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Tuesday, October 22, 2019
Home Specialties Primary Care/Family Medicine Chronic Disease Patients with 'Empathetic' PCPs Have Lower Risk of Mortality

Chronic Disease Patients with ‘Empathetic’ PCPs Have Lower Risk of Mortality

Forming a connection with patients and demonstrating empathy is central tenet of healing, and a new study sheds light on why: It can have life-saving effects.

What Did the Study Find?

A U.K. study published in the Annals of Family Medicine conducted through the University of Cambridge found that type 2 diabetes patients experiencing greater empathy in the year following their diagnosis saw beneficial long-term clinical outcomes.

To come to this conclusion, researchers analyzed questionnaires of 628 individuals in the Anglo-Danish-Dutch Study of Intensive Treatment In People with Screen Detected Diabetes in Primary Care. The surveys taken one year after diagnosis addressed patients’ perception of practitioner empathy during the preceding year. They also received follow-up care for an average of 10 years.

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Of the participants, 19 percent experienced a cardiovascular disease event during the subsequent 10 years, and 21 percent died during this period from causes such as cancer and heart attack.

Researchers found those who reported more empathetic experiences with their PCP had a 40 to 50 percent lower risk of mortality during the 10-year follow-up compared to those who reported lower empathy from their PCP. Those who reported lower empathy also had a higher risk of cardiovascular disease events, though this data point was not statistically significant.

What Does the Study Mean for Clinicians?

The extent to which empathy can create positive outcomes surprised even the authors.

“As a doctor, I think empathy is incredibly important, and it’s part of what we learn and what we practice,” Hajira Dambha-Miller, MD, lead study author, told Medscape News UK. “But I wasn’t expecting such a significant finding. A 40 percent lower risk of mortality is more profound than any drug on the market, or any drug in combination on the market. We hypothesized some effects but the level of the effect was much more than I anticipated.”

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While this study focused on patients with type 2 diabetes in primary care settings and was also limited by a small pool of ethnicities, its findings have applications for anyone working with patients on a regular basis — especially those in environments that make them feel scared or uncomfortable. 

How Can Clinicians Improve Their Empathy with Patients?

Even on days you’re struggling, “the reality is you still have to go to work,” notes healthcare professional wellness expert Nathalie Martinek, PhD, who also co-founded the SafeSpaceHealth app. She offers the following tips to make sure you’re still communicating empathy, which is often the first casualty of clinician burnout.

Notice when your empathy is fading.

The first sign is that you’ll feel a lot of exhaustion and judgement, especially of patients’ behavior. “You’ll notice a tendency to criticize — maybe not verbally, but it’s in there,” Martinek explains. “When you’re judgmental, you’re not a safe person, and patients with complex illness really need safety.” To remedy this, you need to reframe your way of thinking about patients.

Ask about your patient’s story.

“Having a patient speak their story and witnessing it is the most powerful thing any healthcare professional can do,” Martinek says. “It creates a connection that energizes both parties.” Some good starting points including asking about their life beyond their illness and what they do in life to overcome illness. This reminds you of their strength and promotes empathy.

Remember you’re not responsible for your patient’s decisions.

You can’t control how your patients handle their own health. “You’re only responsible for the part you play in helping them feel cared for and at ease,” Martinek advises. When you feel like judging their choices, remind yourself that “everyone makes choices that keep them alive,” she adds.

Focus on one task at a time.

Empathy requires full focus, and multitasking can make putting the patient at the center challenging. Martinek recommends telling yourself, “This one thing is what I’m giving my attention to right now. I’m going to do this one thing really well.” It helps you be present for your patient.

Respond to complaints and concerns with open-ended questions.

“Recognize that if a patient is getting agitated, it’s because they’re not feeling safe,” Martinek explains. Try statements like: “I can see this is really uncomfortable being here, and I can’t imagine what you’re living with. What can I do to make you feel more safe or comfortable?” or “Tell me what’s hard,” and “Can you tell me what’s been going on for you?”

Focus on your breath.

“Breathe through the moment,” Martinek says. “Come back into a centered state. When you’re agitated, you will not be empathic.”

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Notice what’s triggering you.

“There might be times where you’re reminded of painful memories, something you’re not at peace with,” Martinek says. “It’s because there’s something in there for you to look into through therapy or debriefing with colleague.” Other common triggers include implicit biases, such as race, gender identity, educational attainment, age and sexual orientation, she adds.

Talk about difficult patient encounters.

You don’t even need to seek advice — just seek the ear of a trusted colleague. Why? “If you don’t disclose, it just eats away, and that’s one of the things that kills off empathy,” Martinek explains.

Understand what it means to be empathetic.

Empathy is not about placing yourself in someone else’s shoes as we’re often taught, Martinek says, because at the end of the day, that simulation is still about you. “It’s being focused on another person, imagining what it’s like for them, appreciating how they’re living with their experience. It requires curiosity.”

“Without empathy,” Martinek adds, “you feel like you’re just going through a bunch of tasks.”

References:
Association Between Primary Care Practitioner Empathy and Risk of Cardiovascular Events and All-Cause Mortality Among Patients With Type 2 Diabetes: A Population-Based Prospective Cohort Study, Annals of Family Medicine.
GPs Reducing Diabetes Mortality with Empathy, Medscape.

Last updated on 10/9/19.

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