Can Clinical Empathy be Taught?

Abstract & Commentary

By Frank W. Ling, MD, Clinical Professor, Dept. of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, is Associate Editor for OB/GYN Clinical Alert.

Dr. Ling reports no financial relationship to this field of study.

Synopsis: collaborative efforts between faculties of medicine and theater can be effective in teaching clinical empathy.

Source: Dow Alan W, et al. Using Theater to Teach Clinical Empathy: A Pilot Study. Society of General Internal Medicine. 2007;2007:1114-1118.

It is one thing to be empathetic, but it is something quite different to be able to convey empathy to the patient. This skill of becoming connected to the patient is what the investigators termed "clinical empathy" At Virginia Commonwealth University, a preliminary investigation included 20 internal medicine residents with 14 undergoing 6 hours of classroom instruction and workshop sessions with professors of theater. The curriculum was focused on increasing measurable clinical empathy in office encounters.

The intervention group showed significant improvement after the instruction in all 6 subscores (p < .011); and, when compared to the control group, it had better post-test scores in 5 of 6 subscores (p < .01). The 6 subgroup categories were: Empathy, Relating, Nonverbal, Verbal, Respect, and Overall Impression.

Commentary

What?! How could this study possibly have any relevance to my practice? I'll bet that's what some of the readers are silently screaming as they peruse this. Give me a few minutes, and I'll explain. Since it is highly unlikely that another paper like this will be published soon, I felt it important that the topic be addressed when there was at least an article with data available. Admittedly the numbers are small, it is nonrandomized and nonblinded. As a result, the level of evidence is not strong. The importance of empathy in clinical medicine is, however, unquestioned.

As one of the 6 core competencies identified in 1994 by the Accreditation Council for Graduate Medical Education, "Interpersonal and Communication Skills" is still not taught in a uniform or rigorous fashion. Certainly those of us trained long before the development of the Core Competencies did not have a formal curriculum in it, even though it was certainly discussed as part of the "art of medicine."

The authors hypothesized that clinical encounters are similar to interplay that goes on between actors who must pick up on the subtleties of relationships between themselves and their colleagues. Whereas clinical teachers are not trained to instruct on developing these interactive skills, theater faculty is so trained. Thus was born the concept of crossing over between the 2 fields.

Just listing the topics covered in the sessions will help the reader appreciate the potential issues that each of us faces whenever we work with our own patient population: insight into patient behavior, building patient trust, active listening, listening for subtext, listening for values and strengths, making links to one's own experiences, strategies for acknowledging the patient's feelings, skills in physical expressiveness, body language, eye contact, breathing rhythms, and time management.

As I read and re-read this article in preparation for presenting it in this forum, it struck me that each of us has the potential to address our doctor-patient relationships without the formal training … at least as a starting point. Whenever you're in the patient room, do you sit? Do you make eye contact? Do you give the impression that you care? Are you watching how the patient is positioned? Are you hearing the message of what she is saying or are you listening to just the words?

As Yogi Berra, the Hall of Fame catcher once said, "You can observe a lot just by watching." How true… and he never went to medical school.

The authors provide the following quotation from Francis Weld Peabody: "The secret of the care of the patient is caring for the patient." I think that statement can help carry each of us forward in our daily practices with each individual patient encounter.