How Health Care Systems Use Clinical Empathy to Support Patients

by Kelly R. Smith

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Surgeon and nurse operating on a patient
Surgeon and nurse operating on a patient

Introduction: What is Clinical Empathy?

What is clinical empathy? The Journal of General Internal Medicine1 defines it this way, “the act of correctly acknowledging the emotional state of another without experiencing that state oneself.” Note that patients desire empathy from providers, and providers want to make it available. As opposed to the layman’s concept of empathy, professional empathy must be purely cognitive, in contrast with sympathy. Otherwise, the professional risks identifying too closely with the patient, endangering the relationship and clouding the judgement needed for proper medical condition diagnosis and treatment.

Of course, this is not to say that the concept of clinical empathy is limited to the relationship between the provider and the patient (although that is the focus of this paper). It affects the entire medical community in one way or another. It applies to all, from the ophthalmologist to the surgeon and everyone in between.

The Role of Social Media

More patients are going online to discuss what they are experiencing. Such as, “Did you have this side effect from your flu shot? Were you warned?” This is having a relatively new influence on the patient/doctor relationship. The question is – how can this situation be managed in the most productive way possible? Empathy skills can be honed by understanding real-life situations and concerns. In order to get a grasp on what kind of relevant concerns are floating around on the internet, data analysis must be . At first glance, due to the sheer magnitude (and “noise”) of the data set, the problem might seem overwhelming.

This is where specialized software comes into the picture. Specifically, data analysis software that has both the statistical and analytical capacity to inspect, clean, transform, and model data in order to derive important information for decision-making purposes.

What sort of patient concerns crop up often in social media? Wait-time is always a big issue that leads to patient frustration. They see a lot of activity in the hospital or clinic, but nobody has a sense of urgency for their care. Another common concern is doctors and staff that are distracted, aloof, and impersonal. It is also quite common for someone online to seek out others that have had their condition and they want advice or confirmation that their treatment protocol will result in a high level of efficacy. Conversely, some patients reach out to share without being asked. This can be considered empathy in its own right.

Providers have noticed an uptick in this type of social media use during the COVID-19 pandemic. Group norms play a large part in this; while spending more time indoors and online researchers have found that individuals gravitate towards similar age groups, lifestyles, and socioeconomic groups that are similar to their own.

In many cases, the provider realistically can’t spend a great deal of time with one individual, or the volume of information is so large that the patient does not absorb it all. The patient may decide to fill in the gaps, and discover other points of view, via the internet. Social media used properly is a benefit to the medical community.2

Improving Clinical Empathy and Setting a Standard

The first step is to reach a consensus among the group of providers involved. Next is to define the current dynamic. and define specific methods to achieve the level of improvement needed. Some things to consider are:

  • Is there a current system of training for the group to ensure that a standard level of knowledge and application exists.
  • Is emphasis being adequately put on communication skills? There are many times when the provider must deliver negative news to the patient. Empathetic skills are extremely important in these situations.
  • Are providers experiencing “burnout” due to stress, administrative duties, long hours, etc.? This will have an adverse effect on providing empathetic care.

The Importance of Clinical Empathy

The importance of empathy in the provider/patient relationship cannot be overstated. In many cases, a patient who harbors the perception that the provider is not caring or involved will not present sufficient information for a proper diagnosis to be made. Empathy creates a communication bridge between the provider and the patient.

An end-game consequence is fewer situations where a patient does not feel like he or she received the expected level of care. More successful case outcomes translate into greater provider satisfaction and fewer issues with burnout.

What Are Some Relevant Barriers to Achieving Clinical Empathy

  • Lack of emotional intelligence, being unaware that one isn’t being perceived as empathetic.
  • Younger providers during training can seek to emulate more established colleagues who themselves are not empathetic.
  • Trying to balance the need to be objective and the need to show empathy and falling on the left side of the scale. This can be especially problematic when delivering bad news.
  • When a provider is experiencing burnout or has simply become jaded due to the long time spent on the job; enthusiasm to help others can get lost over time.

Empathy Gaps

Empathy gaps occur when the patient has seen his provider but comes away unsatisfied, feeling misunderstood. This can occur when:

  • They feel misunderstood or that the wrong assumptions were made.
  • They feel that the advice was boilerplate rather than personalized.
  • They feel that the level of service was substandard. This can be a problem for doctors that accept Medicare and Medicaid and try to book as many patients as possible.
  • No advise was given for supplements that could help their conditions or interfere with current treatment.

Changing behavior that causes these gaps can be done through MAPS (Motivation Ability Processing). This is formal training that providers go through that touches on areas of concern that have been identified.

Summary

Clinical empathy is not a recent phenomenon but advances in technology present new and powerful tools to identify issues and correct them. A suitable attitude is, “never be satisfied nor complacent.” Empathy has affected the medical community in many ways and is itself being affected by ever-changing conditions. Two of the prominent recent ones are the expanding presence of social media and the COVID-19 pandemic and subsequent lockdown. Ways to alleviate it in order to provide a better experience for the patient and the provider are being explored and implemented.

