Is there room for empathy in the emergency department?

No everyone, I am certainly not saying you are not an empathetic person. But as a specialty, we seek individuals who are commanding, adaptable, and facile at moving from one task to the next. In residency, we ask you to hone your skills in rapid decision-making, quickly acting on a treatment plan, and establishing a disposition as quickly as possible. As doctors, we move quickly from one patient to the next and juggle a multitude of tasks in an environment that is, to most others, pure chaos.

So, the fact that empathy may be lacking in this environment is not entirely surprising. How would we fit it in amidst the craziness? And perhaps more importantly, why should we? I suggest that making time for empathy will help both you and your patients.

I was attracted to Emergency Medicine for all the reasons that we all are. I liked the prospect of each of my days being different and without the drudgery that I always associated with “upstairs” medicine and outpatient care. I liked the fact that I could rapidly fix things. And in fact, I liked that there were no drawn out relationships and no long-term connections to our patients which made it easier to go home and enjoy my life outside of medicine.

Until year four of residency. At that point in my training, I was disenchanted. If I was going to have resilience in this field, I was going to have to find a fix, and I found that in palliative medicine.

Now don’t get me wrong. I am certainly not suggesting that palliative care is everyone’s cup of tea. But, what I have learned from my palliative care work and what I do try to carry over into my EM life is to take a minute or two throughout your chaotic shifts to make time for empathy; this will make you a better doctor and give you more satisfaction in what you do.

Hojat defines empathy as a “predominantly cognitive attribute that involves understanding (rather than feeling) of a patient’s concerns, experiences, pain, and suffering combined with a capacity to communicate this understanding and an intention to help”1. There is a succinct distinction between empathy and sympathy (an affective response) because an overabundance of sympathy can be detrimental to patient care whereas empathy, due to its cognitive nature, is always beneficial1.

Interestingly, the evidence (yes there have been studies on this!) supports this. One U.S. study of 29 family physicians and their 891 patient with diabetes, physicians with higher scores on the Jefferson Scale of Empathy (JSE) were significantly associated with patients with indicators of better diabetic control (Hb A1C < 7% and LDL cholesterol < 100)2. In another larger study of 242 physicians and their 20,961 diabetic patients in Parma, Italy, higher physician empathy was significantly associated with a lower incidence of acute metabolic complications of diabetes that required hospitalizations3.

Additionally, empathy can be protective of that thing our specialty is especially at risk for: physician burn-out. A study of 298 nurses and 115 nursing students on the correlation between empathy and burnout shows that empathy declines with age and career (common sense – we get tired), but high levels of empathy can be protective against the development of burnout4.

So, take a minute to put yourselves in your patient’s shoes during your next shift. Ask him about his occupation. Ask her about her children in Trinidad and what they know about what is going on. Just imagine that you are living their lives for a minute.

The simple answer is that it will remind you why you committed yourself to this life which in and of itself, is a very powerful thing.

Hojat M, Louis DZ, Maio V, Gonnella JS. Empathy and health care quality. Am J Med Qual. 2013 Jan-Feb; 28(1): 6-7.
Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS. Physician empathy and clinical outcomes for diabetic patients. Acad Med.2011;86:359-364.
Del Canale S, Louis DZ, Maio V, et al. Physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy. Acad Med. 2012; 87: 1243-1249.
Ferri P, Guerra E, Marcheselli L, Cunico L, Di Lorenzo R. Empathy and burnout: an analytic cross-sectional study among nurses and nursing students. Acta Biomed. 2015 Sep 9; 86 Suppl 2:104-15.