Role of empathy in healthcare systems

Studies have shown that empathy declines during medical training and without targeted interventions, uncompassionate care and treatment devoid of empathy results in dissatisfied patients

Empathy plays a critical interpersonal and societal role, enabling sharing of experiences, needs, and desires between individuals and providing an emotional bridge that promotes prosocial behavior. This capacity requires an exquisite interplay of neural networks and enables us to perceive the emotions of others, resonate with them emotionally and cognitively, to take in the perspective of others, and to distinguish between our own and others’ emotions. Studies have shown that empathy declines during medical training and without targeted interventions, uncompassionate care and treatment devoid of empathy results in dissatisfied patients who are unlikely to follow through with treatment recommendations, resulting in poorer health outcomes and damaged trust in health provider relationships. In the past, empathy was considered an inborn trait that could not be taught, but research has shown that this vital human competency is mutable and can be taught to health-care providers. The evidence for patient-rated empathy improvement in physicians has been demonstrated in pilot and retention studies and a randomized controlled trial. Further evidence that communication skill training for physicians improves patient satisfaction scores was reported in a large-scale observational study. Empathic medical care is associated with many benefits including improved patient experiences, adherence to treatment recommendations, better clinical outcomes, fewer medical errors and malpractice claims, and higher physician retention. Why is the human brain designed for this complex, intricate task? If human existence was simply the result of “survival of the fittest,” we would be wired solely to dominate others, not to respond to their suffering. Our capacity to perceive and resonate with others’ suffering allows us to feel and understand their pain. The personal distress experienced by observing others’ pain often motivates us to respond with compassion. The survival of our species depends on mutual aid, and providing it reduces our own distress. Mutual aid exists in the earliest reports of tribal behavior and remains a powerful force in today’s world, where thousands of organizations and millions of people work to relieve global suffering.

Research in the neurobiology of empathy has changed the perception of empathy from a soft skill to a neurobiologically based competency. The theory of inner imitation of the actions of others in the observer has been supported by brain research. Functional magnetic resonance imaging now demonstrates the existence of a neural relay mechanism that allows empathic individuals to exhibit unconscious mimicry of the postures, mannerisms, and facial expressions of others to a greater degree than individuals who are unempathic. Patients unconsciously mimic the actions and facial expressions of others through brain mechanisms that mirror the actions of others by stimulating the same motor and sensory areas in the observers’ brains as the person they are observing. This mirroring capacity has been demonstrated at the level of single muscle fibers. If a person’s hand muscle is pricked by a fine needle, for example, the same motor and sensory areas are activated in the brain of an observer.

Studies also demonstrate that while patients are either imitating or simply observing emotional facial expressions, activation of a similar network of brain areas occurs in the observer. Within this network, there is activity during simple observation of emotional faces, and greater activity during imitation of emotions. In addition to inner representations of others’ facial displays, shared neural circuits have also been demonstrated for tone of voice, touch, disgust, and pain. Researchers conclude from these studies that observers feel what others feel to an attenuated degree. This is achieved through a mechanism of neural action representation that often modulates observers’ own emotional content and motivates empathic responses. Differences in these neural processes may account for different individual capacities for empathy.

We actually do feel the pain of others, but only in an attenuated form. Attenuation makes it possible to empathize but not become overwhelmed with another’s personal distress. Our own distress would likely render us less helpful. Indeed, there is a balance between empathy leading to helping or distancing behaviors due to personal distress. An important balance must be struck by ensuring that health-care providers receive enough care, support, and empathy from their institutions in order to provide high-quality empathic care and to benefit from the positive side effects of empathy.

A cardinal feature of empathy is that it usually helps connect people to others. Because of the evolutionary development of this brain-based capacity, affective empathy, or emotional sharing, most easily occurs among members of the same “tribe”. Individuals tend to have the most empathy for others who look or act like them, for others who have suffered in a similar way, or for those who share a common goal. We see these biases play out repeatedly in communities, schools, sports teams, and religious communities. The truth of the matter is that empathy is not always an equal opportunity benefactor. People are evolutionarily wired to recognize and respond to differences and socially or culturally based perceptions can trigger subconscious fears that threaten emotional homeostasis.

