“You never really understand a person… until you climb in his skin and walk around in it,” Harper Lee writes in To Kill A Mockingbird about empathy. For healthcare professionals, the skins they have to walk in daily may just be too much of a burden to bear.
A 2018 pilot study published in the Singapore Medical Journal revealed that residents in Singapore had lower empathy and higher burnout scores compared to their counterparts in the United States. While Singapore boasts an impressive and robust healthcare system, have we, in the strive for progress, neglected the health of those labouring on the frontlines?
Beyond adverse impacts on the wellbeing of healthcare professionals, physician burnout has proven detrimental to clinical practice and can erode professionalism, influence the quality of care and increase the risk of medical errors. Of the greatest consequence, perhaps, is the depersonalisation of doctor-patient relationships, with doctors being less capable of demonstrating empathy and listening to their patients.
Traditionally, doctor-patient relationships are characterised as a paternalistic model where doctors are given absolute authority over medical decisions. With modern emphasis on one’s subjective experiences, doctor-patient relationships have since morphed into a collaborative model that recognises patients’ rights in making decisions over their treatment and care.
The lack of empathy from doctors, however, may just be the spanner thrown in the works.
A clear example can be seen in one of the most controversial conditions in medical history. Topical Steroid Withdrawal (TSW), otherwise known as the Red Skin Syndrome, is the adverse reaction one may experience when discontinuing the use of topical steroids. What makes this condition a nebulous concept is the polarising views held between doctors and those who experience TSW.
While early research suggests TSW to be a product of chronic steroid overuse, the lack of conclusive diagnostics has given it the facade of scarcity. Put simply, TSW, to most doctors, is statistically low and negligible when evaluating the risks of using topical corticosteroids. To those experiencing TSW, however, it is a tangible result from a careless prescription of steroids, whose long-term usage has made their lives a living nightmare. Increasing paranoia has driven many to avoid topical corticosteroids against medical advice.
Interestingly enough, while international organisations such as The National Eczema Association have since acknowledged TSW through revised guidelines, little reassurance has been provided in local context beyond an acknowledgement of the rise of phobia regarding these drugs. Could this passive response be attributed to a lack of empathy in the Singapore medical field?
When debating new guidelines surrounding informed consent in October last year, Second Minister for Law Edwin Tong noted that doctors in Singapore were careful to speak “in a manner that they themselves judged would best absolve themselves of liability should the patient complain”. Fear of litigation has reportedly created a palpable atmosphere of defensiveness which morphed doctor-patient interactions into a battlefield that benefits none.
What then can be done to transform current dynamics between doctors and patients?
One strategy would be to emphasise empathy in medical practice beyond the undergraduate curriculum.
Defined as the cognitive capability to understand the inner experiences, feelings and concerns of a patient, physician empathy is communication with the intention to help. While some regard empathy to be innate and unable to be taught, a systematic review of research concluded otherwise. Improvements in empathetic communication was observed in 1,466 healthcare practitioners following training, with empathy proven to be more efficient in eliciting therapeutic changes in patients.
Empathy can be easily communicated through silent gestures such as looking at the patient when conversing or actively listening to their concerns. These small gestures can provide a holistic experience that ensures greater patient satisfaction and work efficiency. While some have raised valid concerns about empathy affecting objectivity in diagnosis, and/or resulting in compassion fatigue, it is nonetheless important to consider the significance of empathy in counteracting emotional irrationality in patients and gaining credibility and trust (Psychology Today).
Furthermore, as Jodi Halpern rightfully points out in her book, it is ironic to recognise the importance of patients’ emotions in their healing while claiming those of the doctors’ as lapses in objectivity. Empathy allows suffering to be real and validates pain experienced by patients. This makes healing possible beyond the physical repair of bodies – that is if doctors get the opportunity to practise what they have learned.
Reputable doctor and healthcare thought leader, Atul Gawande commented that the corporatisation of medicine has bogged doctors with tedious administrative processes which can be better spent interacting with their patients. A recent study discovered that for every hour spent with a patient, double the time is wasted on administrative paperwork.
Not only do these bureaucratic processes present a pertinent threat to the quality of healthcare, it also has the unintended effect of “patient depersonalisation” which reduces patients to mass data in online databases, widening the disconnect felt by doctors.
For empathy to be actively practised in hospital and clinical settings, a systematic evaluation has to be performed to strengthen administrative support in areas found lacking. Healthcare organisations should ensure empathy is common practice among professionals and adopt a model of shared decision making which places patients at the centre of their treatment and care.
As Hippocrates (460-370 BC) once said: “It is more important to know what sort of person has a disease than to know what sort of disease a person has.”
The insistence on a detached form of concern observed by doctors is absurd considering the subjective nature of patients’ experiences in discomfort and illnesses.
Empathy should be the first and foremost language doctors communicate in.