Connecting with Patients: The Basic Ingredient of Care

While medicine continues to advance, receiving healthcare as a patient is fundamentally a human process. At the center of effective care delivery is a connection between the provider and patient. Yet in the last 25 years many pressures have eroded the quality of this human-to-human healing connection. The good news is that in spite of all the external and very real pressures on the patient provider relationship, research reveals something many of us have known: Providers can learn fairly simple skills that make a large difference.

Many of us dream of a treatment context without escalating pressures, yet we’re probably better off facing reality. Even in the 1970’s when I was a new cardiac nurse, there was not enough time be present and listen while patients discussed their symptoms and fears. In recent years a growing population, the acuity of patients in many treatment settings, and a shrinking provider population has compounded this. Couple that with challenges brought on by insurance billing and electronic medical records and it’s clear why it’s so difficult for the provider and patient to have meaningful, connected conversations. While there is great uncertainty about the future of healthcare in the U.S., there is little doubt that time demands on providers will continue to increase, thus putting the patient provider relationship more at risk for diminishing satisfaction.

Strengthening Connection

Given this reality, the ability to efficiently and effectively connect with patients has become increasingly important. Fortunately, there are simple, practical skills available for providers to develop their ability to be present and listen while accomplishing their electronic health records functions and diagnosing. Just as medical professionals develop medical intelligence, providers must increase their emotional intelligence, thus closing the gap and promoting the human connection.

When I raise this topic with the physician and nurses I coach, there are typically two objections: “I don’t have time”; and, when they are really being honest: “I don’t know how.”

No Time for Empathy

Time pressure is intense. The financial reality of modern healthcare creates a relentless pressure to reach a swift diagnosis and treatment plan, to get the billing codes captured, and to move on to the next patient. These objectives are not conducive to empathy. Professionals often assume that empathy is a time-consuming exercise of drama and has little effect on ultimate health outcome: “If I show caring, the floodgates will open.” Recent research has shown surprising results, however: Empathic expression does not actually take more time if it is accomplished effectively[1][2][3].

In a fascinating study, researchers found that when discussing life-threatening diagnoses, patients offer many opportunities, or openings, for empathic response, and doctors respond to only 10% of these emotional needs. Surprisingly, “When empathy was provided, the responses from patients ranged from 1 to 2 words up to 1 sentence. On the other hand, we did notice that when empathy was not provided, some patients repeatedly attempted to have these needs addressed by creating additional empathic opportunities” [1]. In other words, empathic response may actually save time, and this finding appears in other studies as well [2][3].

Developing Empathy Skills

In terms of skill, it’s easy to understand that medical, and other professionals have focused on technical knowledge. This has become the norm for those steeped in the Scientific Method. They are not generally selected and trained for emotional intelligence, and in fact, little time is spent during medical training on connecting with the patient. These are, however, learnable skills [4]. The most important step in that learning is a connection between provider and patient that can increase healing and decrease time spent.

Let me share a story about connection that stands out. At seven years old, my twin granddaughters are extremely distressed when encountering dogs, to the point of phobia. While they were visiting recently during winter break, just after I gave my husband a new puppy, we had the opportunity to introduce them gently and positively to the presence of the dog.

We were very careful to keep the dog in his pen. On New Year’s Eve, while we were enjoying a celebratory evening, the dog was crying. A moment of connection occurred, and one of the girls, full of fear, but equally full of compassion, turned to me and said, “Let’s let him out of the pen.” This event opened up a world of learning about the positive effects of dogs for both girls.

Likewise, it’s scary to “let the dog out” and enter into an unknown way of interacting. Giving oneself permission to actually feel the empathic connection – the care in healthcare – is the secret to achieving this step. It’s not about a particular set of words or a way of sitting, or a formula of how to touch a patient’s hand. The reason real empathy takes no extra time is that true empathy is not about an action: it’s about a feeling.

More and more research is emerging to show that using skills such as empathy not only reduces patient anxiety, but also improves clinical outcomes [5] and reduces malpractice claims [6]. The data is compelling, but what’s convinced me is the real world experience. In emotional intelligence training, I’ve watched doctors and nurses overcome their fears, connect with their own emotions, and genuinely connect with others. My hope is that all of us, professionals, patients, friends and family, will remember that we have the fundamental ability to connect, to experience what it means to be fully human, to care – and this caring is ultimately both simple and profound.

References

[1] Morse DS, Edwardsen EA, Gordon HS. Missed Opportunities for Interval Empathy in Lung Cancer Communication. Arch Intern Med. 2008;168(17):1853-1858. doi:10.1001/archinte.168.17.1853. http://archinte.jamanetwork.com/article.aspx?articleid=414476#ref-ioi80080-2

[2] Roter DLHall JAKern DE et al. Improving physicians’ interviewing skills and reducing emotional distress: a randomized clinical trial. Arch Intern Med 1995;155 (17) 1877- 1884

[3] DiMatteo, M. Robin; Hays, Ron D.; Prince, Louise M. Relationship of physicians’ nonverbal communication skill to patient satisfaction, appointment noncompliance, and physician workload. Health Psychology, Vol 5(6), 1986, 581-594. doi: 10.1037/0278-6133.5.6.581

[4] Fariselli et al (2006). Increasing Emotional Intelligence, staging.6seconds.org/tools/sei/research

[5] Canale, Stefano Del MD, PhD; Louis, Daniel Z. MS; Maio, Vittorio PharmD, MS, MSPH; Wang, Xiaohong MS; Rossi, Giuseppina MD; Hojat, Mohammadreza PhD; Gonnella, Joseph S. MD (2012) The Relationship Between Physician Empathy and Disease Complications. Academic Medicine.

[6] Physician-Patient Communication: The Relationship With Malpractice Claims Among Primary Care Physicians and Surgeons, Levinson et al (1997) JAMA. 1997;277:55.3-M9

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