A Short Video on Empathy Featuring Brené Brown

Sue Raffa, PhD, a colleague at Alpert Medical School, Brown University,  recently shared a wonderful animated video on empathy with me. The brief video was created by the Royal Society of the Arts (RSA) and features Brene Brown, PhD, LMSW, a research professor at the University of Houston Graduate Colleage of Social Work.

You can find the video at: https://www.youtube.com/watch?v=1Evwgu369Jw

The video offers a wonderful, quick,and amusing lesson on empathy and how if differs from sympathy. 

I particularly like Dr. Brown's  reference to the 4 key qualities of empathy:

1. perspective taking
2. staying out of judgement
3. recognizing emotion; and
4. communicating what you notice

I also like her idea that empathy "fuels connection", contrasted with sympathy, which "drives disconnection". Empathy, she states, can be operationalized as "feeling with" other and requires a "vulnerable choice". She adds, "To connect with you, I have to connect with something in myself that knows that feeling", which can be painful. Empathy, she notes, is not about trying to make things better, it's about being present and expressing understanding to a person who is struggling>

"Rarely can a response make something better....what makes something better is connection."

Awesome! 

Rachel Remen, The Healer's Art, and Healing Healers

Two recent columns in the New York Times by David Bornstein highlight the work of Rachel Remen, MD, a physician, healer, educator and writer whom I deeply admire and respect.

David Bornstein is a journalist who has chronicled the impact of social entrepreneurs (I love his book, How to Change the World).  David writes a blog for NYT called "Fixes". In his September 18, 2013 column, Medicine's Search for Meaning, he writes about burnout among physicians that results from the challenges of practicing medicine in the current environment, one that focuses on productivity and treatment outcomes, rather than on meeting the emotional and functional needs of patients. To paraphrase:

"....healing involves far more than knowledge and skill. The process by which a doctor helps a patient accept, recover from, adapt to, or endure a serious illness is full of nuance and mystery......Great doctors don’t just diagnose diseases, prescribe medications and treat patients; they bring the full spectrum of their human capabilities to the compassionate care of others....."

Bornstein also writes:

"As administrative and documentation burdens have exploded in the past three decades, doctors find themselves under pressures to work as quickly as possible. Many have found that what is sacrificed is the very thing that gives meaning to the whole undertaking: the patient-doctor relationship."

Bornstein quotes medical educators who note that these burdens produce high levels of distress, depression, loss of satisfaction, fatigue, and burnout, producing "medical errors, substance abuse, and doctors quitting" and asks,  "How could we help medicine overcome its own illness?"

Bornstein answers his own question by describing work of Rachel Remen, who, as I noted in my introduction, has been a source of inspiration and healing for me for many years. Rachel is a wonderful clinician, educator and writer who has dedicated her career to meeting the broad biopsychosocial and spiritual needs of her patients. Through her writings and trainings, she has also helped practicing clinicians, as well as clinicians in training, to recapture the core values...the "meaning" ... that often led them to choose medicine or nursing as a career.

The Healer’s Art course was developed by Rachel over 2 decades ago at the University of California, San Francisco medical school. As David writes, The Healer's Art:

"is predicated on the idea that medicine is an ancient lineage that draws its strength from its core values: compassion, service, reverence for life and harmlessness. When students  derive meaning and strength .....[from these values, they] can 'immunize' themselves against the assaults of the medical curriculum and even the health care system itself."

The Healer's Art has now spread to dozen's of medical and nursing schools in the US and to a growing list of professional schools around the globe.

A similar program for practicing clinicians,  Finding Meaning in Medicine (FMM), provides a supportive forum for exploring core values and sharing positive experiences related to working with patients. I was a member of a FMM group for a few years and found it highly enlightening, rewarding and satisfying. Though I left the group when I changed jobs, I am still longing for participating in a group years later.

There were so many poignant and heartfelt responses by clinicians to the Sept 18th column that David wrote a follow-up column, Who Will Heal the Doctors?. This produced even more responses, reflecting the need for more programs like The Healer's Art and FMM.

