Episode 151
[00:00:00] Hey guys, welcome back to the podcast. I'm Amanda. I'm Laura. I'm Kendra. And last time we did empathy part one. Today we are going to do empathy part two. Kendra, what are we talking about? Okay. Well, we're going back to Dr. Brene Brown and her Atlas of the Heart.
We had such a great discussion about sympathy versus empathy. And so this is kind of like the application. Part two of applying, let's put it into practice and using, you know, that patient-physician relationship, which we talk a lot about, we think it's very important and we always can do a better job.
So, as we go through these, they might sting a little, but I just encourage you to be curious about them and try to just remember times when you said it and just think, oh, yeah, that might have been received a little bit off, and some of these don't really sound that bad, but could be misconstrued, especially when we're giving news sometimes on patients worst days of their life.
There's just a whole bunch of emotion wrapped up in that, and even though you're well-intentioned, sometimes [00:01:00] it just can miss, and it's okay. We're human. We're doing the best we can. So we're just going to give you a few new tools and try them out for size. And just go with it, just go with it. Empathy is at the heart of healing, but sometimes we fall short of truly connecting with our patients in ways that they need.
Today, we're gonna explore these empathy misses, reflecting on how they show up in clinical settings. We'll share some practical examples and how we really can improve our ability to connect.
Empathy connects us with our patients, whereas sometimes sympathy can be a disconnector if you recall part one. The idea here is that empathy isn't just about being there for someone or offering a sympathetic ear. It's about really understanding their pain and suffering without making them feel minimized or invalidated.
As physicians, we often try to fix things too quickly or we give advice that might not be what our patients need in that moment. So, just think about it, let's get curious, and here we go. The first one is the sympathy vs. sympathy, kind of a review for part [00:02:00] one. But an example of this would be like, Oh, I know exactly how you feel.
This is really classic, even if, you have gone through this, so say you had a gallbladder surgery and you're talking to someone that may have to prepare for gallbladder surgery or think about getting their gallbladder out, you know, I've caught myself saying this, oh yeah, this is how it was when I went through it, or oh, this is how I felt, and we're really just assuming we know exactly what the patient's going through, however, even though we're experiencing something similar, even though we want to equip them with medical knowledge, we may miss really what they're trying to express.
We may miss understanding their pain, and it may not always be about that giving of knowledge like information giving. Sometimes it's just about delivering the information and then sitting there and kind of feeling the temperature of the room. Even though we've been through hardships ourselves, we can't fully know how another person feels.
Their context is unique. Their experiences are different and their emotional responses are [00:03:00] theirs alone. So for instance, I had a cholecystectomy. I feel like I am the know all of cholecystectomies, right? No, so obviously everybody's experience is different. Mine was quick, I knew the surgeon, I was in and out, I had a few things post op, like all the things.
But even in all of that, and being a patient, and being a physician, it's still going to land differently. This classic example I come up with was I was talking to a mom who was like six or eight months postpartum, same situation, Shoulder pain, scapula pain, like feeling like most likely this is gallbladder, seemed reasonable, she had a few attacks during pregnancy, and all these things.
But she really took the news very hard. And I did do this, I'm like, oh, I know how you feel, it is scary to have surgery, especially even elective surgery, blah, blah, going on and on. And her Gentle tearing, like, elevated to sobs, like I was doing nothing to cover this poor lady.
And I just [00:04:00] stopped talking, because I just really realized I could possibly be making this worse. And I just didn't say a thing. Because I was like, oh, what am I saying? Like, you know, you immediately, or I do, I get introspective and I'm like, what did I say? This is not going well.
So I just sat there. I probably could have said something to just acknowledge that she was ultra upset about this news or even just the possibility of having to schedule a surgery or see a surgeon and so something like, I see that you're I'm extremely upset about this. I see this is causing you pain, hurt, whatever, whatever.
Is there anything that I can do or do you want to talk about how it's making you feel right now? I don't know. Something like that. Just a little bit more about like, okay, pause. I just delivered this information. This patient's seems to be upset. And then, you know, later before she discharged from my care, she was just like, I was just really sad.
