A few years ago at a large teaching hospital in Texas, a medical resident asked a nurse how to order an autopsy for a patient they were currently treating. It was a reasonable request. Autopsies help further the understanding of disease. There was just one problem: their patient, who was very much alive, was lying nearby. He’d overhead the request, and that’s how he found out he was soon going to die.
This story illustrates a broader crisis in medical education. Today, most schools myopically focus on turning out technicians. Through textbooks, lab experiments, and lectures, budding doctors learn the hard science of medicine. They memorize body parts, processes, and conditions, then dutifully demonstrate their knowledge in high-stake examinations.
This purely technical approach can obscure the human side of medicine and erode empathy — the ability to understand and care about what makes a patient tick. In fact, the empathy levels of medical students actually decline as they progress through school. Many become emotionally disengaged from the people they’re caring for — and that disconnect can impair care.
Forging a strong emotional connection with a patient can be just as important to the healing process as prescribing the right drugs or performing the right surgery. A 2012 study published in the journal Academic Medicine found that the rates of serious complications among diabetic patients were almost 50 percent lower among those whose doctors had high empathy levels compared to those whose doctors had low levels. Improving physician empathy has been shown to help overweight individuals with diabetes drop more weight, arthritis patients experience less joint pain, and those with high blood pressure reduce it.
A 2014 study published in the journal PLoS One examined a baker’s dozen of clinical trials in which doctors were taught empathy-building techniques, even simple ones such as making regular eye contact. Their patients fared significantly better than doctors who didn’t receive such training.
How does empathy do this? A patient who feels emotionally connected to his or her doctor is more likely to disclose important medical information and to follow the doctor’s advice. That connection can serve as the basis for true teamwork, with the patient working proactively with the medical team to improve health. Simply put, patients who feel cared about feel better and do better.
There’s also great promise in osteopathic medicine, which couples traditional medical interventions with skilled, specialized, hands-on treatments for the body’s complex system of nerves, muscles, and bones. “Healing touch” isn’t just a metaphor. This simple physical action evokes trust in patients.
Without empathy, doctors run the risk of alienating their patients. The relationship can become one-sided, with the physician simply dictating treatments and the patient following orders. Core emotional needs can be ignored, leading patients to feel lonely and downtrodden. And that deterioration of mood can make it less likely that they will experience positive outcomes from treatment.
Can medical schools teach empathy? Of course. Relationship-building and effective communication are skills. They can be taught, learned, and practiced.
To teach empathy and related “soft” skills, schools should consider starting up emotional intelligence boot camps — intense, immersive training programs that students complete before their formal medical schooling begins.
Such a program would assign students tasks that encourage them to build communication skills and directly address patient needs before they start classes and interact with the entire health team. Budding doctors would spend several months in a hospital or clinic bathing the infirm, changing bed sheets, taking blood pressures, and doing other tasks that help them connect with the humanity of their future patients. Equally important, this would foster constructive collaboration with nurses and other staff and build a firm foundation for respectful interprofessional teamwork.
At the New York Institute of Technology, our college of osteopathic medicine encourages students to engage in empathy-building exercises outside of the classroom. Our chapter of the Gold Humanism Honor Society recognizes students and faculty members who care for patients with compassion, empathy, and integrity. Our students also run a ceremony each year in which first-year students honor their “first patients,” the people who donated their bodies to science. It reminds the students that cadavers aren’t just training tools — they’re a precious gift from selfless donors and their families.
The quest for empathetic physicians should probably start even earlier. Medical schools could reassess how they select students, using metrics for hard skills like grades and Medical College Admission Test scores as guides, not exclusive criteria. Schools should create a well-rounded picture of each student by putting serious weight on his or her past work activities, personal interests, in-person interviews, and personal references. Being open to applicants who don’t fit the traditional mold, such as older people with previous careers, is another strategy.
To help mold the physician of the future, medical schools must rethink their books-before-people approach. A myopic focus on the technical aspects of fighting disease can lead to worse patient outcomes. Good doctors should be proficient in both the scientific and humanistic facets of medicine — truly caring for their patients while looking for a cure.
Wolfgang Gilliar, DO, is the Dean of the College of Osteopathic Medicine at New York Institute of Technology.
Everyone’s comments are appreciated, indeed! Health and health care are like a puzzle, and each person – from patient to physician – laboratory technician to the nurse – each team member contributes to the overall appearance of the ‘picture’ – but in the end, it is the patient we need to put center and approach her/him as a person who has a medical (bio-psycho-social-spiritual) issue and not as a technological medical problem that happens to be connected ‘somehow’ to an unknown person, somewhere.
This year I interacted with three doctors. The first was great. He put me at ease by poking fun at himself and congratulated me for getting to the practice as part of my effort to overcome my agoraphobia. He was warm, personable, acknowledged my difficulties and made me feel good about myself for doing a very difficult thing. He treated me as a person and listened to me.