As I noted in my comment, my heart goes out to all my colleagues who continue to make daily sacrifices to care for their patients, providing every ounce of compassion they can in the few minutes they have with patients.

I have been planning to attend the Healer's Art training program at Commonweal for several years now so I might serve as a facilitator of the program at Brown University's medical school. Just yesterday, I made a commitment to apply to attend the 2014 course, with Rachel, at The Institute for the Study of Health & Illness (ISHI). I am already excited about attending and experiencing some healing myself.

See more on Rachel, The Healer's Art, FMM and ISHI at:

www.rachelremen.com 

www.ishiprograms.org

www.theheartofmedicine.org

Danielle Ofri's Reflections on Fear Triggered by Illness

Danielle Ofri's recent column on Slate, the online magazine, addresses the topic of fear that results from uncertainty and the risks associated with medical illnesses and procedures, even minor ones. Danielle shares the distress and acute fear she experienced as a mom when her young son required minor ear surgery. Even though, as a physician, she understood that the risk of the procedure was low, she nonetheless imagined the worst and became gripped with raw fear that  didn't abate till her son was fully recovered from his surgery.

Dr. Ofri's distress during that minor ordeal increased her awareness of the needs of her patients and their family for her  support, empathy and compassion during episodes of illness, especially when tough medical decisions need to be made. As Danielle points out, the process of shared decision making requires more than information sharing and collaboration. It also requires eliciting and responding to the emotions that are aroused by uncertainnty and risk. As she she beautifully writes, 

"When I sit with a patient now, deciding on a treatment, I still lay out the risks and benefits as systematically as I can. But then I take a moment to acknowledge the raw fear that cannot be assuaged by even the most convincing clinical data. This conversation can’t eliminate the necessary leap of faith. But at least there is some recognition of the stomach-plummeting sensation that occurs" when a decision has to be made.

Thank, Danielle for your enlightening column! I also highly recommend Dr. Ofri's well written memoirs, including her latest book, What Doctors Feel: How Emotions Affect the Practice of Medicine .

EmpathyWorks Has Had 10,000 Views!

On July 11, 2009, I wrote My First Post on EmpathyWorks (click on text to view).

In the 57 posts that have followed, I have shared links and comments about articles, books and research studies on empathy and related aspects of relationship building. Many of my EmpathyWorks posts were links to a column I wrote for MPNforum, an online magazine for people who, like myself, are self-managing, or helping a loved one manage a myeloproliferative neoplasm.

I have enjoyed writing and sharing these tidbits and hope they have provided readers with opportunities to become more aware of the ways in which empathy can be a tool for enhancing understanding and promoting compassion and caring, particularly in health care settings.

I look forward to continuing to continuing to write and reflect on the impact and value of empathy here.

It would be great to have more comments and dialogue with readers, so please feel free to share your thoughts or ideas, either in the comment section on the blog, or via e-mail at goldsteinm52@gmail.com.

Enjoy!

Michael

Don Berwick Urges UK's NHS to Emphasize Empathy

In a report commissioned by the British National Health Service (NHS) to address  concerns about recent slippage in NHS's patient safety and quality ratings, Dr. Donald Berwick  encouraged NHS leaders to focus on empathy, compassion and support for both patients and health care teams.

Helen Riess provides her perspective on the report in her blog post for The Huffington Post- http://m.huffpost.com/us/entry/3757483

Bernie Lown is My Hero

Bernie Lown is my hero and a exemplary role model for physician healers, scientists, and social activists.

As co-founder of International Physicians for the Prevention of Nuclear War, Bernie Lown accepted the Nobel Peace Prize for this organization in 1985. Before that, we was one of the founders of Physicians for Social Responsibility. An accomplished academic cardiologist, he actually has an arrhythmia named after him, the Lown-Ganong-Levine Syndrome. (Please don't ask me to describe it). Bernie is a medical inventor as well. He developed the first direct current defibrillator and still holds an academic position as Professor of Cardiology Emeritus at the Harvard School of Public Health.

