How a lack of empathy affects our healthcare

Thirty years ago, medical schools taught that the most important component of a mental health healing encounter is empathy, human connection, and authentic relationship between a physician and a patient. And beyond this connection, and much less important to positioning the patient for optimal healing, was the specific technical approach to the healing, (for example, Cognitive Behavioral Therapy; pharmaceutical intervention; surgery).

Of course, I immediately went to see if this "New Age" teaching was consistent with the Hippocratic Oath and lo and behold I found this in the Oath: "I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug."

They're aligned. Love it!

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But does this also apply to healthcare outside of a mental health encounter? And if so, is it being taught? Is it being leveraged to improve the health of individuals and communities?

If this was truly a key to healing wouldn't the healthcare "system" clearly recognize that an 8 to 12 minute office visit between a patient and physician is not optimal for developing empathy, human connection and authentic relationship and thus would lead to less than optimal care and higher medical costs? Shouldn't the "system" self-correct to honor the oath that physicians have sworn to?

As I considered these questions I received the JAMA article, "Empathy in Medicine--A Neurobiological Perspective," from a friend of mine. Funny how the universe works.

According to this article, "lack of empathy dehumanizes patients and shifts physicians' focus from the whole person to target organs and test results." What's more, "evidence supports the physiological benefits of empathic relationships, including better immune function, shorter post-surgery hospital stays, fewer asthma attacks, stronger placebo response, and shorter duration of colds."

The author Helen Riess, MD, goes on to describe the measurable neurobiological functions that take place between the physician and patient during an empathic encounter and shares a plethora of empirical data supporting benefits of this healing encounter.

She blames our medical education system for some of the decrease in empathy between a physician and patient and claims that much of this is due to the medical education system's emphasis on emotional detachment, clinical neutrality and an over-reliance on technology limiting human interactions.

So the Hippocratic Oath, our medical schools (at least 30 years ago), and empirical data all agree that (to quote the Hippocratic Oath again): "warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug." Yet with all this wisdom we still have a healthcare "system" that is not leveraging this information to improve the healing encounter and to improve the health of individuals and communities.

The "system" continues to rely on short episodic office visits. The funding model still rewards based on production primarily. Our "innovation" of a Patient Centered Medical Home (PCMH) creating a care team consisting of a physician and extenders is still predominantly reimbursed based on production, and still does not position physicians to develop empathy, human connection, and authentic relationship with their patients and in many cases exacerbates the issue by trying to leverage rotating practitioners as a means to improve access, optimize reimbursement and lower overhead.

The pay for performance (P4P) component of the PCMH reimbursement model is flawed as well as it is based on flawed clinical outcomes data (but that is a whole other discussion). Even the current medical education system is designed to train physicians to not honor the importance of empathy and relationship in the healing encounter.

I initially thought the reason(s) for the lack of empathy, human connection, and authentic relationship between a physician and a patient was because the stakeholders in the broken healthcare "system" did not know any better.

Could it possibly be that the importance of empathy, human connection, and authentic relationship between a physician and a patient is known, has been known since the days when Hippocrates drafted the oath, and is intentionally being ignored due to other factors?

My heart says "no way"... but then I see the reality of our broken "system" and must wonder...

Do we dismiss the importance of empathy, human connection, and authentic relationship between a physician and a patient because creating a healing model that leverages these principles would decrease productivity and cut into revenues because each visit would be too time-consuming?

Do we avoid empathy, human connection, and authentic relationship (and dismiss the concept as "woo woo") in general because relationships are hard and we are afraid to "go there?"

A "yes" to any of the above items is distressing and as healthcare leaders we must reevaluate our motives and stop being afraid. Our patients and our communities need us to best position them to be well. If we need to tackle the hard stuff and change our reimbursement model ... so be it.


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