References

  1. Jodi Halpern MD, PhD. What is Clinical Empathy? Journal of General Internal Medicine. https://onlinelibrary.wiley.com/doi/full/10.1046/j.1525-1497.2003.21017.x
  2. Katherine Chretein and Terry Kind, Social Media and Clinical Care, Circulation, https://www.ahajournals.org/doi/10.1161/circulationaha.112.128017

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About the Author:

Photo of Kelly R. SmithKelly R. Smith is an Air Force veteran and was a commercial carpenter for 20 years before returning to night school at the University of Houston where he earned a Bachelor’s Degree in Computer Science. After working at NASA for a few years, he went on to develop software for the transportation, financial, and energy-trading industries. He has been writing, in one capacity or another, since he could hold a pencil. As a freelance writer now, he specializes in producing articles and blog content for a variety of clients. His personal blog is at I Can Fix Up My Home Blog where he muses on many different topics.


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Loneliness as an Effect of the COVID-19 Pandemic

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Loneliness and depression during the COVID-19 pandemic.
Loneliness and depression during the COVID-19 pandemic

Although the COVID-19 pandemic (or Coronavirus, if you prefer) has caused abundant death, the toll in terms of depression and loneliness is even more widespread. Former Surgeon General Vivek Murthy reffers to it as a “loneliness epidemic.” Spending so much time in isolation wreaks havoc on our emotions. When we do get out, it is increasingly harder to see the person behind the mask; it is essentially dehumanizing. It can cause what has become known as pandemic dreaming.

Our Brains Operate in Two Modes

Matthew Lieberman is a founder of the field of social cognitive neuroscience and he discovered that our brains operate in two distinct modes. He found that one is utilized for engaging with the physical world around us. Looking for shelter when a hurricane is blowing in, for example. The other for is utilized for considering mental states; it views other people in terms of being psychological entities with distinct thoughts and feelings of their own. He used MRI imaging to show that the second mode, what he called the social brain, is actually the default mode. That could explain our some of our current issues with isolation.

We are Wired to Mingle with Our Fellows

Some 2,348 years ago Aristotle told us that man is by nature a social animal. By in large that is true, although introverts are the chemical exception to the rule; they are more governed by a neurotransmitter called acetylcholine, which warms up as they turn their focus inward. Extroverts, on the other hand, are governed more by their dopamine reward network. This is triggered when external stimuli and sensory input happens. In other words, if you are a party animal or used to spend a lot of time at the office moving through the cubical farm gossiping or being a kvetcher, this lock-down is hurting you more that your more taciturn neighbors.

Social Media is a Poor Substitute for Real Interaction

We have all grown used to social media over the years, texts, emails, Facebook, etc. But are these really good substitutes? Not at all, although talking on the phone and Skyping may be marginally better. In fact, social media may make things worse. Just look at how bad and polarized things were even before the lock-down. Does Donald Trump bashing and BLM and Antifa ring a bell? Too many trolls, so little time.

One study conducted in 2018 of 18 – 30-year-olds concluded that the odds of depression were significantly decreased by face-to-face encounters, but significantly raised by interacting via social media. Yet another study discovered that lowering time spent on social media lowered feelings of loneliness in 18- to 22-year-olds.

According to Primack, using social media may be simply a way of projecting a version of ourselves out there or perhaps they’re fostering real social connections we otherwise wouldn’t be able to have. There is just no way to know at this point.

How Can You Cope with Pandemic Loneliness and Depression?

  • Maintain a Schedule. A consistent routine can make things feel more normal. Go to bed at a reasonable hour, use an alarm clock, lunch at noon, tea and scones in the afternoon if you are a subject of the Queen; you get the idea. If you are sick, try keeping a log to monitor your symptoms.
  • Keep Yourself Informed. Staying up to date on health information and advice on precautionary measures will make you feel more proactive and in control of your situation.
  • Learn lucid dreaming. If you are experiencing pandemic dreams, follow these techniques to learn lucid dreaming. I learned it long ago out of curiosity and I’ve been controlling and actively participating in my nocturnal adventures ever since. It is easier for some than others but well worth the effort.
  • Maintain an active lifestyle as much as possible. The authorities want you to stay indoors as much as possible. But, and then this is only my opinion, you can still get out to walk, bike, or run (if allowed where you live). If you must stay in, you can still do resistance exercises with household objects or get up and walk around. My Garmin 235 watch not only counts my steps but also alerts me when I have been sitting too long.
  • Indulge in some self-improvement. Take an online course. Pick up that instrument, dust it off, and start practicing. New Years resolutions are valid anytime. Myself, I’m learning Irish Gaelic. Ta go maith!
  • Stay connected. Use Skype. Watch a Netflix movie at the same time as one or more friends and critique it as it plays. If you have ever watched Mystery Science Theater 3000 you know what I mean! Write letters. Remember when that was a human function?
  • Cook some new comfort food. Here are some of my recipes. I like to experiment much to the chagrin of my wife.

