The importance of being empathetic

Empathy (and its manifestation in effective communication) has been described as an essential capacity of physicians, impacting doctor-patient communication, patient engagement in their care, and the effective care of patients as a whole. We know that empathy is essential to maintaining physician emotional and mental well-being, including avoidance of burn-out, depression, and suicide.

And, of course, one of the things that we know is that empathy among medical students declines during the third year of medical school. In the traditional curriculum, that’s the year that students start to take care of patients almost all of the time, as opposed to the first two years in the classroom.  At the time when empathy is perhaps needed the most, both for the students and for their patients, is when they have an increasingly short supply of it.

I was reminded again today that the benefits of empathy are too great for it not to be taken seriously by all of us.  I am a big fan of Eric Barker’s Barking up the Wrong Tree blog and learn something routinely from his weekly emails that I receive.  This morning’s blog/ email?  3 ways that empathy can improve your life.  It was honestly too important and too relevant not to share, especially once three different Tweets were in my timeline this morning discussing aspects of clinical empathy.

The real meat in his blogpost, and that I will not rehash entirely here, is that it is possible to “grow” your empathy muscles- and most of the ways in which this can be done aren’t that difficult or time consuming.  The actions fall into three broad categories:  Listen, meditate (especially loving-kindness, or Metta, meditation), and expose yourself to different ways of living.  New experiences and different ways of living also improve creativity, meaning they also play a significant role in fostering progress and change.

For the parents out there, if you want to foster empathy in your children, it appears you perhaps should give in to their pleas for a dog.  Music lessons and unstructured play time (something that seems to be disappearing) also are important in development, so I am grateful my Mom provided all three of these.

Now, go find a way to hang out with some different people and listen to them.  It’s good for you.

Hanging on to our better selves

First, a confession about how this particular blog post came into being.  It all starts with an image of a panda bear that was included in the Tweet that Nick Kristof posted, linking to his NY Times piece on how we can increase empathy.  Chances are that I would have found my way to the essay anyway, but the panda…well, who can ignore a panda, right?  And I didn’t.

I’ve shared this great (short) video before in which Brene Brown (one of my personal heroes for her wonderful work on shame) explains the difference between empathy and sympathy, and the importance of connection.

What we know:

  • Empathy has been described as an essential capacity of physicians, impacting doctor-patient communication, patient engagement in their care, and the effective care of patients as a whole.
  • Empathy is also essential to maintaining physician emotional and mental wellness, including avoiding burn-out, depression, and suicide.
  • Student empathy scores (using a validated measurement tool) decline during medical school, specifically once students enter the clinical years.
  • We are ineffective in teaching students how to balance the presence of suffering with the maintenance of empathy, probably because we have historically relied up on the “hidden curriculum” to do this (and many of us do it poorly).

So how do we do this better?

Maybe the answer is in having a wellness curriculum for our trainees. Of course, there is the critical issue of getting our own houses in order as well- burnout has become a prevalent topic, particularly in the surgical literature, and we know that emotional exhaustion and depersonalization are predictive of burnout.  In the absence of much formal training, we just plain make it up as we go…so we practice yoga, we read literary fiction, we learn about meditation (and try mightily to sit still!), we look at pictures of cute animals.

Gratuitous Olivia Photo
Gratuitous Olivia Photo

Most importantly, we have to be brave when it’s not easy to be brave.  Our “culture” teaches us to chin up and keep going and sometimes that’s not the right answer- we need to pause to process, we need to talk to a colleague about what happened.  And we need that colleague to sit with us and say, “I know what it’s like down here, and you’re not alone”  No, “At least…”, and no offering of sandwiches.  Because, really, we’re all in this together, aren’t we?


An elephant in the corner

I was grateful for this essay published in the New York Times last week, just before National Suicide Prevention Week.   The author cites some important statistics, the most important of which is that physicians are more than twice as likely as non-physicians to commit suicide.  He also cites the suicidality data from a recent multi center study, which he mentions to the exclusion of the depression data in the same study, which showed a depression rate in trainees of over 20%, with the rate higher in medical students.  Subsequent work has shown an increased incidence of burnout among residents and fellows rather than depression, although burnout is higher in all levels of physician trainees than in population norms.

As surgeons, we tend to want to believe that we are different:  we’re somehow tougher, more immune to the qualities that make everyone else merely mortal. Perhaps that tendency itself is one of many causes behind a rate of suicidal ideation in surgeons that is nearly twice that of the general population (and the associated tendency to not seek help for burnout and depression).  We also seem to want to find a simple formula for self-care and personal wellness that can serve as a panacea for depression, burnout, and their associated consequences.  And while the truth is that self-care and wellness help, perfectionism and an easily-accessed sense of shame are drivers of many high-performers…and I will agree that surgeons are, as a group, high-performers.

If you know me well at a personal level, you know that I have been a HUGE fan of Brene Brown’s work on shame and authenticity for several years now.  Quite honestly, her work was life-changing for me because of the perspective it provided me on dysfunctional behaviors that I witness and dysfunctional behaviors I may have exhibited myself at some point.  Using that lens of shame, I was able to see how often we use it as a tool in education.  I was flabbergasted when we were doing our interviews for the disruptive surgeon study and several interviewees mentioned the tendency of disruptive surgeons to use shame as a “motivational technique.”

We have seen the enemy, and apparently it is us.

So, where do I propose that we go from here?

If you’re feeling burned out, if you’re able to recognize that you’re depressed, ask for help.  Find someone whom you trust, someone who you feel has “earned the right” to hear your story, and talk to them.  In hindsight, I’ve realized the value of a couple of my friendships during residency, both of which were sanity-savers, if not life-savers.  In particular, during my last two years of residency, my friend Katie and I would meet nightly to walk her dog on the Shoreline Trail. I probably can’t count the number of times as we talked when each of us thought “Wow!  I get that.  It’s happened to me too.”

If you see signs of depression or burnout in a colleague, offer to be that support.  Providing some empathy if they say, “I’m stuck, it’s dark, I’m overwhelmed!” might just make the difference.