned to his office for her first postsurgical follow-up, he found the operated foot wasn’t just edematous; it was blown up like a balloon with redness, drainage, and one or two ripped sutures. Frustrated and flustered, he barked, “Did you even elevate your foot? Didn’t you stay off it as instructed?” Regrettably, she remarked she was unable to manage either and felt the doctor never understood her unique circumstances at home.

Dr. Aiken was “clinically” certain how he wanted to treat his patient—he studied that extensively in school—and so he entered into the surgical agreement with a confident mindset. However, in addition to explaining the clinical procedure to his patient, pre-op discussion should also have disclosed whether she was a good candidate for foot surgery as far as adherence. Would she be willing and able to follow post-op instructions? Unfortunately, that discussion never happened. Had he taken for granted her cooperation? Did he just not care enough, or did he assume she fully understood the whys and wherefores of the instructions she was given?

If Dr. Aiken had engaged in this necessary dialogue with Mrs. Jones prior to scheduling the surgery, he would have learned that she actually did not understand that her surgery would alter her life to the extent that it had. A member of the Sandwich Generation, she was a full-time working wife and mother and thought she could continue (and needed) to care for both an elderly parent and two teenage children at home after her surgery. By failing to connect with his patient on a deeper, personal level, and understanding her difficulties prior to her operation, Dr. Aiken never learned that staying off her feet was improbable—resulting in her compromised healing and a less than satisfactory result.

Turns out, his failure to open his eyes and heart to any potential hardships she might have didn’t serve either one of them well. Dr. Aiken lost Mrs. Jones to a colleague down the street, leaving him with nothing except a bad online review and the threat of malpractice. Ouch.

I have never been a medical student; however, I have been a patient, as we all have, many times over. I know what it feels like to have a doctor listen, relate to my situation, and make a conscious effort to incorporate my issues into a treatment plan amenable to my lifestyle. I can tell when a doctor “hears me and gets me” and when they don’t. Most patients can. And I can tell you how important that is when deciding whether the relationship is worthwhile ... and when it isn’t.  

The benefits of being a compassionate physician are many while the efforts are few. In addition to it creating a more compliant patient with resultant improved healing, empathy and compassion instill a more trusting, respected doctor-patient relationship. Truth be told, that is true of any relationship.

Acknowledging and understanding another’s feelings is merely a manifestation of kindness. It requires a little humility, a dose of sensitivity, and a lot of genuine concern—all things we could all use a little more of these days—in health care and in life. In fact, in a world where you can be anything … be kind. I mean, why not?

Ms. Homisak is the President of SOS Healthcare Management Solutions in Federal Way, WA.  She completed a Health Coach Training Program from the Institute of Integrative Nutrition, and received certification as a Holistic Health Practitioner from the American Association of Drugless Practitioners.

References
1. Hirsch EM. The role of empathy in medicine: a medical student’s perspective. Virtual Mentor. 2007; 9(6):423–27.
2. Kostantinos ME, Pappas TN. Creating a medical school curriculum to teach empathy. Ann Surg Open. 2021; 2(3):e085.
3. Laughey WF, Atkinson J, Craig AM, et al. Empathy in medical education: its nature and nurture—a qualitative study of the views of students and tutors. Med Sci Educ. 2021; 31(6):1941–50.

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