Better outcomes for engaged patients may start with an empathic doctor

An engaged patient, one who is knowledgeable about his condition and feels confident in his skills to help manage his own care, may in turn contribute to improved outcomes and reduced costs for himself and for the system.  There are even ways to measure their ability to take a stake, including the Patient Activation Measure (PAM).

On last Tuesday’s Great Challenges Hangout, we gathered a team of thought leaders to explore PAM and how well it measured patient engagement. Of course, getting patients to take a more active role is a two-way street; well-managed care involves solid clinician-patient collaboration.

What, then, can providers do to make this happen, and who tracks how well they do it?  We’re not talking about best-doctor magazines or web site rankings, but an across-the-board measure of how doctors succeed in relating to patients – a “doctor activation measure,” as one of our Community Members called it in his tweet.

As it turns out, there’s no universally used rating for clinician engagement. But there is one trait that has, in study after study, shown to positively affect patient engagement and outcome: empathy.

Clinician empathy leads to greater patient satisfaction, increased compliance and better outcomes. It boosts job satisfaction for providers.  It may be particularly helpful in cases of chronic illness; In one study, patients with diabetes had measurably better outcomes when their doctors scored higher on the Jefferson Scale of Empathy, a tool that measures patients’ perceptions of physician caring. A recent systemic review and meta-analysis concluded that the patient-physician relationship had a small but measurable effect on patient health outcomes.

Yet with so many patients seen in limited time increments, and the increasing specialization of medicine, how can doctors get – and remain – empathetic?

Here’s the neat part:  They can be taught. Researchers as Massachusetts General Hospital gave residents three 60-minute empathy training modules. The courses explained the neurobiology of empathy, showing physiological responses to dismissive comments. Based on another scale, the Consultation and Relational Empathy (CARE) measure, the group with training showed higher scores than those without.

Understanding how our brains process and respond to verbal and physical cues is key to shaping behavior, says Helen Riess, a psychiatrist who developed the modules and led the study. As grounded in science as clinicians are, they can forget their autonomic nervous systems may lead them to act in ways they don’t intend.

That doesn’t mean a physician needs to or should feel deeply emotional about a patient’s outcome. More important is an awareness of how actions might be perceived.

“Empathy has cognitive, emotional, behavioral and moral components. Sometimes we really feel for another person; another time we cognitively understand what they’re going through, but we may not feel it because we’re tired. That still leaves us a choice to behave in a more empathic and caring way,” Riess says.

Empathy among med students tends to erode in the third year.  Perhaps this is where intervention can begin; as this blog has reported, some schools, including Harvard Medical, are exploring ways for doctors to learn to see patients holistically, including a curriculum called the Longitudinal Integrated Clerkship in which students follow a patient’s case from beginning to conclusion.

In the end, showing empathy can start with measures as sitting down to listen to a patient and making eye contact.

“If you can learn empathic behaviors and be respectful and kind, that’s really what the patient is going to remember at the end of the day,” Riess says.