Empathy is a factor that draws individuals to helping professions and plays a critical role in understanding the nuances of others’ experiences. Empathy is a complex capability enabling individuals to understand and feel the emotional states of others, resulting in compassionate behavior. Empathy requires cognitive, emotional, behavioral, and moral capacities to understand and respond to the suffering of others. Compassion is a tender response to the perception of another’s suffering. Compassion cannot exist without empathy, as they are part of the same perception and response continuum that moves human beings from observation to action.

Self-empathy is a much neglected area and is necessary to ensure that health-care workers have the necessary resources to remain empathic toward others. Human beings have intricate, shared neural circuits in motor, sensory, and emotional (limbic) areas of the brain to help them understand the experience of others, leading to helping behaviors. However, when emotionally overloaded, overwhelmed, exploited, or burned out, the capacity for empathy declines as a result of the degree of emotional labor expended. It is critical that as medical professionals and caregivers that we exercise self-care to maintain healthy levels of empathy.

Plato’s ancient question, “Can virtue be taught?” is one to consider at our present day juncture in health care. When newly minted doctors take the Hippocratic Oath on graduation day, they swear to provide ethical and compassionate care for their patients. What can be done to ensure they will keep their promise? Understanding that self-empathy is necessary in order to provide empathic care to others is at the core of wellness programs that are growing in popularity in medical education.

Enterprise wide faculty development programs that include empathy training need to become an institutional priority to preserve and refresh the vitality of our health-care system.

Self-empathy and other empathy lead to replenishment and renewal of a vital human capacity. If we are to move in the direction of a more empathic society and a more compassionate world, it is clear that working to enhance our native capacities to empathize is critical to strengthening individual, community, national, and international bonds. As the Dali Lama so succinctly stated, “Love and compassion are necessities not luxuries. Without them humanity cannot survive”. Let us be the examples in health care that the world may follow.

The writer is Former Head, Department of Medical Sociology, Institute of Epidemiology, Disease Control & Research (IEDCR),

Dhaka, Bangladesh

 

Role of empathy in healthcare systems

Studies have shown that empathy declines during medical training and without targeted interventions, uncompassionate care and treatment devoid of empathy results in dissatisfied patients

