Doctor as patient: finding all-important empathy

WHILE working as a junior doctor, I was diagnosed with Hodgkin lymphoma and treated with radiation therapy. During my experience as a patient sitting on the other side of the desk, I discovered the contrast between two seemingly interchangeable terms I had previously used in my regular practice: sympathy and empathy.

A recent study of patients with cancer describes sympathy and empathy as separate entities of communication. Sympathy is unwanted and pity-based and is a response to a difficult situation where self-preservation of the clinician is dominant. In contrast, empathy involves an attempt at understanding the distress of an individual through emotional resonance with acknowledgement and acceptance of the patient’s experiences.

Communication skills are a core component of medical practice and significantly improve patient outcomes and satisfaction. While these skills include a broad range of competencies, arguably the most important is empathy.

Before my cancer diagnosis, I was naively driven to feel sympathy by an internalised expectation of how I thought I should feel, without attempting to understand the full experience of my patients.

As doctors, our working culture is challenging and encourages the belief that we are superior to the illnesses we treat. After my diagnosis, I was concerned that my new vulnerability had pushed me off the proverbial pedestal. In limiting the recognition of our own vulnerabilities as doctors – perpetuated by a long-standing traditional culture resistant to change – we put a barrier between observing the patient’s feelings and sharing them.

Upon my return to work after treatment, I became acutely aware of the systemic barriers that constrain our ability to practise with empathy as junior doctors.

We are forced to exhibit a sympathy-based response towards our patients as we work in a time-pressured, stressful environment conducive to burnout. Practising with empathy requires working closely with patients to gather interactive feedback, achieve satisfying discussion and engage in personal reflection, all of which help us to understand the patient’s experiences and contribute to improving outcomes.

Empathy levels self-reported by medical students reduced as they moved through training and the National Mental Health Survey of Doctors and Medical Students published by beyondblue reported emotional exhaustion and cynicism as most prevalent among young doctors. The highest rates of burnout overall were in young doctors and female doctors.

In 2009, it was established that 71% of junior doctors had recently been concerned about their physical or mental health, and the beyondblue survey identified significantly higher rates of mental illness among health professionals compared with the general population.

We need to be cognisant of this and embrace our vulnerabilities to better understand our patients. This will improve our medical culture and, while challenging, it is a required move for the future of our profession. Not only will we benefit, but our patients will too.

While there is undeniable need for system change, there are practical ways to enhance the patient experience.

Even before any personal interaction, we must remember that patients can hear us and we are all guilty of corridor discussions; we need to be mindful of the language we use. Sitting in a busy outpatient clinic, it is easy to forget that each patient holds their individual story clutched to their chest and its recall can exacerbate stress and unease. The anxiety associated with standard review appointments revisits the whole patient experience even if the result is now good news. Recognising this can immediately improve rapport.

Practising with empathy involves taking the time to understand a patient’s experience and the attached emotional responses. The ease of hastily signing a radiology form in an outpatient clinic does not acknowledge the patient’s experience of booking an appointment, fasting, finding transport, sitting in a busy waiting room, having an intravenous cannula inserted, wearing a hospital gown, lying uncomfortably in a scanner surrounded by foreign noises and, finally, anxiously awaiting the results. By taking the time to consider the arduous journey, by explaining this in advance to better prepare our patients and communicate a shared understanding of the process, we can begin to alleviate the challenging emotions that will inevitably arise.

There are ways to make the hospital or outpatient experience easier for the patient by giving back a degree of control and empowering them. Examples include suggesting the patient ask for music to be played during a scan or bringing their favourite novel to read while waiting at a busy clinic. It could be suggesting the patient bring a support person if you suspect they might need a hand to hold, or offering to help with the administration for travel subsidies. Further ways to give back some control can be explored by networking with multidisciplinary colleagues and by appreciating the vital role they play in improving the patient experience. This will help our patients and also promote a more inclusive environment within the hospital system.

My patient experience helped me to recognise that I was expressing a sympathy-based response to illness, driven and perpetuated by systemic barriers and workforce culture. Taking the time to actively engage in the patient’s emotional experiences and encouraging feedback and reflection is vital for empathy-based practice, even though this can be difficult in a bed-blocked emergency department, busy ward round or overbooked outpatient clinic.

The systemic constraints that prohibit practising with empathy are challenging but can be battled in small ways through improving patient familiarity and control. Ideally, to provide an environment that fosters practising with empathy, our profession needs rostering that reduces fatigue, supportive supervisors, and a shift in the overarching medical culture to help us embrace our vulnerabilities as doctors and promote a more inclusive working environment.

Only when we can achieve these together will it reduce burnout and give us the time and emotional resonance to not only see our patient’s experiences but to understand them too.

Dr Sophie Manoy is a Resident Medical Officer at Cairns Hospital, embarking on a career in paediatric public health. As an intern she was diagnosed with Hodgkin lymphoma, which has influenced her perception of her career and medical culture in the workplace and has made her a passionate patient advocate.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.