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Sympathy in the surgery


Doctors are encouraged to be open with patients when things go wrong, to show compassion when dealing with sensitive issues and to communicate effectively. Sarah Whitehouse asks whether there is room for empathy, or even emotion, in the clinical setting


“I


remember telling a family that their father, who had been admitted only hours earlier, had died in theatre,” recounts Mr Tom Berry, a trainee general surgeon. “I prepared as I have been taught. I took a nurse with me. I left my pager with someone else. I ensured that we had somewhere private. I prepared to answer any expected questions and what I would say the next steps were. Despite all this, as I broke the news to his wife, I realised I had tears in my eyes. His wife asked if I was okay. I felt guilty, as if I was intruding on their grief or trying to elicit sympathy.”


WHAT IS EMPATHY? Coined from the Greek roots em and pathos (feeling into), empathy is the ability to put yourself in another person’s – the patient’s – shoes.1


It is understanding


a person’s subjective experience by sharing it vicariously, but maintaining an observant stance.2


The observant


stance is perhaps the key to empathising effectively in medicine – as a doctor, you cannot afford to become so consumed by a situation that you do not have the capacity to treat. Emotion, though, is what makes us human – should it be seen as something to shy away from?


EMOTIONAL INTELLIGENCE “I don’t think I would be able to do my job properly without being able to empathise with my patients,” says Dr Ayesha Rahim, former Deputy Chair of the UK’s BMA Junior Doctor Committee. As a junior doctor in psychiatry, she explains: “It’s a huge thing for patients to tell you something extremely personal about themselves. It’s important to be attuned to what they are saying, and how they are saying it, by looking out for non-verbal clues.” Traditionally, empathy in clinical practice was bound up with the vague term “bedside manner” – you either had it, or you didn’t. It couldn’t be taught or improved. Now, however, empathic communication can be seen more as a taught skill, and one that is essential in order to fully understand a patient’s condition. Clinical empathy is about understanding a patient’s symptoms and feelings, and communicating that fact to the patient. It is important to check back with the patient when taking a history to show you fully understand, for example, “Let me see if I have this right.” Verbalising their emotion, eg, “You seem


anxious about your chest pains,” demonstrates active listening. Being blind to emotional cues can lead to longer consultations and increased frustration from patients. It might even make a patient more likely to pursue a clinical negligence claim or complaint, should something go wrong. Dr Ann McPherson is Medical


Director of the DIPEx Health Experiences Research Group, which established www.healthtalkonline.org, documenting patients’ experiences of their treatment. She says: “It’s not easy to be empathic to vulnerable, needy people 100% of the time. Being able to do it is something healthcare practitioners have to learn – in the same way that they learn clinical skills. “Over ten years, researchers employed by Oxford University have carried out detailed interviews with more than 2,000 patients. Many of them express gratitude and respect for the practitioners who have cared for them, but you only have to click on the ‘communication with healthcare practitioners’ link to find examples of people who have been upset, embarrassed, or even damaged by a lack of empathy and compassion on the part of doctors and nurses.”


ARTICLE


UNITED KINGDOM CASEBOOK | VOLUME 19 | ISSUE 1 | JANUARY 2011 www.mps.org.uk


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