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The History of Empathy from SMACC GOLD

Gday

About six months ago I was at the SMACC GOLD conference in Queensland having a blast and rubbing shoulders with the great teachers of the FOAM family.  I was lucky enough to be asked to give a talk and really given free reign over the topic.  Which sounds like a good thing, but means that I had to think long and hard about what I really wanted to talk about.

I certainly feel a good measure of the “Imposter Syndrome” when I go to these amazing meetings and give my five cents as a rural generalist.  After all we specialise in knowing just enough to get by – so what can we add to such an amazing group of specialists.  So I chose a topic that I think we GPs know very well and one that I believe can solve many of the dilemmas facing the broader medical community.

Empathy. Yep – sounds like a really dull topic.  Very wishy-washy, touchy feely and far removed from the hardcore airway and resuscitation realm.  But I love a challenge – I wanted to have a crack at making empathy relevant to doctors in the coal face of critical care.  Putting it in terms that we can understand and integrate into our practice.  The challenge – to sell “empathy” to the super smart FOAM docs.

To put this into context – I was sitting in the audience for the opening ceremony where Dr Vic Brazil gave an awesome talk about the Tribes of Medicine – in which she discussed the troubles of intercollegiate empathy.  This was heartening to hear as I was up to speak a few hours later on some similar themes.  And then I saw that I was due to speak at the exact same time as the venerable Dr Cliff Reid – he was talking on Dogmalysis in Resuscitation.  Once again – another theme I wanted to explore – as dogma is an enemy of empathy.

So please have a listen to the podcast.  The audio is here:

NOTE for viewers :-  It is a very visual talk with lots of images.  So it works best if you listen and follow the slides below.

It is a complex and fascinating topic – one that I hope will be the start of a discussion about how we can do better in our moment-by-moment interactions with our patients, friends and colleagues.

I would really love to hear your thoughts and if you have any ideas or practical tips for us all.  How do you enhance your interactions with your patients and colleagues?

Let the conversation begin.

Casey

Comments

  1. Empathy is vital. I reckon we all have (or had it) and some medicos lose it (perhaps early in career at uber-competitive entry to med training level) as a form of defence.

    But you’ve GOT to have love…for your patients, for your craft.

    A wise EM physician taught me the power of a handshake at the beginning of every patient encounter…not just in routine consults, but in pointy end ED (peri-arrest excepted). Even that gnarly aggressive psych patient kicking off in cubicle 3 can be de-escalated with the offer of help, indicated by touch, a handshake, a degree of empathy. Ditto the middle-aged man with chest pain, struggling for breath…a moment to touch, to make a connection, to cement the idea that YOU as a clinician are there to help HIM….that the patient is not just a plaything for our intellect or ‘the one with the disease’.

    Can it be taught? Probably….but ai think as humans we are all empathetic….just that some have chosen to shut it down.

  2. Fantastic post Casey! Yes, historically Empathy has ruled taking care of oatients before modern medicine came along and diverted our attention from this important aspect of care. Some tips I learned from Walter Himmel, JP Champagne and Ann Shook: the more you ask questions like “help me understand what your fears are” the more empathic you become. If you train yourself to do Patient Centered Care you will become more empathetic, your patients might have better outcomes, and you will have better job satisfaction. Smiling, thanking patients for waiting, telling them ” that must be very difficult for you” are just some of the things you can do to improve how you care for patients.

    • Thanks Anton
      Yes I think there is something to be said for having a range of “scripted lines” which you can pull out to help engage the patient and make them feel you “get them”.
      Although this might seem a bit fake -- this is basically what very empathic Docs do without thinking about it!

      Kurt Vonnegut famously said: “We are what we pretend to be.” If you act empathetic then you will likely be perceived as such and you will open the door to more meaningful patient interactions.

      Casey

  3. I thought everyone’s favourite German word was Schadenfreude…?
    I’d better go back to studying for that EQ test, eh.
    Fantastic talk Casey, easily one of the best at smaccGOLD.
    Well done!
    Chris

  4. It’s nessecary that we learn to talk about professional nearness, not distance .Compassion for care makes us more connected with ourselves, our colleges and the people we care for. To be vulnerably is now longer a weakness, it’s strenght. To say what you feel, can prevent you from burnd-out, makes and keeps you an inspired professional and an understanding physician. We can learn so much from storytellers, patients and relatives who have experienced intensive care. Compassion needs strong leadership and storytellers with courage and great personality .Every human being has an impact on another.Why don’t we want that in a patient /doctor relation to ?

  5. Just added a link from Effective Patient Communication, Patient Centered Care and Patient Satisfaction episode on EM Cases to this fantastic talk. Hope to see you at SMACC Chicago!
    Anton

  6. Hi Casey, I was interested in references for the sources you gave in the talk, so I went and found them. Excellent talk mate, I’m really inspired by your approach to this.
    Cheers
    Stu

    Decety J, Yang CY, Cheng Y. Physicians down-regulate their pain empathy response: an event-related brain potential study. Neuroimage. 2010 May;50(4):1676-82 [pubmed]
    Neumann M, Edelhauser F, Tauschel D, Fischer MR, Wirtz M, Woopen C et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med. 2011 Aug;86(8):996-1009 [pubmed]
    Riess H, Kelley JM, Bailey RW, Dunn EJ, Phillips M. Empathy training for resident physicians: a randomized controlled trial of a neuroscience-informed curriculum. J Gen Intern Med. 2012 Oct;27(10):1280-6 [pubmed]
    Milgram S. Behavioural study of obedience. J Abnorm Psychol. 1963 Oct;67:371-8 [pubmed]
    Haney C, Banks C, Zimbardo P. Interpersonal Dynamics in a Simulated Prison. Int J. Crim Pen. 1973;1:69-97 [pubmed]
    Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med. 1984 Nov;101(5):692-6 [pubmed]

    • Thanks Stuart
      It was remiss of me to not put the references up with the slides.
      Appreciate your filling in the gap.
      As you would have read -- the literature is a bit scant and there are few hard studies that can really help us -- so I have used a few to make the case.

      Glad you enjoyed the talk -- I was trying to make other doctors look at the everyday patient interaction in a new light -- one more based in science and with a functional imperative -- it can be easy to see it all as a bit soft and wishy/washy.
      Please share if you like.
      Casey

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