A New Era of Empathy in Patient Interactions

“I want a doctor who takes a little time to explain (things) to you, one who shows a little empathy.”

“I started crying because I couldn’t handle it. And then as an afterthought, he (the doctor) said, ‘Yeah, I’m sorry this is bad news’.”

“The doctor was very practical but totally unempathetic.”

“Sometimes the patient knows more about their own case than the doctor can from their books and structured medical learning. But the doctors don’t accept or appreciate this.”

“There’s no support for the family members, right? They’re just like, ‘sit outside. Wait, when the doctor comes in, we’ll give you an update. Don’t bother us’.”

“The hospital staff may not be familiar enough with some procedural requirements and may contradict each other and make you run around.”

These are a few quotes from patients/caregivers I interviewed for a Patient Perspective paper that was recently published in Current Medical Research and Opinion. 

The patient journey map I created based on these interviews and my own experience as a patient living with a rare disease and multiple chronic diseases, shows that out of the wide range of emotions that patients experience throughout their journey, stress is one of the most prominent and persistent emotions. 

Patients with chronic and/or serious conditions experience extreme stress when waiting for a diagnosis, making treatment decisions or during hospitalization.

It is not surprising, therefore, that empathy came through as one of most critical needs expressed by patients/caregivers I interviewed.

What is clinical empathy?

The Oxford dictionary defines “empathy” as the ability to understand and appreciate other people’s feelings or experiences. In medical practice, clinical empathy has been defined as “the ability to understand the personal experience of the patient without bonding with them.” It is also understood as “the ability to observe emotions in others, the ability to feel those emotions and finally the ability to respond to those emotions.” This latter definition of empathy encompasses compassion, which is “about taking action in response to empathy”.

It follows that if a healthcare professional (HCP) displays empathy and compassion, patients feel safe and comfortable enough to share their thoughts, questions and concerns with the HCP. 

Clinical empathy allows patients to feel validated and that their experience of illness is real and important. This makes empathy one of the most fundamental and vital tools that can be applied in the doctor-patient relationship to achieve the desired outcomes for the patient.

On the other hand, it is also true that when doctors develop a deep emotional connection with their patients, it can hamper their objectivity and rationality in clinical decision-making. This is why clinical empathy requires the self-other distinction, where the doctor understands the patient’s feelings but does not mistake these feelings as their (the doctor’s) own.

Why is empathy only being discussed now?

In business and leadership development contexts, empathy seems to have emerged as a buzzword or trend in recent years, and empathy at the workplace is being discussed at length in many business podcasts and leadership journals.

Yet, few other industries would have empathy at the workplace take on as much significance as it does in healthcare.

Patients need to be treated with empathy and compassion. 

This seems like an obvious statement that should be recognized as a timeless and universal truth.

However, as with the trend in other industries, it is only in the last decade or so that the healthcare industry has begun to give center stage to discussions about empathy in patient interactions. Several papers published in the last few years aim to meaningfully define clinical empathy and its scope, outline the benefits of and barriers to empathy in clinical practice, and assess its impact. 

Industry discussions about empathy dovetail well with broader conversations about patient centricity, which have also become popular in recent years. This recent inclusion of empathy and patient centricity in industry language is indeed an important starting point, but we have a long way to go before empathy becomes commonplace in clinical interactions with patients. 

Why is empathy missing in clinical interactions?

Empathy is believed to improve not only patient satisfaction but also physician satisfaction with their work. 

So why isn’t it more ubiquitous in practice?

In a recent episode of the podcast “Not Just Patients,” which I co-host, Dr. Victor Montori, Professor of Medicine at Mayo Clinic and an expert in shared decision-making, discusses the conditions required for careful and kind care for all. 

He argues that in the industrialization of healthcare, where patients tend to be processed like goods in a factory, the heart of healthcare – which is care – gets lost.

According to Dr. Montori, care, especially for chronic diseases, involves the clinician understanding where the patient is coming from – their hopes and dreams, values and preferences – and having unhurried conversations to determine a treatment plan that fits into the patient’s life.

He believes that young people entering medical school, aiming to become doctors, have their heart in the right place and are inherently empathetic. But then because medical training emphasizes and rewards technical skills over all other skills, by the time these medical students become doctors, they have lost some of the empathy and compassion they had when they started out. 

Additionally, he discusses how the capacity of the medical system is stretched because people have lost the art of self-care and community-based care.

Can empathy be taught?

Yes it can!

However, empathy training for medical professionals requires a complex balance of pedagogical coursework, role modeling and creating a culture where empathy is valued and celebrated. 

