The empathy gap: How A Lack Of Understanding Is Fueling Poor Outcomes And Health Disparities

I recently watched The Color of Care, a documentary highlighting the disparate and inequitable care received by Black and brown individuals during the COVID-19 pandemic. During the movie, Executive Producer Oprah Winfrey opined that one of the primary health care issues is the “empathy gap.” Upon hearing the phrase, I shot up in my chair, as it felt eerily (and painfully) similar to what I described in my 2019 TEDx talk: Overcoming Invisibility, Improving Healthcare, and Restoring the Doctor-Patient Relationship.

In my TEDx talk, I shared my experiences with the health care system as a pediatrician disguised as a family caregiver. While caring for my late father, some of my biggest challenges occurred in medical settings where I had to pierce the shield of invisibility to be seen, heard, and validated. For reference, I am a Black woman. As much as I would love to believe that my race had nothing to do with how I (and, more importantly, my dad) was treated, I am certain that belief would be rooted in fantasy.

If you’re wondering what broke the invisibility spell, I invite you to watch the recording. (Hint: It involves the 2-letter title that follows my last name.)

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I challenged health care professionals to spend the first ninety seconds of every clinical encounter engaging in intentional human connection with patients and their families, an experience I coined “The 90 Second Encounter.” This can be as simple as asking questions such as, “What is your favorite food/TV show/vacation spot?” or “What’s the last book you read?” If the patient mentioned a milestone event at the last visit, such as an adult child’s wedding, you could follow up by asking them how things went.

Everyone is unhappy about the current state of health care — doctors, nurses, ancillary staff, patients, and families. Could it be that the erosion of the sacred doctor-patient relationship is fueling physician dissatisfaction and burnout and patient dissatisfaction, mistrust, and disengagement? I believe that the perverse focus on efficiency and productivity at the expense of empathy, compassion, and meaningful relationships is the root cause for poor outcomes broadly and health and health care disparities specifically.

Empathy is “the psychological identification with or vicarious experiencing of the emotions, thoughts, or attitudes of another.” Empathy is required to establish trust and develop a therapeutic alliance with patients. A lack of empathy interferes with our ability to provide holistic care that respects a person’s intersectional identities, hopes, fears, and desires.

The empathy gap explains why Black and brown patients were disproportionately denied emergency medical care and hospital admission at the peak of the COVID-19 pandemic and why there is a long history of health and health care disparities for minoritized individuals. The empathy gap illuminates the need for a more diverse workforce, not to check a box because we are more likely to demonstrate empathy when we see ourselves in others. (If you’re not a believer, a wealth of studies demonstrate improved health outcomes when there is racial and language concordance between the patient and the clinician.)

The empathy gap is a powerful igniter of bias. It allows us (largely unconsciously) to disregard someone’s inherent right to dignity and respect as a fellow member of the human race. The empathy gap breeds rash, misinformed judgment against others.

So what do we do about it? Needless to say, the systems in which medical care is delivered need to be re-examined, disrupted, and transformed. However, I’m not letting my esteemed health care colleagues off the hook.

We must deeply acknowledge, examine and challenge our own biases. Why do we believe certain things about groups of people based on their race, ethnicity, socioeconomic status, gender identity, sexual orientation, disability, physical size, or geographic location? What is the source of those beliefs? Are the beliefs rooted in our own experiences or based on something we saw on TV or social media, heard from a friend or family member, or maybe even learned from a misguided teacher or culturally uninformed textbook?

What would happen if we all made the brave decision to open our hearts and engage in a meaningful way with others?

We can each contribute to closing the empathy gap by expanding our capacity to be curious, loving, and kind. When gas and food prices are high, interest rates are rising, and a recession looms ahead, this, my friend, costs you nothing.

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