Dalhousie Faculty of Medicine Communication Skills Program

EXPRESSING EMPATHY TO PATIENTS

The skills of empathy like any other communication skills can be learned. The challenge is to identify the building blocks of the empathic response which enable residents and other medical learners to integrate the elements of empathy into their natural style so that it is genuine to both doctor and patient. Empathy is a two stage process: 1) the understanding and sensitive appreciation of another persons predicament or feelings 2) the communication of that understanding back to the patient in a supportive way. The key to empathy is not only being sensitive, but overtly demonstrating that sensitivity to the patient, so that they appreciate our understanding and support. It is not good enough to think empathically, you must show it too. Empathy demonstrated in this way overcomes the isolation of the individual in their illness and is strongly therapeutic in its own right. It also acts as a strong facilitative opening, enabling the patient to divulge more of their thoughts and concerns. And ultimately, it reveals the doctor as a caring person. Many skills in the medical interview show the patient that we are genuinely interested in hearing about their thoughts, including non verbal communication (an attitude of interest in the patient, use of silence, facial expression) and verbal communication ( tone of voice, use of FIFE ). However, a clear expression of empathy involves overt communication of specific types of phrases.

What are the verbal skills that allow you to demonstrate empathy?
Empathic statements are supportive comments that specifically link the I of the doctor and the you of the patient. They both name and appreciate the patients affect or predicament.

Some examples of empathic communication:

I can see that your husbands memory loss has been very difficult for you to cope with. I can appreciate how difficult it is for you to talk about this. I can sense how angry you have been feeling about your illness. I can see that you have been very upset by her behavior. I can understand that it must be frightening for you to know the pain might keep coming back.

Silverman J, Kurtz S, Draper J. Skills for Communicating with Patients. Oxon, England: Radcliffe Medical Press, 2005.

Dalhousie Faculty of Medicine Communication Skills Program EMPATHIC STRATEGIES IN THE MEDICAL INTERVIEW

The N-U-R-S-E approach

RESPONDING TO EMOTIONS WITH WORDS
Patients emotional statement: These migraines are killing me! Empathetic physician response: The N-U-R-S-E approach N U R Name the emotion or feeling Understand the emotion or feeling Respect the patient It sounds like this has been frustrating. It must be difficult to be in pain like that. Im impressed that youve been able to keep up with your treatment and the rest of your life while having these migraines. I will help you with these migraines. Tell me more about how these migraines are affecting you.

S E

Support the patient Explore the emotion

Adapted from: G.J.Tulsky and R.Arnold. Communicating a poor prognosis. In R. Portenoy and E. Brueraeds. Topics in Palliative Care. Oxford University Press, New York, 2000, as quoted by Anthony Black, Robert Arnold and James Tulsky. Mastering Communication with Seriously Ill Patients, Balancing Honesty with Empathy and Hope, New York: Cambridge University Press, 2009