For decades, Bernie has been an outspoken critic of the growing medical industrial complex and the business of medicine. He writes eloquently about how these developments contribute to infatuation with and overuse of technology, overtreatment, waste of health care resources, escalating health care expenditures and, most importantly, unnecessary harms to patients.

Now in his 90s, Bernie is still voicing his concerns, as well as encouraging medical practitioners to return to the core values and behaviors that characterized medicine before it became a business. These principles include:

• listen to your patients and to their "stories";
• put patients and their needs, values and preferences at the center of your attention;
• build and nurture healing relationships with patients, using empathy and compassion;  
• evaluate new and emerging technologies carefully and choose wisely;
• engage patients and caregivers in informed and shared decision-making; and
• focus on enabling and empowering patients to help them stay healthy and engage in self-care and self-management.

These principles were the bedrock of good medical care when Bernie, and my dad, completed medical school in the 1940's. I dare say they were core elements of medical training in the days of Flexner and Francis Peabody, when my grandfather trained in the early 20th century. As Francis Peabody remarked in 1927, "One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is the caring for the patient."

Recently, a wonderful interview with Bernie was published on a blog created by Melanie Lown, a communication specialist and Bernie's granddaughter. See: The Lown Conversation.

Melanie is the daughter of Beth Lown, Bernie's daughter, a friend and colleague and a wonderful physician and educator. (See the photo on The Lown Conversation blog of Bernie and 6 year old daughter Beth, taken when Bernie arrived in Boston after accepting the Nobel Peace Prize.)

See also the following sources for more vintage Bernie:

• Lown lecture on Avoidable Harms - 2012
• Bernard Lown's Blog

The Empathic Appreciative Closer

Tonight, after pitching a perfect 8th inning for the American League in Major League Baseball's All Star Game, Mariano Rivera told TV reporter Ken Rosenthal that he appreciated the standing ovation he received from fans, fellow players and even opposing players and coaches from the National League. Choked  up with emotion, Mariano, who is retiring at the end of the season at age 43 after an amazing record setting career that all consider to be the best ever as a closer, told Rosenthal that the experience walking off the mound was "priceless" and "up there" with his experience closing World Series victories.

This show of emotion and sincere appreciation for the adulation he received from fans and peers  is not an unusual response for this great athlete with a huge heart. See the article that appeared in The New York Times today to learn how Mariano has chosen to spend his last day in each of the cities he is visiting this year: http://www.nytimes.com/2013/07/16/sports/baseball/yankees-rivera-spends-his-goodbye-tour-saying-hello.html

Fear + Avoidance + Reflection + Courage = Compassion

My colleague, Anna Reisman, a practicing internist and talented writer,  published a touching,  revealing and instructive New York Times blog post that demonstrates the value of reflective practice. See: The Death House

Anna writes movingly about her angst and ambivlance about visiting one of her patients at an inpatient hospice. Her ambivalence is rooted in her fears and anxieties about what she might experience during her visit, imagining suffering, sadness, hopelessness and a heavy dose of death (.."a steady line of hearses idling in the parking lot like taxis at a train station"..). Her avoidance is also linked, she reveals, to concerns that her patient will be suffering or too ill to acknowledge her presence, and she shares her worries that she will not know what to say to family members who may be present at his bedside. I would guess that most, if not all,  caring and compassionate clinicians harbor similar feelings....I know I have had these fears and anxieties when I was clinically active and had patients who were dying. However, Anna also feels a strong desire to visit her patient to pay her respects and provide some measure of comfort to the patient or his family. So, she wills herself to visit the hospice, where she is pleasantly suprised to find a homey, supportive and even healing environment, and, most importantly, a patient who is grateful for her presence. I was deeply moved by her prose.

