The value of empathy in medicine is seldom debated. Just as the art of medicine is taught as the balance of knowledge and application, so has empathy been recognized as both a value to be fostered and a skill to be learned. Medical curricula have reflected this, and while didactics are increasingly filled with various conversational frameworks and behaviors that convey empathy, rarely do they include specific language to convey it. To master empathy, students first must hear what it sounds like. Just as learners need to be instructed on the proper clinical applications of textbook knowledge, so do they need to be given the words to translate kindness to clinical practice. Regarding medicine, I define empathy as a provider’s ability to understand the patient’s perspective, feelings, and goals of therapy, act on that understanding in a collaborative way, and develop a bond of trust and respect. To understand this practice, I chose to rotate with palliative care physicians who regularly engage with the nuances of challenging communication. Through conversations that discussed end-of-life care and treatment goals for an incurable illness, I understood how deliberate one’s communication must be to foster empathy. My biggest lesson was, in essence: words matter. Practitioners must have words that effectively respond to patients’ health and emotions and which are versatile enough to accommodate the variability of patient care. The following are examples of specific language for empathetic communication that I learned from palliative care. Tips and strategies for empathetic communication Respond to emotions. Patients and families may react with sadness, fear, frustration, or anger. Allow space for this. Avoid providing premature reassurance or responding with factual information, as ignoring emotions signals that the physician is uncomfortable with difficult conversations and discourages patients from honestly discussing concerns. Responses to strong emotions can look like the following. Understanding: “I get that this must be very frustrating to hear.” Naming: “I notice you seem tense. What’s going on?” Exploring: “What are you worried might happen?” Validating: “Your reaction makes sense. In fact, I’d be surprised if you weren’t upset right now.” Normalizing: “I would be angry too.” Silence: Allows patients to process and express their emotions. Remember the power of “I wish” statements. “I wish” statements are effective at aligning with the patient’s goals and wishes and can be used with great versatility in situations including breaking difficult news, providing reassurance, and keeping patients on track. “I wish I could make this better. I can tell you medically that if your condition continues to worsen, you may need to be hospitalized or consider invasive treatment.” “I understand that you’re having a hard time believing you have diabetes. I wish I could tell you differently.” “I wish I could promise that we could cure this illness, but I can’t. What I can promise is that I will work as hard as I can to control your illness in the way that is best for you.” “I wish the illness had responded to treatment.” ” I wish we had more time to talk about your family. I would like to make sure we have enough time to discuss your thoughts on treatment options.” Use “and” or “at the same time” instead of “but” when contrasting two ideas. This allows for acknowledging the reality of the situation without diminishing hope. “I see that you’ve done a lot of work to exercise regularly, and it seems like your body may need medication to lower your blood pressure effectively.” Prioritize prognostication. Discuss potential outcomes whenever possible. This may include discussing the expected illness course, medication side effects, and steps to take in the event of unsuccessful treatment. Give prognostic information as a range, especially with unpredictable prognoses (e.g., days to weeks, months to years). More than informing the patient on what to expect, communicating prognosis encourages patient compliance and greater involvement in their health. Note that taking a parental or instructive role may be viewed as disenfranchising. Be sure to side with the patient as a teammate when providing information. Illness course with treatment: “Based on your labs and the fact that we have no treatments to stop your kidneys from declining further, it is likely that you will need dialysis sometime in the future. While we can’t know exactly when I estimate it will be in the next weeks to months. I am hoping for the best, and at the same time, I think that we need to prepare for the future so we can arrange the best care for you.” Illness course without treatment: “I want to see you get better. I think treatment is important because I don’t want to see you getting Complication A or Complication B.” Treatment efficacy: “In my experience, this treatment works for one in ten people. For them, their symptoms were controlled for X to Y number of months.” Medication side effects: “You can expect the following side effects when taking this medication. I will work to manage these side effects as best I can. If they become too troublesome, we can consider stopping or changing the medication.” Course of action if treatment is ineffective: “If you still have symptoms after completing treatment, come back, and we can consider a longer course of treatment.” Reassure the patient and family that they are not alone. Patients may feel overwhelmed when making difficult decisions. Family members, especially when acting as health care proxies, may be scared to support decisions that could leave them with guilt or that other family members may disagree with. “You’re not making this decision alone. We are in this with you.” Practice using difficult words like “death” and “dying.” Patients want the truth about their prognosis and deserve direct, honest discussions on illness progression when asked for. Avoiding euphemisms eliminates the potential for misinterpretation and false hope. Source