The second doctor wasn’t so good. He told me it was my own fault I was lonely because I didn’t make an effort to keep in touch with friends. He didn’t know that I’m usually the one who stays in touch, and when I got tired of chasing friends and decided to let them get in touch with me for once, I never heard from them again. He judged me on a non medical issue that I mentioned in passing. He judged me by his own values, because he was good at making and keeping friends and I’m not. He treated me as a recalcitrant patient and scolded me.
The third doctor refused to prescribe me tranquilisers because in her opinion they were highly addictive. She didn’t ask me how many tranqs I was asking for or find out whether I have a history of drug dependency. I wanted 3 tranqs, at a dosage of 2mg each. That was what I’d been prescribed four years previously. She didn’t ask why I wanted the meds, didn’t recognise that I was going through stressful, prolonged circumstances even though we’d discussed it, and that I wanted to take half a pill (1mg) only when it was absolutely necessary to avoid having panic attacks in public, which would have made my agoraphobia even worse.
She didn’t check my notes to confirm that in over 20 years of being a service user in the mental health system, I had only ever been prescribed a total dosage of 6mg of tranquilisers which I used over a four year span, and had no drug dependency issues whatsoever. Even in mental health crisis I have never used or abused a benzodiazapine. I did, however, use them to attend stressful events like the dentists, of which I developed a tremendous fear and needed to avoid becoming panicked in the chair.
If the doctor had asked me pertinent questions and checked my notes she would have seen I was at low/zero risk of addiction. Instead she just told me of her concerns about giving me tranquilisers. I also had to explain how agoraphobia works, as she was clueless. She treated me like I was a child flippantly asking for a bag of sweets, as if I didn’t know what benzodiazapines are, how they work, their half-life and their potentially addictive properties. She treated me as if I hadn’t done research. Instead of asking why I wanted them and how high or low a dosage I was requesting, she assumed I was asking for the ‘normal’ quantity and decided I couldn’t handle them. She made me feel foolish, ignorant and small, and I have not been to the practice since. She made me lose faith in myself as a knowledgeable, proactive patient.
When medical practitioners in any health specialism forget about empathy, even the most confident, switched-on, positive patients end up feeling like foolish burdens who should just hurry up and die or get well and go away so the good doctors can get on with the more important business of being heroic. Lack of empathy actively hinders patients. After all, if your own doctor doesn’t care about you, why would anyone else in the medical field?
Unfortunately there is too much truth in this article.
I think all doctors study medicine because they want to help people. Then hospitas destroy that feeling making they work 100+ hours a week. They are so tired that they can’t think. In university hospitals, patients are also a problem, must of them are homeless and drug addics and they treat the doctors like trash. If the doctors gave them a wheelchair, the sell it and come back for more, and acuse the doctors of not treating them well. Then the problem with the health care programs. Many doctors have to see more than sixty patients a day. Honestly, if this things are not fixed, you will not receive a lot of empathy.
Beautiful, wise, important article! Thank you so much.
We must never forget the power of the human elements of caring, not just because of our common and shared humanity, but also because it has been proven that the compassionate connection between doctor and patient increases immune function and aids healing. Illness is a human journey and we are all in this together.
Very well written. It is so very important in society today to have an empathetic heart, and the the understanding of why it is so important. This should always be practiced in and out of the medical world.
No it’s not. People just don;t get that doctors are not supposed to empathetic for their own sake. They see many people die per die, if they were to invest in their feelings they would go insane. Doctors protect themselfs by being cold. Nobody could be that empathetic and still be sane.
When I was in nursing school in the 60’s, I remember reading about a Canadian study that had some nurses touch their patients (hand, shoulder, arm) while talking with them and other nurses who conversed without any touching. The patients who received the touching were able to be discharged several days earlier on average than the non-touched patients who did not reach a state of recovery sufficient to permit discharge at an earlier date. Later, in law school, I participated in a mock trial and used a technique I learned. While making my summation to the jury, I approached my “client” (who was guilty as sin) and placed my hand on his shoulder. The client received a verdict of innocent. Anyone who has been a parent or caretaker of small children can have no doubt about the need for human touch. Too often today, our medical personnel seem to forget that medicine is both an art and a science. We need more artistic caretakers.
The “power of touch’ is omnipresent. The directed, skilled use of touch as part of the communication with a patient, and for both diagnosis and treatment, makes the art and science of medicine truly real, in my opinion. Even our language reflects the power of touch: we say we ‘are touched’ by a story or something we hear.
In the end, the good physician is she/he who knows how to listen to the patient’s story, recognizes what is important to the patient and then treats according not only to a medical diagnosis but an outcome that the patient wishes to have happen as well. Thus, being empathetic is not just knowing or feeling what the patient may feel, but is the full engagement and grasping of what the best mutual outcome is desired when the patient AND physician are on the same page with the same goals.
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