November 30, 2011

Can Empathy in Patient Care Be Taught?

By Niki S. Mehdizadegan, Pharm.D., PGY1 Pharmacy Resident, Union Memorial Hospital 

I entered a patient’s room in the Anticoagulation Clinic.  A middle-aged lady wearing a colorful scarf was sitting quietly in her wheelchair. “Hello Miss. M! How are you doing today?” I said with a smile.  She remained quiet and barely raised her head. In the three seconds between saying hello to her and pulling the chair to sit in front of her I thought to myself: “Oh, she is so friendly! (sarcasm). Let’s see how this goes.” 

We often form our opinion of individuals in the first few minutes of meeting them.  Malcolm Gladwell, the author of the book Blink defines our ability to make a decision or form an opinion within a limited period of time of facing a situation as “thin-slicing.” 1  He explains that although in most instances having a limited amount of information can be sufficient in decision making, sometimes our unconscious prejudice and stereotypes can bias that decision. 

In a society with significant cultural and socioeconomic differences, it is inevitable that  as healthcare professionals we will interact with a diverse group of patients whose behavior, expectations, and lifestyles are vastly different from ours. The question is: can we teach health care professionals to be empathetic towards patients in spite of these differences? Empathy has been defined as the “ability to behave in a caring manner toward a patient while demonstrating to the patient that his feelings are understood.”2 

In one study that was a joint collaboration between two schools of pharmacy, the authors employed Patient Empathy Modeling (PEM) pedagogy to teach pharmacy students  empathy towards underserved patients.3  The students were enrolled at two schools of pharmacy located at a rural and an urban site in the United States (Purdue University School of Pharmacy and University of Connecticut School of Pharmacy).  Students were given a patient scenario simulating the life of a patient with multiple chronic illnesses who was coping with a socioeconomic, cultural, or communication barrier. The student then had to live the life of that patient for ten days.  For example, one student role-played “Jamie Illiterate” - a patient who had multiple chronic illnesses, had financial problems, and had a learning disability that prevented her from learning how to read. The student was given prescription vials labeled in unintelligible texts. Assignments during the 10 days included: (1) having a one-time counseling session with a pharmacist (role-played by another pharmacy student) which simulated the challenges a patient might encounter, (2) setting up pillboxes or other reminder systems to take medications (vials containing placebos were provided), (3) observing the surroundings and attempting to read signs and other everyday objects for half an hour each day and recording feelings in a journal, (4) preparing a list of resources for illiterate patients in the area where the student lived, and (5) developing a medication brochure for illiterate patients. 

The effectiveness of this pedagogical approach was quantitatively and qualitatively assessed using the Jefferson Scale of Physician Empathy for Health Care Professionals (JSPE).  In addition, the authors assessed student journal entries as well as a final reflection paper. JSPE is a validated tool which analyzes 3 factors related to empathy: perspective taking, compassionate care, and the ability to stand in a patient’s shoes. The scores of the students participating in patient scenarios improved after completing the assigned activities.  Three major themes were identified from student’s journal entries and reflective papers: (1) greater appreciation for the difficulty in medication adherence, (2) increased empathy for patients from different backgrounds, and (3) improved ability to apply the lessons learned to real patient scenarios during their advanced experiential rotations. 

My first impression of the lady that I saw that day in the anticoagulation clinic was perhaps not the most positive. However, during that office visit I discovered that she was diagnosed with acute deep vein thrombosis (DVT) that day and that she had been scheduled to have knee replacement surgery. Due to the DVT diagnosis, her surgery would now be postponed.  This meant that she would suffer from continued pain from severe arthritis. She also needed treatment for her DVT.  This would require an injectable medication for a few days followed by an anticoagulant that required frequent blood tests and monitoring for the next few months. That day I tried my best to be empathetic towards her. I told her that I realized how painful her arthritis can be (perspective taking) and that my mother suffers from arthritis too (the ability to stand in a patient’s shoes).  I told her that I was more worried about her going into surgery with a new clot in her leg than postponing the surgery.  It was important that she receive the best possible treatment so that she can recover and be the healthiest she can possibly be prior to her surgery (compassionate care). She smiled and nodded her head and said that she understood.

As the study I have cited demonstrates, pharmacy students can be taught to be empathetic by engaging in role-play and facing difficulties from a patient’s perspective.  Schools of pharmacy across the country have designed various activities to teach empathy in their curriculum. Empathy does not require a genetic predisposition, but rather facing situations similar to those faced by our patients.  It is through these experiences that we can learn to relate to the similarities that bind us together rather than the differences that divide us.

1. Gladwell, M. Blink. New York : Little, Brown and Co., 2005
2. Lonie JM, Alemam R, Dhing C, Mihm D. Assessing pharmacy student self-reported empathic tendencies. Am J Pharm Educ. 2005; 69:Article 29.    
3. Chen JT, LaLopa Jb, Dang DK. Impact of Patient Empathy Modeling on Pharmacy Students Caring for the Underserved. Am J Pharm Educ. 2008; 72: Article 40.

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