Emotions & Empathy

Emotions are present in most clinical encounters. Patients’ worry, relief, joy, frustration and other feelings can be expressed verbally or non-verbally, more often with subtle and indirect ‘cues’ than with direct statements. Recognizing these emotions helps to build connection and trust in the physician-patient relationship. Emotions can also serve as data that helps clinicians to understand a patient’s perspective, context, hopes and fears.

Empathy can be defined as the capacity to understand and relate to the patient’s illness experience, emotions and feelings. Clinicians often focus on gathering information and overlook opportunities to demonstrate empathy, making patients feel that they haven’t been heard even though their words have been registered.

Empathic responses to emotion

It can be tempting to try to “fix” negative emotions, by encouraging someone who is disappointed or reassuring someone who is fearful. But this is often counterproductive. An empathic response is a better alternative.

Empathy can be expressed in many ways. A nonverbal expression of empathy can be as simple as respectful silence, offering a tissue, or if culturally appropriate, placing a hand on the patient’s arm. A statement or question can also acknowledge the emotion and explore it in more depth.

PEARLS

The PEARLS framework for demonstrating empathy, developed by the Academy of Communication in Healthcare, suggests different types of responses.

As you learn to communicate with patients, mnemonics and frameworks like PEARLS can be a good starting point. Communication with patients is not ‘one size fits all’ – the suggested phrases above would feel natural to some physicians and inauthentic for others. Try them out and over time you will build an approach that feels authentic and genuine for you.

In your first interviews, it may be quite difficult to balance collecting medical information and attending to emotion.  Don’t worry – this is normal!  As you gain comfort with the content and process of the interview, you will have more and more cognitive space to respond empathetically.

Empathy, Sympathy, and Compassion

Empathy, sympathy, and compassion are distinct but related concepts. While empathy involves trying to understand and relate to someone’s experience, sympathy is based on pity. Someone feeling sympathy recognizes a distressing situation from the outside, as illustrated in this short video from Brene Brown.

The word compassion means “to suffer together”, from the Latin com (together) and pati (to suffer). Suffering is an inevitable part of illness, and as physicians, you will have the opportunity to demonstrate compassion every day. Recognizing suffering and demonstrating your readiness to help, even if the only thing you can offer is listening or presence, is the key to compassionate care.

References & Resources

Emotion Cues as Clinical Opportunities | Emotion in the Clinical Encounter | AccessMedicine LINK

Forsey, J., Ng, S., Rowland, P., Freeman, R., Li, C., & Woods, N. N. (2021). The Basic Science of Patient-Physician Communication: A Critical Scoping Review. Academic medicine 96(11S), S109–S118. LINK