In short, none of us is immune to loneliness as an effect of the COVID-19 pandemic. It is just good to understand it, accept it, and mitigate it as much as possible.

References:

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About the Author:

Photo of Kelly R. SmithKelly R. Smith is an Air Force veteran and was a commercial carpenter for 20 years before returning to night school at the University of Houston where he earned a Bachelor’s Degree in Computer Science. After working at NASA for a few years, he went on to develop software for the transportation, financial, and energy-trading industries. He has been writing, in one capacity or another, since he could hold a pencil. As a freelance writer now, he specializes in producing articles and blog content for a variety of clients. His personal blog is at I Can Fix Up My Home Blog where he muses on many different topics.

People Experiencing Coronavirus Pandemic Dreams Should Learn Lucid Dreaming

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Lucid dreaming
Lucid dreaming

What are Coronavirus pandemic dreams? In a nutshell, they are dreams that are more intense, strange, and different from the dreams we experienced before society began grinding to a halt and required us to hunker down at home. Dreams are our way of coping with the day’s intense emotions. They happen when in REM (Rapid Eye Movement) sleep. The abrupt withdrawal from our usual environments and daily stimuli has moved many of us to new frontiers of dreaming. This makes it a perfect time to learn lucid dreaming. You can think of it as a late New Years resolution.

What is Lucid Dreaming?

At its basic level, during lucid dreaming, you are simply aware that you are dreaming as opposed to just “remembering” it for a short time after waking. As you get better at the technique you can gain control over the actions in the dream, specifically your actions. Obviously, this can make strange or scary dreams more palatable, but also more fun. Moreover, the practice of learning to lucid dream in order to stop nightmares from occurring or reoccurring is called lucid dreaming therapy.

I learned lucid dreaming years ago when I became fascinated with the concept. I had always been interested not only in the content of my dreams but I wondered why, when as a child, I had the same exact dream every Christmas Eve and another different one on Easter Eve. Both had been filled with symbolism but I was merely an observer. The ability to be a participant was impossible to resist!

Techniques for Learning to Lucid Dream

When practicing these techniques, keep in mind that success is more easily attained for some than others. The key is practice, practice, practice. Be patient; the payoff is well worth it. Make these techniques a daily ritual for the best results. Your abilities will only improve over time.

  • Reality testing: also referred to as reality checking, is a method of mental training. It increases metacognition by training your mind to notice your own awareness. To do this, first ask yourself several times a day, “Am I dreaming?” Next, examine your environment to confirm whether or not you are dreaming. There are several ways to do this. For example, check a clock or your watch several times. If the time only changes slightly this indicates wakefulness. If it changes more than that, you’re likely asleep. Or look in a mirror. Do you look right? Finally, examine your own consciousness and in what ways you’re engaging with your current surroundings.
  • WBTB (Waking Back To Bed): First, set your alarm clock for five hours after your bedtime. Next, go to sleep as usual. When your alarm wakes you, remain awake for 30 minutes indulging in a quiet activity such as reading a book. Obviously, don’t drink coffee. Finally, go back to sleep. This process will make your brain more receptive to lucid dreaming.
  • MILD (Mnemonic Induction of Lucid Dreams): MILD is conceptualized on prospective memory. This means a focus on an intention to do something later, in this case, to remember that you are dreaming. First, as you fall asleep, think of a recent dream you’ve experienced. Recall something that struck you as irregular or strange in the dream such as the ability to fly in the sky. Focus on returning to that specific dream while telling yourself that the thing you found strange only occurs when as you dream. As you do this, tell yourself, “When next I dream, I will remember that I’m dreaming.” Note here that MILD is more effective when you combine it with WBTB (if you’ve been dreaming when your alarm goes off).

Not only is lucid dreaming a helpful tool as we work through the new lifestyle of lockdown and experience Coronavirus pandemic dreams, but it will also be useful (and entertaining) when we finally get back to normal. Learn it now; you will look forward to bedtime.

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Visit Kelly’s profile on Pinterest.

About the Author:

Photo of Kelly R. SmithKelly R. Smith is an Air Force veteran and was a commercial carpenter for 20 years before returning to night school at the University of Houston where he earned a Bachelor’s Degree in Computer Science. After working at NASA for a few years, he went on to develop software for the transportation, financial, and energy-trading industries. He has been writing, in one capacity or another, since he could hold a pencil. As a freelance writer now, he specializes in producing articles and blog content for a variety of clients. His personal blog is at I Can Fix Up My Home Blog where he muses on many different topics.