More Strategies for Expressing and Teaching Empathy

In a previous EmpathyWorks blog post, I addressed the question, "Can you actually teach empathy?".  As i noted in the column, the answer is a resounding, "Yes!" , at least for medical students and health care professionals.

Research has demonstrated that courses like, "The Healer's Art", (see: The Healer's Art webpage),  developed by Rachel Remen at the University of California San Francisco, profiled in EmpathyWorks, and also in a New York Time feature article, are effective in promoting humanistic attitudes and practices among medical students.  

Rachel Remen

And  there is strong evidence that skill training and practice can promote patient-centered skills, including empathy, among practicing clinicians. (See:.http://www.ncbi.nlm.nih.gov/pubmed/23235595)

Motivational Interviewing skills were featured in my previous post on strategies for teaching empathy. 

Another strategy for helping students and clinicians learn how to respond with empathy has been disseminated by Robert C. Smith, MD and colleagues at Michigan State University. The approach, NURS,  is a mnemonic that stands for Name, Understand, Respect and Support. This approach is described in detail in Dr. Smith's textbook, Patient-Centered Interviewing. You can also read an recent article on this approach in the medical journal, Patient Education and Counseling: 

See below for a modified version of the NURS approach, NURSE. The E is for Empower

• Name the emotion - reflect what you heard or noticed non-verbally. 

          Examples include:

• "You feel frustrated..."
• "You're angry....".
• "You seem pretty sad..." 

•  Understand  - express understanding, or normalize, without trying to fix

           Examples include:

• "It's understandable that you are frustrated, considering all you have been through."
• "I  can understand you why you would be angry about...."
• "Many of my patients have experienced deep sadness for a long time after losing a loved one."
• "I think I can understand how distressing this has been for you."

• Respect - affirm and express respect for the patient's efforts to cope 

          Examples include:

• "I'm impressed with your efforts to manage your diabetes, despite the challenges"
• "It's remarkable that you were able to.....".
• "I appreciate how hard this has been for you..." 
• "Thanks for letting me know"

• Support - let the patient know that you are willing to help 

          Examples include:

• "I want to help in any way I can."
• "I am here for you."
• "I am willing to help you get through this".
• "I will work with you to figure out a way to help." (Some educators call this "Partnership")
• "Let's work together to address your concerns" (Some educators call this "Partnership")
• "What can i do to help?"  (Asking this question reflects your willingness to explore how you might be helpful)

• Empower - identify and support strengths and capabilities

          Examples include:

• "What are you currently doing that is helping?"
• "What have you done in the past that has been helpful?"
• "What success have you had?" 
• When strategies are mentioned: "It's good that you have been able to xx"
• "How can you build on previous success?"
• "What else can you do?"
• "Who can help you?"
• "What can i do to support you?
• When resources are identified: "You have been able to identify some helpful resources and sources of support."

As always, i am interested in hearing about your feedback and in learning about your favorite strategies for teaching empathy.

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

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