Tuesday, 7 April 2009

Empathy, caring, emotion, communication and learning

Oh, a long time since my last post again. Yet, again I have many things going round in my head and holding my attention for variable lengths of time. It is a chaotic narrative an one which may disturb you if I share it in its entirety:) So instead I will mention some parts.

Today, I got news that a colleague and myself have won an ASME small grant to explore how students might learn from the patient's online voice. We're starting with students- what do they think they learn from reading patient narratives in forums and blogs and what do they think of this process. I wonder if reading the way that people talk to each other about health and illness online will help students develop empathy for patients.

There are a lot of questions around empathy that I would like to be able to answer:
  • What is empathy?
  • How is empathy different to sympathy?
  • How do we feel what another is experiencing?
  • Is empathy necessary to be a good doctor?
  • Is too much empathy bad?
  • Can we help students develop empathy? And should we?
  • How do others know we feel empathy with them?
  • Can we fool others into thinking that we feel empathy for them when we don't?
  • Can we understand an experience we have not been through?
I used to think I knew the answer to many of these questions but as is the nature of these things when you start reading and thinking more you start having more questions, and you realise that the questions you thought you had answered have not really been dealt with.

So in my next few blog posts I will endeavour to discuss some interesting papers that I have come across in the last few months and I hope that we can discuss them together.


  1. Kia ora Anne Marie!

    This is an interesting set of questions. I'm not a medical doctor. I'm a teacher. I recognise that there is a need for empathy in teaching as there is in medicine.

    I've studied empathy - not in a traditional (degree or diploma) way - as I have had certain life experiences that have forced me to think about this aspect of human sensitivity. Empathy is sensitivity to understand sympathetically the feelings of other people and the ability to reflect that sympathy effectively so that it is recognised.

    Can it be taught?

    I wonder if empathy can be learnt, though I am aware that it should be possible to learn the behaviour and actions that are associated with empathy (this applies to your valid question, "Can we fool others into thinking that we feel empathy for them when we don't?")

    The book with the tacky title "How To Win Friends And Influence People", by Dale Carnegie, is actually an extremely good study of human behaviour. In it there are descriptions of how observation and sympathy as well as a few skills of astuteness can bring about a behaviour that can pass off for being genuinely empathetic.

    The natural empath

    Some people have a natural proclivity for being truly empathetic, though they may well not be aware of the sensitivity, skill and ability they have. Others, who have some elements of this useful sensitivity that's required, can learn to use it to the best advantage through observation and learning how to respond to the signs once recognised, and through practice.

    The autistic can learn, by this same process, how to communicate their feelings, for often the autistic person has the feeling and the sympathy, but does not necessarily understand how to convey these to another.


    Like active listening, which can be taught, the behaviour that goes with empathy can be learnt by someone who is aware and sensitive enough, by improving their observation skills in a way that is echoed by their body language - facial expression, tone of voice, choice of words, demeanour, etc.

    Just as tact can be acquired with good grooming, empathy can be given an acutance through appropriate training. It has a subtlety that is certainly not mechanical, for such reaction belies the pseudo-empath.

    The true empath has all of the skills, abilities and sensitivity I mention here. Those with the abilities alone can learn the skills and become (more) empathetic. But just the skills, no matter how they are practised, will not necessarily achieve empathy.


    The skill of the online empath is possibly a set of behaviours that can be learnt. But like the plausible face to face equivalent, someone with this training and experience also requires all the other skills associated with genuine empathy to be truly empathetic online.

    Catchya later
    from Middle-earth

  2. Hi Ken
    Thanks for your great reply. Thinking about Dale Carnegie. Would any business person admit to following his rules now at a time when everything is meant to be about transparency?
    Anne Marie

    PS I intend to post some more about all of this and really good to know you are reading.