A survey of medical schools in the UK showed that while some form of empathy training is included in the undergraduate curriculum, the cultivation of empathy is not really assessed, and educators believe a lot more can be done.

Outside of medical schools, some organizations, such as “The Patient Revolution”, led by Dr. Montori, offer courses and fellowship programs that train patients and others involved in healthcare to understand and apply the concept of careful and kind care for all, with the goal of transforming healthcare from “an industrial activity into a deeply human one.”

Can GenAI help?

The healthcare industry is exploring with great interest the transformative potential of generative artificial intelligence (GenAI) and its potential applications.

But what applications could GenAI possibly have in driving empathy – the most human of all traits?

More than you’d imagine, according to a couple of recent studies have shaken up the industry.

A JAMA study compared physician responses with AI-generated chatbot (ChatGPT version GPT3.5) responses to 195 patient questions on the Reddit forum r/AskDocs. The responses were evaluated three times, independently, by a team of licensed healthcare professionals. The results showed that the evaluators preferred the chatbot responses, rating them significantly higher than the physician responses for both quality and empathy.

Another study – a preprint in arXiv (not yet peer reviewed) – shows that Google’s healthcare-specific AI optimized for diagnostic dialogue, called AMIE, performed better than primary care physicians on several parameters, including communication skills and empathy.

While these studies have some limitations and their results should be interpreted with caution, they certainly point to the futuristic promise of GenAI to, ironically, make the healthcare system more human.

Where do empathy and compassion fit in clinical trials?

Compassion has been referred to as a key success factor in clinical trials.

Empathy in clinical trials goes far beyond the point of doctor-patient interactions and in fact starts at the stage of trial design. 

In two separate episodes of “Not Just Patients,” Bronwyn Lewis, Global Head of Patient Engagement at Boehringer Ingelheim, and Robert Joyce, a Patient Expert who advocates for patient involvement in clinical research, each share stories illustrating how involving patients in clinical trial design can make the trial more considerate of patient needs –  more empathetic: 

• Bronwyn shares a story about a clinical trial for scleroderma, where the protocol required the use of adult-sized mouthpieces for lung function tests on adult patients. It was only when the study design was shared with patients that the researchers realized that adult-sized mouthpieces are very uncomfortable for scleroderma patients who have loss of elasticity around the mouth. The protocol was amended for pediatric mouthpieces to be used instead.
• Robert talks about a study for multiple sclerosis (MS), where the study information was meant to be presented to patients in a book that had to be held with both hands. As a patient researcher on the study, Robert was able to explain to the research team that MS patients can have disabilities with their hands and would need a book that could sit on the table and the pages turned with one hand.

Clinical research benefits greatly from patient involvement. In both the above cases, the true patient need would never have been identified if patients had not been involved in the study design.

In clinical trial settings, participating patients may experience stress because of long or difficult commutes to trial sites, unclear information about trial procedures and what to expect, inadequate accommodations for physical challenges, and/or the use of outcome measures that don’t really matter to patients.

A LinkedIn post describes a patient, now deceased, who used to be a pharma industry executive and was very well versed with clinical trials and then entered a trial as a participant. To his dismay, he felt as though he was being treated as a trial subject rather than a patient, and that the trialists were preoccupied with hitting recruitment targets rather than paying attention to his needs. 

In a patient survey conducted by Climedo, “more empathy, sensitivity and appreciation by staff” tied with “less time expenditure” as the second most important factor that would make patients more likely to participate in a trial in future.

Empathy in trial design requires that the researchers understand the people behind the protocol population and put themselves in the patients’ position. This may involve a combination of interventions, such as the following, which carefully consider the patients’ needs and preferences:

• delicately balancing digitalization with trial site visits, 
• reducing paperwork and procedural inconvenience to patients, 
• compensating patients fairly, 
• having investigators easily accessible for all participant queries or concerns and
• ensuring that the same staff members or care team are available for every onsite visit.

Where do we go from here?

Clinical empathy is the foundation of good medical practice and an ideal that lends universal benefits to patients, HCPs and industry alike. As a concept, it is being discussed more than ever as a key component of patient centricity. These discussions are very welcome. But now empathy needs to make its way from literature and discussion to every consultation room and clinical trial site. 

Participating in a clinical trial is usually a leap of faith that patients take at a very challenging time in their life. Putting their needs first and applying empathy in trial design and interactions is a basic commitment that the study team can offer in return, which not only improves patient experience but also participation, retention and the chances of trial success. 

If AI, which is trained on human input, can display empathy, surely humans in healthcare can too.