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The Doctor Is In | May 2009

Empathy and Its Role in Optimizing Patients’ Satisfaction

Empathy is a term that often comes up in discussions of how to manage unhappy patients, yet it should be established in any clinical encounter. Empathy has been demonstrated to improve patients' satisfaction, but physicians often argue it is not time efficient. In fact, it is time efficient and reduces the risk of litigation. Wouldn't you rather spend time trying to understand a patient's perspective in your office than trying to defend your perspective to a jury?

Empathy involves understanding the patient's experience, perspective, and feelings and communicating that understanding to the patient. The basic steps of empathy consist of (1) active listening, (2) identifying not only the facts but the emotions involved, even if they are not directly expressed, (3) reflecting the content back to patients, and (4) checking with them to see if you understand so that they can correct you if needed. This article discusses some pearls to enhance your empathic skills.

Make an Effort at Active Listening

Active listening requires effort. Whenever anyone is speaking, the listener's mind is running ahead of the actual words being spoken and generally formulating a response. You have to actively suppress that tendency to jump ahead while showing patients that they have your full attention. Nodding your head, saying "um hmm," and mirroring the patient's facial expressions often demonstrate that you are listening. To be effective, avoid exaggeration. Although a few nods of your head are helpful, you do not want to look like a bobble-head doll. Nor do you want to sound like you are rushing the patient by uttering "uh huh" every other second. Remember to monitor your facial expressions.

Numerous framing statements can let patients know you want to understand what they are saying and feeling (eg, "sounds like," "what I hear you saying is…. Is that right?"). To be effective and not sound like a recording, you should avoid using the same phrase all the time. Another common mistake is to restate only the patient's physical complaint and avoid any comment on the emotional component.

Surgeons typically are action oriented, but patients can be put off if they think you are superficially addressing their concerns. It is easy to immediately say, for example "Well, halos and glare are normal after the surgery. I counseled you about that before surgery. Remember?" It is better to pause for a moment, let patients know first that you understand their concern about their symptoms, and then discuss that certain symptoms are quite common. If you rush to remind them that they should have expected the symptoms based on preoperative counseling and informed consent, they are likely to feel you are reprimanding them for bringing up their concerns. If you feel you must remind patients at that initial point that you already discussed something preoperatively, avoid sounding like you are rebuking them for being bad listeners.

The ability to consistently demonstrate affective empathy, particularly with elective surgery patients, is a key component in their postoperative satisfaction. Even if your dispositional empathic baseline is low, regularly practicing the techniques described herein will improve your skills and augment the overall success of your practice.

Jennifer S. Morse, MD, is in private practice as a consultant for medical and surgical psychiatry in San Diego. Dr. Morse may be reached at (619) 405-5919; jmorsemd@aol.com; www.the-doctor-is-in.com.

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