Title: Using Empathy Safely: the evolution of empathy over a medical career
1Using Empathy Safely the evolution of empathy
over a medical career
- Edward Latif
- A/Prof. Carmelle Peisah
- Prof. Kay Wilhelm
- School of Psychiatry Faculty of Medicine
University of NSW - Sydney Australia
2Empathy
- Empathy
- Emotional and cognitive insight
- Affective demonstration
- Unlike sympathy
- Demonstrated importance in
- Communication
- Doctor-patient satisfaction
- Patient behaviours (compliance litigation)
3Empathy over a career
- Little knowledge of change post training
4Our study
- Aims
- Determine qualitatively whether doctors believe
their level or use of empathy has changed - Identify explanations for this
- Hypotheses
- Doctors will report positive changes in their
empathy
5Study design
- Selection criteria
- Registrars or higher who were currently
practicing - Data collected
- 15-30 min semi-structured interview
- Jefferson Scale of Physician Empathy
- Maslach Burnout Inventory
- Kessler-10 Psychological Distress Scale
6Demographics
- 51 of first 86 (59.3) doctors enrolled in
quantitative study were interviewed
7Construct scores
- Empathy
- Higher compassionate care score (plt0.05)
- Higher total JSPE score (plt0.05)
- Burnout
- Higher personal accomplishment (plt0.05)
- Lower emotional exhaustion (plt0.05)
- Lower depersonalisation (plt0.05)
- Psychological distress
- Lower psychological distress (plt0.05)
8Interview results
- Defining empathy
- 31.4 Accurate definition (16/51)
- 68.6 Mistakenly defined sympathy (35/51)
- Teaching empathy
- 62.8 never taught (32/51)
- 82.4 said teaching as JMO would have improved
practice to date (42/51) - 56.9 said it was too late now (29/51)
9Examples
- A male rheumatologist in his 60s
- doctors use a kind of empathyits a
professional stance which is not quite the same
thing I think as true empathy - A male general practitioner in his 50s
- empathy comes from the heart wed be teaching
pseudo-empathy - A female sports physician in her 50s
- empathy cant be taught but encouraging it is
another thing entirely
10Evolution of empathy
- 74.5 (38/51) reported INCREASED empathy or
empathy became easier to use - Four key reasons
- Life experience
- Work experience
- Medical knowledge
- Changing work conditions
- 15.7 (8/51) reported DECREASED empathy
- 9.8 (5/51) reported NO CHANGE
11Examples (increased)
- A male rheumatologist in his 50s
- youre very nervous when you just start offthen
when youve done it enough times and youre old
enoughand as youre knowledge builds upit gets
easier and easier - A male gastroenterologist in his 30s
- Now Im more technically adeptI think Ive just
developed a more systematic approach to
communicating which incorporates empathy - A female general practitioner in her 60s
- I think its been some change with maturity
inlife experiences I think (Sic.)
12Examples (increased) (Cont.)
- A male anaesthetist in his 60s
- we were so busy I would see 165 people in a 12
hour shift. There was no time for empathy I
tried but I didnt have a momentI look back on
those days and I crawl in my skin what those
people must have thought of me I got better at
it as time went by. Looking back over my career
it is the one thing I wish I had of got right or
done better long long long before.
13Examples (decreased)
- A male general surgeon in his 50s
- no one wants a surgeon whos empathic but cant
cut - A female neurosurgeon in her 40s
- I am looked upon as abnormal in surgery because
I give my patients the attention they needI was
always told that I was too much of a patient
advocate and that this surgery would be a bad
course for me to follow
14Empathy and protection
- 72.6 (37/51) mentioned one or more of the
following themes without prompting - Burnout 29.4 (5/51)
- Protection and barriers 37.3 (19/51)
- Emotional hardening 13.7 (7/51)
- Limited available empathy 35.3 (18/51)
- A female oncologist in her 40s
- being able to say no is the number one tool for
protecting yourself
15Quantitative findings
- Empathy
- No statistically significant differences by age
(pgt0.05) - No statistically significant differences by years
in practice (pgt0.05)
16Discussion
- Do doctors become more empathic
- Quantitative results dont support this but data
cross-sectional - 74.5 believed they did
- Disparity may reflect
- Increasingly emphasised in medicine more
conscious of empathy - Changed perception of significance of empathy
- Interview cohort were more empathic artefact
17Discussion (cont.)
- Work environment
- Increasing control and self determination
increase in empathy - Juniors work context still training pressures
- Public practice reduced control
- Impingement on personal life balance distorted
18Discussion (cont.)
- Work experience and medical knowledge
- Increased experience increased comfort using
empathy - Exposure to mentors trial and error
- Improved understanding of disease process
- Reality of practice cure patient centred
19Discussion (cont.)
- Life experience
- Parallels the accumulation of knowledge
- Better perception of social background and
pressures - Personal exposure to illness
- Being a parent empathise with parents
20Discussion (cont.)
- Need for protection
- Reflection on their experiences
- Learned protective behaviours
- Burnout prev. shown not to relate to empathy
- Is caution bad
- 2/3 mistaking empathy for sympathy hazardous
- gt60 never taught about empathy point of
intervention
21Conclusions
- Doctors feel they increase in empathy
- Qualitative support
- No quantitative support longitudinal studies
needed - Doctors remain concerned regarding empathy use
- Influence on practice barriers
- Influence on doctors burnout
- Many couldnt define it are they practicing
sympathy
22A parting thought
- A male rheumatologist in his 50s
- For any given day each of us has a quantum of
compassion and you know sometimes at the end of
the day youre out of compassionyou hear a very
sad story happening and you think I cant dont
tell me anymore I cant hear one more story
todaytell me tomorrow when Ive had a good meal
and a good sleep and Im strong again