In the field of healthcare soft skills are as important as the so called hard skills which includes theoretical knowledge and the like. But the question remains as always – How do I become an effective “deliverer” of healthcare? What skills should be most applicable to me to serve my patients well?
Consider the following cases, and the ensuing discussion (please note that all names are fictitious):
Case 1- The Case of Mr. Brown
Mr. Brown is a 75 year old patient diagnosed with terminal illness which he does not want to reveal to his family for reasons that he does not want to be a burden anymore to his family most especially financially. If you were the attending how will you approach Mr. Brown’s request?
Case 2- The Case of Mrs. Smith
Mrs. Smith is a 41 year old mother with a family history of breast cancer in her maternal grandmother at age 65 and paternal aunt at age 72. Mrs Smith recently underwent a surgical excisional biopsy of her right breast for further evaluation of screening-detected calcifications that demonstrated atypical ductal hyperplasia (ADH) on stereotactic core biopsy. Surgical pathology revealed additional foci of ADH, but no evidence of malignancy. Her surgeon just recommended that she enroll in the hospital’s High-Risk Breast Cancer Screening Program, but she has concerns, and questions.
Case 3 – The Case of Baby Danny
Danny is a 2 year old toddler seen for acute onset of severe, colicky, and intermittent abdominal pain and passage of mucus with blood in his stool. Her parents are extremely worried. They have been recommended labs and imaging studies, including a barium enema, but want to talk to a “real specialist”.
Case 4 – The Case of Ms. Jane
Ms. Jane is jittery and seemingly in pain. She is a 30 year old female, who presented with a swollen nose and black eye that she incurred when she apparently tripped, fell and struck her head on a table end. She denies any loss of consciousness, visual disturbances or alcohol consumption. Physical examination reveals several areas of ecchymosis (discoloration of the skin resulting from bruising or bleeding) in various stages of resolution along her back. She starts weeping.
Many clinicians have had limited exposure to intentional training focused on communication and defined models for interacting with patients. Many view these as “soft skills” that are non-technical and hence of lesser value. But this cannot be farther from the truth. These “soft skills” may make all the difference in the world to patient. Whether in speaking with a concerned elderly man with terminal illness who does not wish to burden his family, or with a middle aged mother who’s petrified of breast cancer and the impact this could have on her family, it is these “soft skills” that often come in handy in really getting to the most optimal care decisions. This is equally true for the worried parents of the 2 year old toddler who seems to be passing blood and needs a bunch of tests that they know nothing about. And in the case of the bruised teary 30 year old female, these “soft skills” could help unearth the domestic abuse she’s been tolerating, and it is these skills that could literally save her life.
The origin of the word ‘empathy’ dates back to the 1880s, when German psychologist Theodore Lipps coined the term “einfuhlung” (meaning “in-feeling”) to describe the emotional appreciation of another’s feelings. Empathy is the capacity to understand another person’s experience within that person’s frame of reference. It is the ability to “put oneself in another’s shoes”. Unlike sympathy, empathy does not require emotional effort on the part of the provider. Although empathy is seen as perhaps the most critical of the “soft skills” needed in healthcare, other skills include negotiation skills, effective communication, relationship building, team work and leadership.
Care-givers often voice misgivings and misconceptions around empathetic communication. These include:
• “There is not enough time during the visit to give empathy.”
• “It is not relevant, and I’m too busy focusing on the acute medical problem.”
• “Giving empathy is emotionally exhausting for me.”
• “I don’t want to open that Pandora’s box.”
• “I haven’t had enough training in empathetic communication.”
“Soft skills” used effectively could help engage the patients, empathize with their concerns, educate them where relevant using clear, concise language, and enlist the patient as a partner in the care journey.
EMPATHY SHIFTS CARE
Overabundance of sympathy can sometimes be overwhelming in patient care, thus impeding the clinician’s performance, but empathy needs no restraining boundaries. Empathy is a predominantly cognitive (rather than emotional) attribute which involves understanding (rather than feeling) of experiences, concerns and perspectives of the patient, combined with a capacity to communicate this understanding (often with words, actions or gestures), and an intention to help.
Patient perception of physician empathy is highly correlated with patient satisfaction with physicians. Furthermore, patient perception of physician empathy is also significantly associated with patient compliance. [Hojar et al, Int J Med Educ. 2009, 1, 83-87]
[Hojat et al, Academic Medicine, 2011; Physicians’ Empathy and Clinical Outcomes for Diabetic Patients]
Empathy should be considered a critical element in patient care and a significant factor of overall clinical competence that must be methodologically taught, and enhanced during medical education, and applied and nourished in the practice of medicine.
In an epic article in The Atlantic titled “How to Teach Doctors Empathy”, Sandra G. Boodman states that “being a good doctor requires an understanding of people, not just science.” The article emphasizes that clinical empathy was once dismissively known as “good bedside manner” and traditionally regarded as far less important than technical acumen. But a spate of studies in the past decade has found that it is no mere frill. Increasingly, empathy is considered essential to establishing trust, the foundation of a good doctor-patient relationship. Studies have linked empathy to greater patient satisfaction, better outcomes, decreased physician burnout, and a lower risk of malpractice suits and errors.
While some people are naturally better at being empathic, said Mohammadreza Hojat, a research professor of psychiatry at Jefferson Medical College in Philadelphia, empathy can be taught. “Empathy is a cognitive attribute, not a personality trait,” said Hojat, who developed the Jefferson Scale of Empathy, a tool used by researchers to measure it.
“It is important to know what kind of man has the disease, as it is to know what kind of disease has the man.”
~ Sir William Osler, 1932.
Can we teach empathy? Here are select methods highlighted by research. [Hojat, 2009, J Health & Human Services Administration, 31, 412-450].
• Improving interpersonal skills
• Audio or video-taping of encounters with patients
• Exposure to role models
• Role playing (e.g. aging game)
• Shadowing a patient (patient navigator)
• Hospitalization experiences
• Study of literature and the arts
• Improving narration skills
I point out in my paper that the problem with communication as it exists in healthcare today, is that we do not listen to understand. We listen to reply. We listen but do not hear. We look, but do not see. Perhaps we need to listen with our hearts, and see with our minds. Empathy is the key to better care, and the way to get there is through effective communication and efficient collaboration that is woven into the fabric of our care delivery workflows.
Join us as we deal with a topic we all need to talk about at #HealthXPh on August 6 at 9pm MLA/9am EST!
T1: What are the most critical “soft skills” needed in healthcare?
T2: Can empathy be taught? Or is this a trait we are born with (or without)?
T3: Should medical training include these soft skills? When/how?
T4: How can we make these soft skills more impactful? Share your stories.
ABOUT THE AUTHOR:
Rasu B. Shrestha, MD, MBA ( @RasuShrestha )
Dr. Shrestha is the Chief Innovation Officer at University of Pittsburgh Medical Center, Pittsburgh, PA, and Executive Vice President of UPMC Enterprises. He is also Chair of the RSNA Informatics Scientific Program Committee; a Founding Member of the Executive Advisory Program, GE Healthcare; a member of the advisory boards of KLAS Research and Peer60; a member of the Board of Directors of the Society for Imaging Informatics in Medicine; a member of the boards of Pittsburgh Dataworks and Omnyx Inc., and a member of the Applied Radiology editorial board.