The evidence on empathy

Empathizing with patients often can help make them feel better, at least emotionally. But can it also result in measurably better outcomes in their health?

A new study from the Academic Medicine journal has put another brick in the wall of evidence shoring up the value of empathy. The research involved 891 patients with diabetes and 29 family physicians who were treating them. The doctors were asked to complete an assessment evaluating where they were on an empathy scale: high, moderate or low. Then they were compared against patient outcomes.

As you might have guessed, patients whose doctors had a high empathy score were significantly more likely to have better control of their diabetes than patients whose doctors were low in the empathy department.

Why, then, is it often so hard to convince physicians that being nice to their patients is more than just touchy-feely psychobabble? wonders Stephen Wilkins, a former health care executive and consumer behavior researcher who blogs about doctor-patient communication at Mind the Gap. He writes:

The problem with empathy research is that no one, including doctors, seems to be paying attention as attested to the fact that nothing has changed. Research documenting the therapeutic value of empathy goes back at least 20 years. Despite the evidence, it seems that physicians are no more empathetic today than when people first started researching empathy.

I’m not sure I would agree that nothing has changed. Health care organizations are paying attention to customer service and patient satisfaction in ways we didn’t see 10 or 15 years ago. Although there are still more than a few health care professionals who haven’t gotten the message, or who think empathy doesn’t matter that much, the majority seem to at least be making an effort.

The bigger question, it seems, is how to successfully instill empathy in the first place, and how to maintain it amid the increasing pressures of the health care work environment.

Is empathy something that can be taught to medical students? To some extent, the answer is yes. Communication skills are part of the curriculum at virtually every medical school in the U.S. Part of the process of becoming a doctor, after all, is learning how to effectively interact with the human beings who are your patients.

What’s disturbing is some of the evidence suggesting that medical students often begin to lose their empathy by the third year of their training. A study that appeared in September 2009 in Academic Medicine created quite a stir when it was published. The authors tracked matched cohorts of more than 400 students through medical school, from their first day to the end of their final academic year, and found a significant decline in empathy scores after the third year. The decline was greater for males than for females, and also was greater for students in technology-oriented specialties.

Not coincidentally, the third year of medical school is when students really begin to dive into hands-on patient care and start experiencing the reality of practicing medicine. This, along with the demands of the training process, may be what erodes empathy, the study’s authors wrote. Their findings are echoed in a number of previous studies examining everything from sleep deprivation among medical students to abusive training environments.

This issue doesn’t seem to be confined to the United States. A recent Twitter conversation in the U.K. raised similar points. Among some of the observations: Even with an emphasis on the importance of empathy and good communication, medical students often don’t put these skills into practice. For many students, distancing themselves from patients can in fact become a necessary coping mechanism. “If you felt every bad outcome you wouldn’t survive your MS3 year in [the] US,” a student tweeted. Someone else observed, “Committed people keep empathy, but some do lose it.”

Empathy can be even more challenging once students graduate from medical school and enter the real world of day-to-day medical practice with all its paperwork and the twin pressures of time and productivity.

So what’s the real issue here? Is it that doctors remain unconvinced that empathy makes any difference in their patients’ health? Or does it lie in the difficulty of sustaining an empathetic state of mind day in and day out in the demanding environment of patient care – and if so, how can this be changed?

Image: “Consolation,” Odette Sculpture Park, Windsor, Ontario; courtesy of Wikimedia Commons