The first National Doctor's day was celebrated in July 1991. In India, this day marks the birth as well as the death anniversary of Dr Bidhan Chandra Roy. He was one of the most renowned physicians in India and former chief minister of West Bengal.
Bengaluru: Times are changing and so are expectations. Advancements in diagnosis and treatment are going on at an exponential rate. A newly qualified doctor would have to update him or herself regularly with all these ever-changing advancements.
However, the skill of being able to connect, relate and empathise with the patient remains a vital skill for healthcare providers. Doctors have to treat the patient by alleviating suffering and not just curing the disease. The balancing act of relating to and yet not becoming completely emotional is a challenge that clinicians face every day. A doctor or clinician, who cannot empathise, is less likely to get enough information from the patients to make the right diagnosis, or even prescribe the right treatment.
In today’s world, doctors in general are looked through tinted glasses and all advice is cautiously taken or is run by someone else for a second opinion. The general feeling prevails that lack of empathy is a perennial problem in clinical settings. Any sort of consultation or hospital admission seems to trigger an uncomfortably eerie feeling. Historically, a doctor is considered the technically sound, rational, emotionally detached persona and this notion inhibits one from emotionally engaging with their patients’ feelings. Research says that this seems to be more prevalent among male doctors.
Empathy is defined in the Oxford dictionary as ‘the ability to understand and share the feelings of another.’ In contrast clinical empathy as defined by Society of General Internal Medicine is ‘the act of correctly acknowledging the emotional state of another without experiencing that state oneself.’
The job of a good clinician is to be part empathetic and part problem solving. A computer or Mr Google could very well compute a diagnosis but the task of healing through listening, talking and empathising is completely human and cannot be replaced possibly for eternity. However, the clinician does not require to vicariously experience the patient’s emotions which would unduly divert the cognitive, logical mind and reduce focus on the problem.
Research has shown that empathy can be directly therapeutic by reducing anxiety levels in the patients. The process of telling one’s story also has a benefit on the psyche of the patients. Patients also may develop psychosomatic manifestations of anxiety and stress. Somatoform disorders are very prevalent in clinical practice and can be up to the tune of 30% of patients. Only clinicians who are carefully attuned to the patient’s needs, can diagnose these problems.
As an example of empathy in a clinical situation, a pregnant lady who was consulting me was very non-compliant with medicines and would miss appointments and always bring her friend instead of family. Although she looked happy, an averting gaze, lack of eye contact and subtle body language gave away an important underlying clue. On careful and empathetic questioning, she was able to narrate her unfortunate experiences with marital discord and domestic violence. Hence, body language, non-verbal cues and emotions help guide and hold attention on what is humanly significant. Trust and disclosure of important history make treatment more directly therapeutic.
There are benefits of empathy for the clinicians as well. Those who have higher empathy levels (being more aware of patients’ emotional needs and responding appropriately to their concerns) experience lesser stress, cynicism and burnout than those with less empathy.
However, there are barriers to empathy. Time pressure and anxiety interfere with eliciting, acknowledging and listening to the concerns. Doctors need to include psychosocial dimensions of the patients’ life in the consultation to be able to communicate better. Cultural barriers, generation gap, preconceived notions on morality and also a prejudiced approach hinder empathy to a large extent. The negative emotions that arise due to tension between the patients and care providers make therapeutic outcomes difficult.
Putting oneself in the other’s shoes’ is a quality that cannot be taught very easily and needs exemplary mentorship through clinic manners and bedside behaviour. The other methods to teach and inculcate empathy during medical training are through questionnaires that aid self-reflection, discussion groups with peers and seniors on emotional experiences.
Overall, empathy is an important tool for all healthcare providers and should be actively assisted and cultivated and promoted. The empathetic component of medicine is what makes the clinician special, without which we are, in essence, highly trained computers.
(Author - Dr Aruna Muralidhar, is the associate director, senior consultant obstetrician and gynaecologist at Fortis La Femme Hospital, Richmond Road, Bengaluru)
Last Updated 1, Jul 2020, 5:26 PM