machado: empathy is good for us and for healthcare professionals. yet, here we are
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a lack of empathy affects not only the relationship between a doctor and patient and patient satisfaction, but also the way things turn out.
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the man who ordered a chai latte with soy milk wanted to know if he was naive, unreasonable or just had too-high expectations.
he was unwrapping a black scarf from around his neck while describing his first appointment with a cancer specialist at a downtown hospital. he had arrived at the cancer clinic with an anxious pit in his stomach and limited information about his health. he knew he had some kind of cancer — his family doctor had guessed as much from a routine blood test. the doctor had also offered a couple of best predictions as to what type based on symptoms and white cell counts, but emphasized that an accurate final diagnosis laid in the hands of an expert and a technician at the kind of complex lab that only exists in hospitals.
several google searches had happened in the days leading up to the appointment with the expert. hours spent reading and rereading copious lists of the signs and symptoms of every possible kind of cancer, teetering between the breathtaking fear that came with learning about those with poor prognoses and cautious hope that he had the other kind — the ones that came with a fair chance, maybe treatment, but most of all, time.
as it is with most of us when we brace for bad news, he felt something not unlike the nervous — sometimes cruel — anticipation of being on a roller-coaster perched at the top of a steep hill. you know it’s inevitable that you are going down, and you really don’t want to, but it’s impossible to get off. and despite the fear, you also know that the sooner you go down, the sooner you will know how bad things really are and the brutal waiting period will be over. you will finally get to see how it ends.
except that when he sat down in the examining room to hear the diagnosis — tears in his eyes — he was told about a clinical trial instead. something about a new drug that was showing lots of promise. all this before even knowing whether he was most likely to live or die.
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“then i asked, ‘promise for what, though?'” he said, taking a big gulp of his latte. he went on to describe how he had to raise his voice a little to focus the discussion on the information that was most important to him. “can you believe that i was being asked to join a clinical trial and i didn’t even know what kind of cancer i had?”
well, yes, yes i can. in fact, just last week, someone being treated for early-stage breast cancer recounted how her doctor told her to stop crying because things could be worse. and then there was the guy at a conference last month who shared a story about how he told his doctor that he was worried that new daily headaches were a sign that brain cancer had returned — staring at his doctor’s back the whole time as he typed at his computer.
say what you want about long wait lists and overcrowded waiting rooms and burned out staff, but this sort of sloughing off of worry, concern and empathy has nothing to do with a healthcare system that’s barely standing. rather, it’s about a healthcare professional unable to take a moment to consider the human in front of them.
consider the doctor in the first case. he is well-known, with lots of big letters behind his name, a healthy supply of lauded acceptances to journals and published abstracts, effective at figuring out ways to treat disease and save lives. these are all qualities you want in the person leading your charge towards survival. other words used to describe him include: “lacking in a bedside manner;” “fast;” and “removed.” as one of his patients put it, “if you are looking for a long hug and a tissue, he’s not the one for you.”
but doesn’t that have an important role to play in what it means to care for someone? perhaps not literally a hug and a tissue, but metaphorically: empathy, compassion and concern. answering questions, noticing and acknowledging tears, and talking out worry and fear. in other words, reading your room.
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certainly, it doesn’t come naturally to everyone. in fact, it’s well-known among patients that doctors who treat very aggressive diseases — the kind that kill — are not always the most sympathetic when it comes to comforting those with diseases that likely have a good ending. save your tears, man, things really could be worse, is generally their vibe. still, fear is relative, and as the man with the latte — who, as it turned out, has a type of cancer that can be treated — will tell you, any cancer diagnosis is terrifying and patients deserve the space to cry, grieve and be frightened. and the burden of it all made a little lighter by an expert, if only because they can.
but it’s not only about identifying just one more way life as a patient can be made better or why sometimes being the one who is sick, tired and vulnerable is so much more difficult than it has to be. a lack of empathy, compassion and the inability to comfort is bad for business. in fact, it is of “great importance,” as one study put it, affecting not only the relationship between the doctor and patient and patient satisfaction, but also “the quality of patient-centred care” and how things turn out in the end. after all, we know that patients who have an empathetic relationship with their healthcare provider tend to do better than those who don’t.
that’s not nothing. think about it. can you effectively treat a patient without understanding their feelings and opinions?
the flip side though is perhaps even more compelling, especially given the state of healthcare today. researchers have looked at the impact of incorporating empathy into patient relationships and found that less errors are made when appointments are little more warm and fuzzy, but also that empathetic healthcare professionals experience less stress, less depression and less burnout. this study also reported that while a number of factors can affect a physician’s level of empathy, such as number of patients and not enough time, a lack of education in empathy also plays a big role in bedside manner deficits.
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whatever the reason, ask most people who have been in the healthcare system in the last decade or so, and it’s likely they’ll tell you that care that comes with empathy and compassion has been feeling like too tall an order for far too long — definitely long before short-staffing, crowded ers and burnout made headlines. if education needs to happen to make interactions with healthcare professionals a little more dignified, then let’s add it to the very long and growing healthcare system improvement to-do list.
but in the meantime, to the man with the latte who wondered whether expecting to know what his disease was before agreeing to a clinical trial was naive, unreasonable or meant that he had too-high expectations, the answer is no. the woman told to stop crying because her cancer “could have been worse” and the man who shared his darkest fears about recurrence to a doctor who didn’t even look him in the eye, well, these are just more examples of how our healthcare system can fail those that depend on it the most.
more importantly, though, these patient experiences remind us that the quality of our care often depends on our willingness and ability to raise our voices and advocate for ourselves. it’s our lives that we’re trying to protect, after all.
lisa machado is the executive producer of healthing’s advocacy & better health. she can be reached at lmachado@postmedia.com.
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