Health care providers across the country are diagnosing, prescribing, and bandaging, but for many patients, that may not be enough to improve health.
Health care providers have a unique opportunity to improve patient health outcomes by practicing empathy for their patients and complex life circumstances. Empathy is defined as, “the ability to understand and share the feelings of another,” and studies have shown that empathy is an important skill for health care providers and is significantly associated with improved clinical outcomes.
Social Determinants of Health
Social and environmental factors (also known as social determinants of health) have a larger impact on health than medical intervention. Social determinants of health such as income, education, food and housing access, and racial and ethnic inequality affect the health of a person from birth to death, and can be difficult to understand and control for within a health care visit. Due to a lack of social resources, patients are unable to fully comply with treatment plans, follow provider instructions, return for a follow-up visit, and ultimately, experience good health outcomes. A few specific examples include: problems accessing care without insurance, finding funds to cover needed services or prescriptions, securing transportation to get to and from appointments on time, or speaking the same language as a health care provider.
Empathy and Improved Health Outcomes
Because of the complexities of the social determinants of health, it will take cross-sector collaboration between the health care system, local community resources, and government to reduce and eliminate their negative impacts. The ability to demonstrate empathy in the health care setting is one solution to this problem.
A 2012 study from Italy analyzed the health outcomes of more than 20,000 patients with diabetes, who were assigned to three different groups of physicians (pre-evaluated for their levels of empathy). The physicians who demonstrated the highest degrees of empathy achieved the best results with their patients; the patients had statistically significant lower levels of diabetic complications than the groups whose physicians had scored lower in empathy. The researchers also point out that patient outcomes may be affected by other factors such as “physician competence, patient compliance, availability and effectiveness of medical management, social support systems, cultural factors, ethnicity, disease severity, comorbidity, multidisciplinary interventions, and environment of care.” By attempting to recognize and empathize with patients, providers improve the odds of successful health outcomes for them.
Provider empathy may help patients better manage chronic conditions, but additional research shows that as medical students transition into clinic-based training during their third year of medical school, they undergo a significant decline in empathy. Possible reasons are varied, ranging from the intense stress and exhaustion experienced during the training regimen to the pressure of maintaining objectivity while facing patients’ suffering for the first time. However, this reported drop in empathy is concerning, especially as we consider patients with difficult life circumstances and complex health needs. It is important that clinicians be able to balance the necessary objectivity to allow for good decisions with the necessary empathy to connect with and understand a patient’s perspective.
For this reason, medical schools and residency programs have been refining ways to teach empathy. In Boston, a recent training module focused on teaching empathy with such methods as reading facial expressions for emotion, recognizing nonverbal cues, as well as coping with one’s own responses to stressful and emotional encounters. When this module was tested for effectiveness, it was found that those who took the module practiced more empathetic interactions with their patients and were able to improve those skills over time.
Colorado and Empathy Training
Colorado is a good example. Although Colorado may appear to be the “healthiest state” in the nation, about 56 percent of residents believe that the health care system inadequately meets their needs. Recent research reveals that about 13 percent of Coloradans report being in fair or poor health; of those below the poverty line, 37 percent report being in fair or poor health.
This is why the Colorado Coalition for the Medically Underserved created a training video and educational materials that focus specifically on the social determinants of health and their effects on a patient’s ability to have their health care needs met. It follows a typical health care visit and interposes provider interviews and population statistics to help providers better understand and address the barriers their patients face. These resources can be incorporated in the classroom or in clinical settings.
The problems of habitual patient noncompliance, the social determinants of health, and their associated poor health outcomes continue. We need new solutions. Substantial evidence supports the need for providers and all members of the health care team to first, understand and appreciate the complex life circumstances facing their patients, and second, to seek ways to involve patients in their own health and health care to achieve better clinical outcomes. Whether the solutions are changes to the way we currently provide care or re-thinking of the role of the provider, demonstrating empathy will be the first step.