Empathy plays a critical interpersonal and societal role, enabling sharing of experiences, needs, and desires between individuals and providing an emotional bridge that promotes prosocial behavior. This capacity requires an exquisite interplay of neural networks and enables us to perceive the emotions of others, resonate with them emotionally and cognitively, to take in the perspective of others, and to distinguish between our own and others emotions. Studies have shown that empathy declines during medical training and without targeted interventions, uncompassionate care and treatment devoid of empathy results in dissatisfied patients who are unlikely to follow through with treatment recommendations, resulting in poorer health outcomes and damaged trust in health provider relationships. In the past, empathy was considered an inborn trait that could not be taught, but research has shown that this vital human competency is mutable and can be taught to health-care providers. The evidence for patient-rated empathy improvement in physicians has been demonstrated in pilot and retention studies and a randomized controlled trial. Further evidence that communication skill training for physicians improves patient satisfaction scores was reported in a large-scale observational study. Empathic medical care is associated with many benefits including improved patient experiences, adherence to treatment recommendations, better clinical outcomes, fewer medical errors and malpractice claims, and higher physician retention. Why is the human brain designed for this complex, intricate task? If human existence was simply the result of survival of the fittest, we would be wired solely to dominate others, not to respond to their suffering. Our capacity to perceive and resonate with others suffering allows us to feel and understand their pain. The personal distress experienced by observing others pain often motivates us to respond with compassion. The survival of our species depends on mutual aid, and providing it reduces our own distress. Mutual aid exists in the earliest reports of tribal behavior and remains a powerful force in todays world, where thousands of organizations and millions of people work to relieve global suffering. Research in the neurobiology of empathy has changed the perception of empathy from a soft skill to a neurobiologically based competency. The theory of inner imitation of the actions of others in the observer has been supported by brain research. Functional magnetic resonance imaging now demonstrates the existence of a neural relay mechanism that allows empathic individuals to exhibit unconscious mimicry of the postures, mannerisms, and facial expressions of others to a greater degree than individuals who are unempathic. Patients unconsciously mimic the actions and facial expressions of others through brain mechanisms that mirror the actions of others by stimulating the same motor and sensory areas in the observers brains as the person they are observing. This mirroring capacity has been demonstrated at the level of single muscle fibers. If a persons hand muscle is pricked by a fine needle, for example, the same motor and sensory areas are activated in the brain of an observer. Studies also demonstrate that while patients are either imitating or simply observing emotional facial expressions, activation of a similar network of brain areas occurs in the observer. Within this network, there is activity during simple observation of emotional faces, and greater activity during imitation of emotions. In addition to inner representations of others facial displays, shared neural circuits have also been demonstrated for tone of voice, touch, disgust, and pain. Researchers conclude from these studies that observers feel what others feel to an attenuated degree. This is achieved through a mechanism of neural action representation that often modulates observers own emotional content and motivates empathic responses. Differences in these neural processes may account for different individual capacities for empathy. We actually do feel the pain of others, but only in an attenuated form. Attenuation makes it possible to empathize but not become overwhelmed with anothers personal distress. Our own distress would likely render us less helpful. Indeed, there is a balance between empathy leading to helping or distancing behaviors due to personal distress. An important balance must be struck by ensuring that health-care providers receive enough care, support, and empathy from their institutions in order to provide high-quality empathic care and to benefit from the positive side effects of empathy. A cardinal feature of empathy is that it usually helps connect people to others. Because of the evolutionary development of this brain-based capacity, affective empathy, or emotional sharing, most easily occurs among members of the same tribe. Individuals tend to have the most empathy for others who look or act like them, for others who have suffered in a similar way, or for those who share a common goal. We see these biases play out repeatedly in communities, schools, sports teams, and religious communities. The truth of the matter is that empathy is not always an equal opportunity benefactor. People are evolutionarily wired to recognize and respond to differences and socially or culturally based perceptions can trigger subconscious fears that threaten emotional homeostasis. Empathy is a factor that draws individuals to helping professions and plays a critical role in understanding the nuances of others experiences. Empathy is a complex capability enabling individuals to understand and feel the emotional states of others, resulting in compassionate behavior. Empathy requires cognitive, emotional, behavioral, and moral capacities to understand and respond to the suffering of others. Compassion is a tender response to the perception of anothers suffering. Compassion cannot exist without empathy, as they are part of the same perception and response continuum that moves human beings from observation to action. Self-empathy is a much neglected area and is necessary to ensure that health-care workers have the necessary resources to remain empathic toward others. Human beings have intricate, shared neural circuits in motor, sensory, and emotional (limbic) areas of the brain to help them understand the experience of others, leading to helping behaviors. However, when emotionally overloaded, overwhelmed, exploited, or burned out, the capacity for empathy declines as a result of the degree of emotional labor expended. It is critical that as medical professionals and caregivers that we exercise self-care to maintain healthy levels of empathy. Platos ancient question, Can virtue be taught? is one to consider at our present day juncture in health care. When newly minted doctors take the Hippocratic Oath on graduation day, they swear to provide ethical and compassionate care for their patients. What can be done to ensure they will keep their promise? Understanding that self-empathy is necessary in order to provide empathic care to others is at the core of wellness programs that are growing in popularity in medical education. Enterprise wide faculty development programs that include empathy training need to become an institutional priority to preserve and refresh the vitality of our health-care system. Self-empathy and other empathy lead to replenishment and renewal of a vital human capacity. If we are to move in the direction of a more empathic society and a more compassionate world, it is clear that working to enhance our native capacities to empathize is critical to strengthening individual, community, national, and international bonds. As the Dali Lama so succinctly stated, Love and compassion are necessities not luxuries. Without them humanity cannot survive. Let us be the examples in health care that the world may follow. The writer is Former Head, Department of Medical Sociology, Institute of Epidemiology, Disease Control Research (IEDCR), Dhaka, Bangladesh