Anna's courage to share her inner thoughts and feelings in her blog is remarkable, and courageous. As you might expect, her post has stimulated many comments, and though most commend her for her compassion, there are also several posts that judge her harshly for having and sharing negative thoughts and feelings about the hospice. This is unfortuante, as I believe these critics are missing the point. The fears and worries that Anna reveals are ubiquitous among clinicians. These feelings often lead to avoidance of patients during the last stages of life, which is unfortunate for both patients and clinicians. Taking the time to reflect and acknowledge  the feelings, in a non-self punitive way, is a step towards challenging them and summoning the courage to confront them. The result is often highly rewarding, and, hopefully,  reinforcing.

I hope Anna's post will stimulate others to be mindful and perhaps help them free up their inner capacities for empathy and compassion.

Does Empathy Produce Poor Moral Decisions? I Think Not!

In the May 20th issue of the New Yorker, Paul Bloom argues that empathy can lead to irrational decisions that are "parochial" and "narrow-minded". He concludes that, "a reasoned, even counter-empathetic analysis of moral obligation and likely consequences is a better guide to planning for the future than the gut wrench of empathy."

However, I agree with the point of view expressed by Michael Zakaras in his blog post, The Case Against the Case Against Empathy, which appeared on the Huff Post World on May 16th. Zakaras reminds us that empathy is more than just a gut reaction; empathy involves cognitive processes similar to imagining and perspective taking.  As Zakaras notes, empathy "requires careful thought, self-awareness, and real listening."

Zakaras continues, "But to truly empathize is not easy. In this sense Bloom is right: we're more likely to do so with those who look and think like we do. So rather than dismiss empathy, why not commit ourselves to practicing it more deliberately and more often, and expanding our spheres of empathy to those who are not just different but who challenge some of our very own moral foundations?"

I agree strongly with Zakaras. We need to practice and deepen our capacity for empathy. And, we must also use the understanding gained from empathy to choose and act wisely. As my colleague Vaughn Keller taught me, compassion is empathy in action.

I Love This Story: College Commencement Speaker Emphasizes Empathy

I love this story!  Empathy can fuel motivation. When combined with passion and persistence, wonderful things can happen! College Commencement Speaker Emphasizes Empathy - The Hoya

The Value of Teaching Empathy

See this thought provoking article from Forbes, Teaching Empathy: The Ancient Way is Now Cutting Edge,  on the importance of teaching empathy and emotional intelligence skills.Though the focus in on teaching children, the points made in this article apply to any educational setting.

Obama Makes Empathic Appeal for Empathy in Israel

M
See the blog from CNN for an excellent article on President Obama's empathic appeal for empathy for Palestinians.
CNN empathy-president-gives-an-empathy-speech

Watch this Wonderful Video: "Empathy: The Human Connection to Patient Care"

Empathy is an essential element of quality health care. This video (Empathy: The Human Connection to Patient Care) simply, and beautifully, illustrates the value of seeking to understand others' experience. Listening, noticing, exploring and responding helps us to build healing connections with patients, family members and  caregivers. Empathy also helps those of us who are privileged to work in health care settings to know and support each other.

The video was published on YouTube on February 27, 2013 with the following information:

Patient care is more than just healing -- it's building a connection that encompasses mind, body and soul.

If you could stand in someone else's shoes . . . hear what they hear. See what they see. Feel what they feel. Would you treat them differently?

CEO Toby Cosgrove, MD, shared this video, titled "Empathy," with the Cleveland Clinic staff during his 2012 State of the Clinic address on Feb. 27, 2013.

 

The Empowered Patient - Shared Decision Making: Should I Have a Stem Cell Transplant?

In my The Empowered Patient column in the January 15th issue of  MPNforum, I provide some thoughts about the difficult decision that people with myelofibrosis face regarding having a hematopoietic stem cell transplant. See: The Empowered Patient - Stem Cell Transplant

It's Not Too Late to Make New Year's Resolutions

Just because it is already January 10th doesn't mean it is too late for New Year's Resolutions. See the link below to my Empowered Patient columnin the MPNforum for some ideas about how to make your New Year healthier.
http://mpnforum.com/michael-dec-17/

New Look for 2013

For the New Year, I changed the template for EmpathyWorks. I think it is a cleaner and more readable look. Let me know what you think.

Happy New Year!

Michael