  3. Hi Anne marie,

    I was reading an article in this weeks NZ Listener magazine, 'Nurses, The Lost art of caring? Calls to restore compassion'. Whilst this article mentions compassion I believe empathy and compassion are inter related when providing care for someone who is sick and vunerable in a bed or sat with you during a consultation. One can only truly display compassion when you have the ability to empathise.
    I remember my nurse training and there was a great deal of emphasis placed upon empathy (the ability to place oneself the other persons shoes) rather than sympathising, which can seem patronising. It was seen as good nursing practice to put yourself in the patients place and see things from their perspective to gain and understanding of what their needs are.
    Auckland Anaesthetist, Robin Youngson started the Compassion in Healthcare Trust in New Zealand after what he felt was the lack of compassionate care his daughter recieved unbelieveably in the same hospital he actually worked in when she came in following a very bad car accident which left her with two smashed vertebrae.
    He describes the usual story meals brought into his daughter`s room left for an hour and then taken away again uneaten because noone had made sure she could even reach the meal never mind come in to help her eat it!
    He actually complained about his own hospital to the Health and Disability Commisioner but he was unable to find a breach in the rights under the code of care that is currently available. He does state though that most of the complaints that reach his office are centred around the nurses taking a "mechanistic approach to their role".

    is the web site that came about the trust Dr Youngson set up following the care his daughter received.

  4. Hi Pam
    Thanks for commenting. We have a piece coming out in the BJGP about whether or not it matters if your doctor cares about you. I'll link to it when it is published. I think it is still a debatable issue but something we haven't been talking about too much. I am fascinated by all aspects of empathy and compassion. I guess it is a big part of the reason I chose medicine as a career and now I wonder when we can do to help students.
    Thanks for the link.
    I will check it out:)

  5. Kia ora Anne Marie!

    You say, ". . . about Dale Carnegie. Would any business person admit to following his rules now at a time when everything is meant to be about transparency?"

    Dale Carnegie's book was written for a different culture and in different times. While I certainly would not advocate anyone using the book as a set of rules, I would recommend that it is a wonderful study in human behaviour. Allan Pease's books on body language are in the same league.

    I don't believe we should dismiss (past) observation and deduction just because culture has evolved when times have changed. There are some things about human nature and behaviour, for instance, that span the ages, which is why we are still learning from the writing of Shakespeare though we are also aware that culture has changed with the times.

    I would be prepared to believe, however, that a few business people will have Carnegie's book tucked away in a drawer somewhere. In fact, I know they have. Do you keep your books in a drawer? Not me :-)

    Catchya later
    from Middle-earth

  6. Loving this discussion, and look forward to following your journey as you explore these issues further, Anne Marie.

    Thinking about our undergrad education - we teach ' communication' which of course, includes empathy, but I am not sure we think about empathy in a lot of depth. Like Ken, I think that some people have natural ability, whereas others can be taught to be good communicators - teach people to be empathetic-I am not sure if you can do that.

  7. Hi, Anne Marie!

    I think the crux of the problem is the practitioners that medical students train with. I'm a final year in Sheffield and even though we have 12 weeks of general practice over two separate sessions, that leaves around 2.75 YEARS of training in hospital.

    My own opinion is that in-hospital practitioners are less empathic because the prevailing attitude is that patients are problems to be solved. The 'House MD' way of looking at things still prevails amongst many practitioners - particularly surgeons but equally amongst medical physicians. Students are 'taught' empathy but equally, are (not overtly) dissuaded from feeling it, talking about it and dealing with it. The pressure is to deal with the 'real' problems - the broken leg, the tweaking of medication doses - and ignore the 'BS' - the trauma of losing a child or partner (unless they can be referred for CBT).

    Contrasting hospital care to general practice, the existence of a lasting relationship between doctor and patient means that these concerns have to be taken more seriously simply because the patient is a recurring figure in the doctor's professional life. In other words, it makes sense to deal with these patients as people, rather than as problems.

    Now, this theory of mine (as weakly-backed by evidence as it is!) holds some water, I feel, since patients who are seen in clinic regularly are treated differently by consultants. These patients' problems are listened to, their concerns are heard and dealt with as much as is possible. Time constraints exist with patients on the ward, as well, but for some reason, (perhaps worries about confidentiality and privacy?) they are not covered as completely.

    Medical students can be taught to reflect and encouraged to empathise by the medical schools as much as possible. But while they are taught as apprentices by overworked and jaded physicians and surgeons who may not have time to empathise as much as they'd like to, true empathy remains out of reach.


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