Using Empathy Safely: the evolution of empathy over a medical career

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Using 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

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Empathy

• Empathy
• Emotional and cognitive insight
• Affective demonstration
• Unlike sympathy
• Demonstrated importance in
• Communication
• Doctor-patient satisfaction
• Patient behaviours (compliance, litigation)

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Empathy over a career

• Little knowledge of change post training

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Our 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

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Study 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

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Demographics

• 51 of first 86 (59.3) doctors enrolled in
  quantitative study were interviewed

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Construct 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)

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Interview 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)

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Examples

• 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

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Evolution 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

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Examples (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.)

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Examples (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.

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Examples (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

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Empathy 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

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Quantitative findings

• Empathy
• No statistically significant differences by age
  (pgt0.05)
• No statistically significant differences by years
  in practice (pgt0.05)

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Discussion

• 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?

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Discussion (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?

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Discussion (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

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Discussion (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

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Discussion (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?

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Conclusions

• 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?

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A 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