One of the places in medical education where I am well-convinced that we are still failing our trainees is teaching them how to have hard conversations. It’s simply not a part of the curriculum, so they rely on role modeling; as we know, that role modeling is as likely to be negative as it is to be positive. We also know that our students lose empathy over the course of their clinical training, and that the loss of empathy contributes to physician burnout and all of the negative repercussions associated with burnout. And, of course, there’s the simple issue of the fact that no one actually enjoys delivering bad news and having hard conversations with patients and families. It’s emotionally easier to not have the talk, or to deliver platitudes, or even to provide that little bit of false hope they can grasp on to so you don’t have to be the bad guy or bad girl.
The erosion of empathy has been a long interest of mine for both personal and systemic reasons. Personally, I know I suffered from a tremendous (and in hindsight somewhat embarrassing) loss of empathy during the 100+hour workweeks of my residency, and that paucity of empathy applied to pretty much everyone, not just patients and families. I’m not saying I do it right 100% of the time now, but I’ve at least developed a tool set so that I’m usually aware if I’m entering an empathy-loss danger zone. And, of course, I’m interested at a systemic level because of the impact that empathy loss has on professionalism and our ability to work effectively as a team member or leader.
In order to remind everyone about the difference between empathy (healthy, connecting) and sympathy (not healthy, disconnecting), here’s a brief video lesson:
So, empathy is feeling with people. Courses are being developed to help us respond to patients and families in a more empathetic manner, and those courses often prescribe similar interventions:
- Give the patient/ family, not the computer, your undivided attention.
- Sit down!
- Avoid medical jargon. Remember that part of medical school was learning that 2nd language of medicine- how would you explain this to your Aunt Velma, the 3rd grade teacher?
- How you say it may matter as much as what you say.
- If the patient is telling you about their feelings, don’t respond to them with facts. Doing so implies that you’re not hearing them.
- When you’re scheduling a hard conversation, allow more time than you expect it to require. This is not a time to be in a hurry.
- Stop explaining. Stop talking. Sit in the silence, no matter how uncomfortable it makes you. I love the quote that “doctors are explainaholics” (because we are). Again, stop talking. It’s amazing what you can learn when you give people time and space to share with you.
As an additional aside, I would add that fostering these communication skills is also helpful for having hard conversations as a leader. While some of the details are different (you can probably use medical jargon with a junior colleague if it’s needed), all of the other rules absolutely apply.
Empathy is hard. It requires work, and it’s something we have to practice routinely in order to become good at it- much like being a surgeon, being a musician, or being a person. We need to recognize when we’re offering up unhelpful silver linings (or sandwiches) rather than genuinely connecting. It’s scary, but it’s also worth it for our patients, their families, our colleagues, and ourselves.