Thursday, 1 December 2016

The empathetic doctor.


Like many GPs I grapple with how to help the patient with chronic (that is longstanding) back pain. Well probably not by shovelling opiates in their direction, since such drugs are fraught with difficulties and drawbacks. And nor are surgeons of much use here. Rather disarmingly one major contribution is "simply' to be empathetic. And yet it seems so touchy feely, or soft even, when such macho men as spinal surgeons are on the prowl.

Nonetheless a BMJ review from 2015 (BMJ 2015;350:g6380), points out that empathetic GPs are more successful at managing chronic low back pain than those who are not. So what is this magic ingredient? It is said that empathy is, 'unlike sympathy, which is defined as feeling sorry for another person, clinical empathy is the ability to stand in a patient’s shoes and to convey an understanding of the patient’s situation as well as the desire to help.' 1. It seems that some GPs, like the rest of the population, have this more than others, and yet according to Professor Hojat from Jefferson Medical College in Philadelphia, it's a skill that can be learned. So my sceptical colleague why should you bother?

1.    Your patients are more likely to appreciate your help and indeed more likely to follow your advice.

2.    Your patients are more likely to cope with and recover quicker from their illness

3.    You are more likely to experience job satisfaction.

4.    Your patients are much less likely to make a complaint against you.

5.    It will save you time! Really? Yea, it can enable you to focus on the patient’s real concerns and seek to address those, perhaps preventing repeat visits.

Empathetics is a course developed by Psychiatrist Helen Reiss from Massachusetts General Hospital. It encourages doctors how to ‘show up not what to say’. As James Tulsky from Duke University points out ‘doctors are explainaholics. Our answer to distress is more information, that if a patient just understood it better, they would come round. In reality bombarding a patient with information does little to alleviate underlying worry’ 2.

In her brilliant Ted talk, Dr Reiss teaches the acromym, E-M-P-A-T-H-Y. It’s a brilliant talk.

E-Eye contact is so important

M-Muscles of facial expressions-learn to recognize emotion

P-Posture matters, standing over a patient's bedside can be intimidating-sit down!

A-Affect. Learn to gauge patient’s mood

T-Recognise tone of voice signifying underlying emotion

H-Hearing. Hear the whole person, understand their context

Y-your response. Allow your emotions to respond.

Lots to think about here. I recall teaching a Communication Skills course to secmd year medical students at a London medical school, some years ago,. They really thought the subject was a waste of time. How sad and I guess by now they are realizing that empathy and other skills are as just important as any diagnositic or surgical skill they may have acquired.
References.
1.http://www.theatlantic.com/health/archive/2015/03/how-to-teach-doctors-empathy/387784/
2. ibid
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