Evidence shows that many patients consider empathy the number-one quality of a good doctor. Physicians’ ability to understand problems from a patient’s perspective is key to an effective doctor-patient communication. The doctor needs to be able to put himself in the shoes of his patient and understand the situation from patient’s point of view. The patient will almost always tell the doctor how he is feeling, even when he is trying not to. Thus, the doctor must be an effective listener and observer.

1. Showing
Empathy
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2.  What is Empathy?
 Empathy in Clinical Practice
 Importance of Empathy
 Empathy vs. Sympathy
 Empathetic Process
 Verbal & Non-Verbal Empathy
 The NURSE technique
 Case Scenario
Lecture Outline

3. What is Empathy?
 EMPATHY is the ability to understand,
recognize, and share someone else’s feelings
and emotions and show concern towards that
person. It is a capacity to put yourself in
someone else’s position and see things from
his perspectives.
 EMPATHY is essential for building and
maintaining relationships. It is the basis of
intimacy and the closest connection. Without
it, our relationships would be superficial from
the emotional point of view. Therefore,
empathy is a powerful “social glue”.

4. Empathy in Clinical Practice
 Evidence shows that many patients consider
empathy the number-one quality of a good
doctor.
 Physicians’ ability to understand problems
from a patient’s perspective is key to an
effective doctor-patient communication.
 The doctor needs to be able to put himself in
the shoes of his patient and understand the
situation from patient’s point of view.
 The patient will almost always tell the doctor
how he is feeling, even when he is trying not
to. Thus, the doctor must be an effective
listener and observer.

5. Empathy has many positive effects:
 It helps the patient comes to trust the doctor
as someone who cares about his welfare.
 It lets the patient knows that he is not alone
in his problem; there is someone who cares
about his welfare.
 It strengthens the relationship with the
patient.
 It helps the patient to become aware of his
feelings and to cope with them.
 It facilitates the patient’s own problem-
solving ability.
Importance of Empathy

6.  Sometimes, Empathy is confused with Sympathy,
but they are actually different processes.
 Sympathy is to feel sadness or pity at that other
person’s suffering, but do not feel the same
emotions or are not in the same situation.
 Showing Empathy for a patient can build rapport,
whereas showing sympathy can show the distance
between the doctor and the patient.
 Sympathy can create a sense of inferiority and
disempowerment for the patient.
 Empathy versus Sympathy gives the client:
– Self-confidence.
– Assurance that the doctor has the strength to
provide support if needed.
– A positive message regarding the doctor’s
professionalism.
Empathy vs. Sympathy

7. v
v
Empathetic Process
Empathy is a Two-Stage process:
First, clarifying and gaining both a clear
understanding and appreciation of another
person’s situation or feelings.
Second, communicating that understanding
back to the patient in a visible and supportive
way.
 Many doctors go halfway; they may
acknowledge and be sensitive to a
patient’s situation, but they often do not
visibly show it.
 The real key to empathy is the overt
demonstration and expression of
sensitivity to the patient in a way that the
patient perceives the doctor’s support.
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8. Verbal Empathy
 Verbal skills allow the doctor to demonstrate empathy through supportive
comments.
 Verbal empathy can name and appreciate the patient’s effect or
predicament.
– “I can see that your husband’s memory loss has been very difficult for you
to cope with”.
– “I can appreciate how difficult it is for you to talk about losing your baby”.
– “I can sense how angry you have been feeling about your illness”.
– “I can understand that it must be frightening for you to know the pain
might keep coming back”.
 Statements reflecting empathy are highly effective because they tell the
patient that the doctor has heard him completely.
 Hence, empathetic statements can communicate non-judgment and
understanding, and help establish trust in difficult situations.

9. Non-Verbal Empathy
 Empathy may also be Non-Verbal (e.g.,
facial expression, eye contact, proximity,
touch, the tone of voice, or silence).
 Empathic non-verbal communication can
say more than a thousand words.
 For example, when a doctor offers a
tissue to a crying patient or gently
placing his hand on a patient’s arm to
show understanding.
 Using a non-verbal behavior in response
to a patient’s expression of feelings can
clearly signal to the patient that the
doctor is sensitive to his predicament.

