Empathy

by JHI Staff on May 23, 2014

EmpathyAt a recent Johns Hopkins Medicine International (JHI) staff meeting, we viewed a brief but powerful video created by the Cleveland Clinic that aims to evoke empathy for a fictional set of hospital patients, families and staff. A moving illustration of the need for empathy in health care, the video has gone viral online, garnering nearly a million and a half views.

While all of us at JHI are involved in working to improve health care delivery, most of us aren’t currently front-line clinicians, nurses or other caregivers routinely working directly with patients. But some of us are, and I assumed those folks would find the video particularly impactful. So I was surprised when, after the meeting, the highly experienced nurse care manager at JHI, Teresita Achanzar, expressed skepticism about the ability of this and other efforts to transmit the true nature of empathy in health care.

Teresita argues that genuine empathy for patients—a level of empathy that allows understanding what they’re going through well enough to be able to meet their needs and adequately support them—can only be learned one way: from the patients themselves. She offers a very simple, straightforward form of observational evidence to support her claim. Namely, she says that a good number of the newly minted nurses she’s worked with over the years, as much as they may sympathize with patients, have lacked that empathy when they start. It doesn’t matter what kind of person they are, or how they’ve been trained, or where, she says. They may be highly empathetic people in general, but when it comes to truly connecting to patients’ needs and challenges, they often fall short.

Part of the problem, Teresita explains, is that when they first land in hospitals after nursing school they have their hands full managing the mechanics of their jobs—mastering the different systems and routines and handling the countless problems that pop up in a patient population in the course of a day. They just haven’t ever had time, occasion or context to focus on relating to what patients are thinking and feeling.

But after a few years, most end up gaining that deep empathy, she says. That’s partly because of the on-the-job training and mentoring they’ve received from their managers and other colleagues, but it mostly comes from constant contact with the patients. Patients tell you how they’re feeling and what they’re thinking, she says, because they need you to understand. Over time, you learn to see it in their expressions and body language, and hear it in the tones of their voices. You can’t help but get it. And you can’t help being affected by it, and wanting to do what you can to help.

Teresita adds that all the challenges of acquiring that deeper level of empathy are magnified in international health care work. In the case of the many international patients who come to the Johns Hopkins Hospital in Baltimore, for example, there are often language barriers, a dearth of family members who can help bridge communications gaps, and cultural mismatches that may lead to clinicians or nurses unintentionally offending or confusing patients, or vice-versa.

In the case of the many hospitals around the world with which we collaborate, there may be cultural contexts that cause patients to hesitate to be fully open with some caregivers—for example, cultures in which women are discouraged from speaking up, or in which elderly patients expect that their children will shield them from decisions about their illness, or in which beliefs in traditional medicine lead to skepticism or fear of modern medicine.

Yet these and other barriers, too, ultimately give way to the process by which caregivers acquire empathy for patients, Teresita insists. Those patient-caregiver bonds form everywhere in the world, she says, and under the most trying of circumstances.

I’m sure many millions of hospital patients, former patients, and family members all around the world would join me in feeling gratitude for that process.

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