The Value of Patient Empathy—and the Risks

The Value of Patient Empathy—and the Risks

August 2016

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What victim empathy is to those who have already violated boundaries, patient empathy is to those who have not yet committed an offense. Both are crucial to physicians and other health care providers who want to protect themselves and their patients from harm. And both are grounded in the empathy that is at the heart of all ethics. “Ethics is not just following the rules,” says Acumen co-founder Peter Graham. “It’s thinking about the potential impact of one’s decisions and actions on oneself and others, and modifying your behavior based on your consideration of those consequences.”

Ethics is not FOLLOWING THE RULES. It’s thinking about the potential impact of one’s decisions and actions on oneself and others, and modifying your behavior based on your consideration of those consequences."

The first step towards patient empathy is to understand what PBI Education founder, Dr. Stephen Schenthal, calls “the first law of boundary violations, that everybody is a potential violator. Everybody.” Given the “right” circumstances, even those who consider themselves least at risk, who have never had any trouble and never expect to, will commit a potentially career-ending violation.

Once a physician accepts the reality of his own vulnerability, the crucial next step is to accept his patients’ vulnerabilities. “It’s important for doctors to understand that they are treating someone who’s messed up, just as they themselves, and every other human being is messed up,” says Schenthal. Understanding that a patient is a full and flawed human being encourages the physician to behave ethically, that is, to consider how their actions will affect the vulnerable person who has come to them for help.

It is important, however, to realize that there are risks involved in taking this holistic approach. Chief among them is that the physician can get sucked into an unprofessional relationship, allowing their involvement to spill over from the professional to the personal realm. The more the physician comes to understand and empathize with a patient’s problems, to care about the patient as a whole person, the more likely they are to cross the boundary that separates a professional relationship from a personal one.

The challenge is to know and care about the patient without losing clinical objectivity. It is not easy, says Graham, “to juggle being a more psychologically sophisticated caregiver by engaging in this kind of empathy, while at the same time not getting too involved, and keeping the interaction focused on the task at hand, which is diagnosis and treatment.” And it is often difficult for physicians to recognize that they are slipping out of their professional role. In fact, according to Schenthal, “This is one of the most difficult things for a doctor to see, because by that point, they’re already part of the problem.”

An important part of maintaining a professional relationship is accepting the “power differential” between doctor and patient. It is not uncommon for well-intentioned physicians to look for ways to lessen this differential in a misguided effort to show how well they understand and how much they feel the patient’s pain. Such efforts place both the doctor and the patient at far greater risk. The difference in power between the person seeking help and the person providing it is real, and efforts to deny it are all too likely to blur the lines between the personal and the professional.

In fact, Dr. M., whose story appears elsewhere in this issue, emphasizes how important it is to recognize this power differential from the patient’s point of view. “When a person in pain comes to a doctor, thinking ‘this person can help me,’ they tend to expect someone safe, smart, perfect—someone they can trust and be open with.” Understanding this idealization is an important part of both victim and patient empathy. It is only by fully grasping the trust that a patient places in their physician that one can fully appreciate the devastating pain the physician can cause by betraying that trust.

In the end, patient empathy involves understanding the patient as a whole human being and as a patient, who has voluntarily placed themselves in a vulnerable position in order to be healed.