Session: Number F152. Empathy: Can it be taught and does it ma;er?

Transcription

1 Session: Number F152 Empathy: Can it be taught and does it ma;er? Jill Reichman, DMH, MPH, PA- C Sheryl L. Geisler, MS, PA- C Rutgers, The State University of N.J. Physician Assistant Program

2 Clinical Empathy Includes emopve, moral, cognipve and behavioral dimensions: Ability to imagine the papent s emopons Internal mopvapon to empathize Intellectual ability to idenpfy emopons Ability to convey understanding of the emopons Empathy can be thought of as emopon- guided imagining Vs. sympathy sharing in the emopons of others (New Webster s Comprehensive Dic7onary, 1993 ed.) Ref: Stepien and Baernstein (2006) Hapern (2011)

3 Why Does it Ma;er? Facilitates papent trust and disclosure Enhances therapeupc efficacy decreasing anxiety - leading to improved outcomes Makes pracpcing medicine more meaningful Ref: Halpern (2003)

4 Improves Clinical Outcomes Deficits in psychosocial quality of care can result in: Worse outcomes Higher complicapon rates Increased stress susceppbility Lower compliance Higher medicapon use (i.e. pain control) Ref: Steinhausen, et al. (2014) Kim, Kaplowitz, Johnston (2004) Hojat M, et al. (2011)

5 Hojat M, et al. Physicians empathy and cliical outcomes for diabepc papents. Academic Medicine. 2011;86(3):

6 Barriers to Empathy In educaponal seings: The hidden curriculum undermines the pracpce of empathy In clinical seings: Anxiety/Pme pressure for clinicians impedes listening PercepPon that emoponal needs of the papent are not a core aspect of illness and care NegaPve emopons that arise when there is tension between the papent and clinician Ref: Garden (2009)

7 Can it be Taught? Empathic Curiosity promotes the development of empathy develop student s curiosity about other people s experiences curiosity requires suspending judgment culpvate curiosity by helping students to develop the ability to listen to papents stories and recognize each of them as unique for each papent Ref: Halpern (2011)

8 What does Empathy look like in PracPce? Empathic Responses ReflecPon - I can see that you are LegiPmizaPon - I can understand why you feel Support - I would like to help. Partnership - Let s work together Respect and Support - You re doing great. Ref: Cole and Bird (2001)

9 Empathy and AcPon Empathy can be viewed as a collaborapon with the papent: Check- back to confirm or correct shared understanding AcPvely involve papent in shaping treatment goals View papent as an expert in his/her own needs Recognizing the uniqueness of each papent Ref: Garden, R. (2009)

10 Validated Tools used to Measure Empathy Interpersonal ReacPvity Index (IRI) Empathy Construct RaPng Scale (ECRS) Balanced EmoPonal Empathy Scale (BEES) Accurate Empathy Scale (AES)* History- taking RaPng Scale (HRS)* Jefferson Scale of Physician Empathy* *specific to medicine Ref: Stepien and Baerstein (2006)

11 Jefferson Scale (Sample actual scale = 20 items) 1. I try to imagine myself in my pa9ents shoes when providing care to them. 2. My understanding of my pa9ents feelings gives them a sense of valida9on that is therapeu9c in its own right 3. An important component of the rela9onship with my pa9ents is my understanding of the emo9onal status of themselves and their families. 4. I try to understand what is going on in my pa9ents minds by paying aden9on to their nonverbal cues and body language. 5. I try to think like my pa9ents in order to render beder care. 6. I believe that empathy is an important therapeu9c factor in medical treatment. 7. Empathy is a therapeu9c skill without which my success as a health care provider would be limited. 8. Pa9ents illnesses can only be cured by medical treatment; therefore, affec9on 9es to my pa9ents cannot have a significant place in this endeavor. 9. I do not allow myself to be touched by intense emo9onal rela9onships between my pa9ents and their family members. 10. I believe that emo9on has no place in the treatment of medical illness. Ref: Hojat, et. al

12 Teaching Empathy Current methodologies include a number of ways to teach students self- awareness: ReflecPve wripng Reading and viewing (films) first hand accounts of illness Direct contact with papents as a companion rather than a health care provider Teaching and pracpcing cultural humility commitment to self- reflecpon, lifelong learning and reflecpve pracpce might include pracpcing mindfulness with students Ref: Garden (2009)

13 References Cole S, Bird J. The Medical Interview: The Three Func7on Approach, 2 nd ed. Philadelphia, PA: Elsevier Health Sciences; Garden R. Expanding clinical empathy: An acpvist perspecpve. J Gen Intern Med. 2009;24(1): Halpern J. From Detached Concern to Empathy: Humanizing Medical Prac7ce. New York, NY: Oxford Univ. Press; Halpern J. What is clinical empathy? J Gen Intern Med. 2003;18: Hojat M, et al. The Jefferson Scale of Physician Empathy: Further psychometric data and differences by gender and specialty at item level. Academic Medicine. 2002;77(10)suppl:S Hojat M, et al. Physicians empathy and clinical outcomes for diabepc papents. Academic Medicine. 2011;86(3): Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on papent sapsfacpon and compliance. Evalua7on & the Health Professions. 2004;27(3): Steinhausen S, et al. Physician empathy and subjecpve evaluapon of medical treatment outcome in trauma surgery papents. Pa7ent Educa7on and Counseling. 2014;95: Stepien KA, Baernstein A. EducaPng for Empathy: A review. J Gen Intern Med. 2006; 21(5):