11. The NURSE technique
The ‘NURSE’ acronym is a valuable tool for Demonstrating Empathy. It is helpful
approach summarizes what to do in responding and accepting patient emotions.
In mnemonic NURSE, each letter stands for a particular aspect of the approach.
Name the emotion
Understand the emotion
Respect the patient
Support the patient
Explore the emotion further

12. Name the emotion
 This shows that the physician is attuned to what the patient is
experiencing.
 By naming the emotion, the physician validates the patient’s
feelings and emotion as expected and normal.
 This may require the physician to read non-verbal cues that the
patient display.
– “Many people in your situation would feel scared”
– “It sounds like you’ve been worried about what’s going on”
– “It seems that this is very upsetting to you”
– “I’m wondering if you are feeling nervous”
 Remember, identify the underlying emotion in a suggestive
manner, not declarative; "I wonder if you’re feeling angry," or
"Some people in this situation would be angry," rather than "I can
see you’re angry about this“.

13.  Show a sensitive appreciation of the patient’s predicament or
feelings. This may require some exploration, active listening,
and use of silence.
 Avoid giving premature reassurance, disagreement, advice,
clinical information or justification without definitely
understanding what their true concern is.
 The patient’s non-verbal cues are nearly impossible to fake,
often paint a picture of what’s really going, and are more
accurate than words.
 Try not to convey that you understand what someone is feeling.
– “I understand what you are feeling”. Instead, use phrases
like:
– “People going through your situation often report
experiencing... Is that how you feel?”
– “If I understand you correctly, you are worried about how your
treatments will affect your job”
Understand the emotion

14. Respect the patient
 Acknowledging and respecting a patient’s emotions is an important step in
showing empathy.
– Acknowledging means recognizing the importance of something.
– Respecting means sending message that the emotions are allowable and
important.
 Respecting can be a non-verbal cues, involving facial expression, touch, or
change in posture, but a verbal statements can be more explicit.
 Praising the person’s coping skills is a good way to show respect.
– "I am very impressed with how well you’ve cared for your mother during this
long illness”
– “You have done an amazing job dealing with your illness”
 Matching the intensity of your acknowledgment to the patient’s the level of
emotion; a strong emotion deserves a strong acknowledgment and respect.
 Accept patient’s perspective without judgement. But remember; accepting their
point of view is not necessarily the same as accepting it. It helps letting them
know you care, that they matter.

15. Support the patient
 Express willingness to help, state your availability, preferably
in a way that demonstrates a partnership.
 Statements of support provide further comfort in emotional
situations.
 Reassure the patient that you are working with him.
– “You are not alone in this. We will continue to be here for
you to help you with the next steps”
– “Our team is committed to helping you any way we can”
– “We will work through this together”
– “I will do my best to make sure you have what you need”
 Remember, it’s not enough to say that you support someone;
in the next step, you need to provide that support.

16. Explore the emotion further
 By the time we reach this last step, the patient should be feeling
much calmer.
 Show explicit interest in the patient’s feelings and emotions and
allow to express their concerns.
 Letting the patients talk about what they are going through often
helps them feel heard.
– “Tell me more about what you mean when you say you don’t want to
give up”
– “Help me understand more about what you need to do your job well”
– “I notice that you’re upset, can you tell me what you’re thinking?”
– “I can only imagine how upsetting it must be to you. Can you tell me
more about your concerns?”
 Exploring allows the patients to express the emotional areas most
challenging to them.

17. Case Scenario
Consider a case of a newly diagnosed diabetic who has expressed fears about his
upcoming hospital discharge. He thinks that he is not ready to handle all of this; testing
blood sugar and giving insulin shots. Respond empathetically to this patient.
1. Name the emotion
2. Understand the emotion
3. Respect the patient
4. Support the patient
5. Explore the emotion further
“You seem very anxious”
“It can be stressful to learn something new
like this that is so important to your health”
“You did a great job with both your glucose testing
and insulin injection today”
“I’ll work with you in the morning and I’ll let the nurse know
you’d like her there right away to work with you”
“Tell me more about specific concerns you have
about managing your diabetes at home”

18.  Don’t try to fix other people’s difficult emotions by
offering advice or giving reasons why it doesn’t
make sense to feel that way. This invalidate the
other person’s experience and make them feel
worse.
 Don’t be judgmental, you have to accept whatever
comes and avoid any critical or negative opinions.
Judgment will make the person defensive and less
likely to share openly and honestly.
 Don’t minimize or negate other person’s feelings.
This is the opposite of validating someone’s
feelings.
 Don’t try to rush the conversation to a specific end
point.
 The level of empathy necessary can be a fine line
between helpful to the patient and harmful to the
doctor. That is why we need to avoid over-
empathizing.

19. Thank You