On Empathy

In team meeting this morning we discussed coming up with a functional definition of empathy.

Any communication between humans occurs on two levels.  Verbal communication occurs on a conscious level.  Another word for “conscious” is “explicit.”  Non-verbal communication — or in other words, emotional communication — typically occurs on a subconscious level.  Other words for “subconscious” include “implicit” or “instinctive.”

In health care at least, we have three tasks when we communicate with patients.  1. Hear what the patient is saying.  2.  Show that we heard it.  3.  Tell the patient what we need to tell them.

So on a verbal level, we need to:  1.  Get a history.  2.  Check and make sure the history is accurate.  3.  Explain the diagnosis and treatment plan.

On a non-verbal level, we need to:  1. Understand the patient’s emotional state. 2. Show that we understand. 3.  Communicate something emotional to the patient.

Since the latter occurs on a subconscious level, we sometimes ignore it.  Even when we don’t ignore it, we don’t understand it.  The challenge is to drag this process into the conscious mind where we can define its role and improve its effectiveness.   “Arriving at a functional definition” means precisely becoming consciously aware of a subconscious process.

The unconscious or “natural” process is not optimal in health care.   The natural process is one of mirroring.  We perceive the emotion of another person and pretty soon we feel the same way, and it’s written all over our face.  This works if you’re having a good cry with your girlfriend, but it doesn’t work with a patient.  For one thing, the patient doesn’t precisely need for you to be in as much a state of fear and panic as they are.  For another, it’s traumatizing to the health care worker.  Humans can only carry around just so much sorrow before they’re done.  That’s what “burn-out” is, in part.

Can we bring empathy into the conscious mind?  Work on it? Improve it?  Make it therapeutic?

Definitely.  Empathy is a brain function, not a personality trait, or a character trait.  We know that empathy can be degraded or enhanced neurologically.  It can be degraded by brain damage; for example, patients with right hemisphere stroke lose the capacity for emotional communication, and people with Asperger’s syndrome never had it.  And there’s a chemical that can not only enhance emotional communication, but at the same time, facilitate bonding.  Listen carefully to what I’m saying: there’s a pill that can make you love someone.  (It’s readily available, but not exactly legal.)

Empathy can also be enhanced behaviorally.  Any psychologist can tell you how to pick up cues as to the emotional state of a patient, and how to let them know you got the message. Any family practitioner who has been around a while can teach you much the same thing.  It’s also possible to be more aware of the emotional message we have for the patient, and to be more adept at transmitting that message.  “You’re going to be fine” can be said sternly, or impatiently, or with kindness, or with whatever mixture of wisdom, nurturing and confidence is required to reach that particular person in his or her particular situation.

Maybe we should be more empathetic to medical students, and teach them these things. We aren’t born knowing how to talk.   It would be good for the patients, and good for physicians also.


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