It may sound like common sense to you and to me, but that wasn’t what I heard at the mandatory five-hour communication course. Instead, I heard that we need to use certain shortcuts and magical phrases to convince patients of our compassion. Of course, there are no shortcuts in life. What we must do to uphold the patient-clinician relationship is to foster empathy. But if mandatory, five-hour training can’t solve it, how do we do accomplish that?
3 Types of Empathy
The first step is to recognize the different components of empathy. Daniel Goleman and Paul Ekman, two preeminent psychologists, have proposed that there are three components of empathy: cognitive, emotional, and compassionate.6 Before we try to build our empathic skills, perhaps it is important to see how we can advance and balance these three components.
Cognitive Empathy
The first component, cognitive empathy, consists of knowing how the other person feels and what they may be thinking. This kind of perspective taking is highly cerebral and has to be done with intense self-scrutiny. In the rheumatology clinic, we can never really truly know how the other person feels; we can only imagine it based on what they tell us and show us. In the mandatory five-hour communication training, they told us to use a very potent tool of labeling others’ emotions (e.g., “It sounds like it was a painful experience”). Perhaps studies have shown that this improves patient satisfaction scores, but does it really improve our sense of cognitive empathy? I would say no. I would say that there is only one way to develop cognitive empathy and that is through attentive listening.
This listening cannot be the passive listening of turning oneself off and being idle, but rather the active listening of trying to foster bonds and relationships, searching deep within one’s heart to find a sense of affinity.7 All of us have experienced pain but no two painful episodes are alike. But tying one’s own pain to another’s pain is a way to get a glimpse of what they may feel. Even more important is to listen attentively to stories—the narrative structure that frames how we intuitively look at the world around us. Understanding how one aspect of the story links to another and how these plot elements—for lack of a better term—create an emotional resonance is vital.
We are all familiar with the medical process of history taking. It has been part of Medicare’s guidelines.8 Yet history taking is not the correct term to frame our efforts to foster cognitive empathy. Rather, let us start calling it for it is: storytelling. To foster cognitive empathy, let us empower our patients to tell us their stories—uninterrupted. Let’s ditch the clichés, such as “I feel your pain” and “Oh, I can only imagine,” that corporate coaches have reduced to meaninglessness in patient rooms. In storytelling, let’s hear not only about the symptoms, but how the symptoms affected the course of their lives. That way, we can gain perspective and move to the next component of empathy.
