The doctor-patient relationship is vital to the diagnostic and therapeutic process. Without a sense of connection and mutual understanding, doctor-patient communication becomes an exchange of medical information disconnected from the context and complexities of the patient’s life and sometimes even the illness.
Patients’ perception of their connection with their physicians significantly influences their sense of satisfaction and levels of concern about their health. Research has shown that, when choosing a physician, patients’ value emotional concern as much as, if not more than, technical competence. According to a 2014 analysis of 13 clinical studies published in the journal PLOS One, a positive doctor-patient relationship can have statistically significant effects even on “hard health outcomes,” including obesity, diabetes, hypertension, asthma, pulmonary infections and osteoarthritis pain.
Empathy is the key factor that lays the foundation of this vital relationship. Research by Kim and colleagues has shown that empathy not only enriches the doctor-patient relationship but also increases patient satisfaction, trust, coping skills and compliance with therapy. Also, doctors who are more attuned to the psychosocial needs of their patients are less likely to experience burnout.
Unlike sympathy, which refers to 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. It includes recognizing when emotions are present but not directly expressed; inviting exploration of unexpressed feelings, and effectively acknowledging feelings so that the patient feels understood.
Empathy involves the ability to: (a) understand the patient’s situation, perspective, and feelings; (b) to communicate that understanding and check its accuracy, and (c) to act on that understanding with the patient in a helpful (therapeutic) way. For example, instead of feeling sorry for the patient grieving the loss of a dear one, an empathic doctor would understand their loss and bereavement and try to provide support. In Germany, researchers found that with 710 cancer patients, physician empathy was positively associated with improvement in patient-reported outcomes of depression and quality of life.
In the area of mental illness, empathy building can be a challenge. Patients are difficult to reach – they may feel misunderstood and cut off from the rest of the world, fear social stigma, or may lack insight into their illness. While listening to patients and their families – whether it be a widow’s grief upon her husband’s suicide, an adolescent’s struggle to confront his heroin addiction, an earthquake survivor sharing his guilt at living while his entire family has perished, the torment of a person with schizophrenia fending off persecutory demons – the psychiatrist uses empathy in striving to understand what people are experiencing behind their narratives. The psychiatrist can give hope in their most despairing times.
If the goal of medicine is to treat the patient—to alleviate suffering and not simply cure disease—then empathy is a necessary clinical skill. The empathic component of medicine is what makes a physician special; without it, we are, in essence, highly trained machines.
Maherra is the head of Quality Assurance in Psychiatry Research at the Jaslok Hospital and Research Centre, Mumbai. She has extensive experience in Clinical Research and Counseling over the past 7 years.