Empathy Training as a Tool to Improve Medical Outcomes

Dr. Riess’s empathy training program has helped physicians develop that deeper connection. In a second and more recent study, 100 residents and fellows from six subspecialties participated in three 60-minute sessions; afterward, patients reported significant improvement in their physicians’ ability to empathize with them (J Gen Intern Med. 2012;27(10):1280-1286).

The Nuts and Bolts of Empathy Training

When Dr. Riess was developing her empathy training program, her first goal was to help clinicians understand the neurobiological and physiological reactions they may have when treating patients who are in distress. “It’s not an abstract feeling,” said Dr. Riess, who is associate clinical professor of psychiatry at Harvard Medical School and director of the empathy and relational science program at Massachusetts General Hospital in Boston. “When you see somebody suffering, your own pain receptors actually light up. [But] that response can be blunted if you get too overwhelmed with too much personal distress. The danger is that physicians can become detached. So we teach them to recognize pain and how to manage themselves so they can be responsive without getting overwhelmed.” (See Empathy for Patients on the Decline Among Medical Students and Residents, p. 6)

A key part of the training is a series of videos that show difficult doctor-patient interactions. Skin conductance tracings are superimposed on the videos to show the characters’ autonomic nervous systems—and the internal distress they are having during those interactions.

“It’s not just about being nice; it’s about really becoming skilled in connecting with people in nuanced and meaningful ways.”

—Helen Riess, MD

For Linda Lee, MD, a fellow in the Johns Hopkins Division of Facial Plastic and Reconstructive Surgery in Baltimore and one of the otolaryngology residents who participated in Dr. Riess’ pilot study, the video images of the doctors’ and patients’ autonomic nervous systems still stick with her. “It was a good reminder that if people initially seem like difficult patients, they may have other stressors in their lives that are not as obvious,” she said.

In the training, physicians also learn to recognize facial cues and nonverbal behaviors that can indicate a patient in distress. For example, if a patient who learns she needs a tonsillectomy says she is worried about how many days she’ll have to take off work, this could mean she has financial concerns. Nonverbal cues include expressions of confusion, which may affect treatment adherence, and subtle signs of anger.

“Most physicians really have no training in learning how to read nonverbal cues,” Dr. Riess said. “It goes beyond making good eye contact and shaking hands. There is just another whole layer of learning how to read people. It’s not just about being nice; it’s about really becoming skilled in connecting with people in nuanced and meaningful ways.”