Scared to be apart from my [00:05:00] newborn. She's six, you know, six, eight month old, you know breastfeeding. What am I gonna do about that? It's just everything flooded into her mind like what am I gonna do being separated from my child and not even thinking about herself or the surgery or anything. I didn't even really stop to ask that and so I felt like oh, I really miss that.
Trying to make the situation better or displace this discomfort, which we'll talk about a little bit later. I was trying to give her more reassuring medical knowledge and that just not was hitting at all. So that's that sympathy or empathy. It's just really trying to understand what they're feeling and not just saying like, oh, I know how you feel.
I've been through this. In a way, it seems like you're promoting community or like, Hey, let's talk about our situations, but it can kind of miss. It seems a little bit Minimizing at times just because you may not know. I didn't even think that the first thing she was concerned about was being.
Apart from her newborn kid. So, and you know, a little bit of disclosure that she was going through a little postpartum depression. So any news of like disrupting the regular cycle of her every day was going [00:06:00] to be very disheartening. So I don't know. What do you guys think? Have anything? Yeah, I mean, I do this all the time.
I do all of these all the time, sadly, like it's so funny after we recorded the last podcast on this, I was having a conversation. I do it the most with my 18 year old son, because he's saying, you know, he says things that about himself that to me are not true and so I immediately jump into, you know, yeah.
Oh, but look at it this way, or, Oh, I remember feeling like that, but this is why it's not true. You know, like trying to fix it because of my own anxiety about my child feeling bad and it totally makes it worse. It doesn't, just doesn't, doesn't help. And it's mystifying in the moment until someone does it to you and you're like, Oh yeah, like I can probably come up with all the things they're going to say to me to try to make me feel better.
And I can do that on my own, but what I really need is someone just to be like, Oh yeah, that really [00:07:00] stinks. You know? Yeah, that's good. The next one is comparing competing. And so, you know, you may be seeing a patient and, you know, we, of course, as ER physicians think worst case scenario. So we may be quick to try to resolve the situation or comfort the patient by saying like, well, at least you're not septic, or at least you're not going to the ICU, or at least you're not going immediately to surgery.
Or at least, you know, something to like say, we think that might offer comfort because we're trying to reframe the patient's experience or make it seem like what they're having now is better in comparison to something worse. And that,, may miss the mark a little. One of the things I've realized is despite the availability of like the internet and Dr. Google and all of these things, sometimes patients don't even hear about some of the things and you're like, Oh, well at least it's not hepatocellular [00:08:00] carcinoma, at least not liver cancer. And they're like, Oh, I could have had liver cancer. And then they just go mopped in anxiety. You're like, Oh crap.
What did I just say? Oh my, Yeah, I definitely had a patient just like that. Same situation. Abnormal CT, abnormal ultrasound, probably going for biopsy, but it looked more like just like a NAFLD or something. And I was like, well, you know, they said it looked like cancer and they're like, Oh, I could have cancer.
Like, that's a possibility. And yeah, it went downhill from there. You know, because that's how I like cheer myself up in, you know, I do that. I do that for myself, but. Right., it totally minimizes, somebody else's experience when we do it to them. It's so hard. Yes, it is. Why can't we just fix everyone's stuff for them?
Yeah. If we go into it with the understanding of like, we're uncomfortable with them feeling uncomfortable, it makes sense why we're even saying that in the first place, but otherwise it's completely irrelevant. Yeah, for sure. Like, we're just. Trying to [00:09:00] make them feel better so we can feel better, right?
And really, we're just the information providers. We just provide information and, you know, one of the things that could improve this response is just something like. This sounds like it's really hard on you. Let's work together to get through this or how can I help you with your next steps? I know this may be confusing, this diagnosis, this hospitalization, this whatever we found today on your workout could be really confusing.
How can I clarify something for you or what do you need in order to make the decision for your next best steps? I think I've found myself lately saying that. Because I feel sometimes that shared decision making isn't always just about medical decision. Sometimes patients need a little support in figuring out the next best steps.
And like, helping to sort that out. And so that might be also a question you could ask. The next one's disappointment. This maybe looks like telling a patient that they have let you, family, friends down by their choices. [00:10:00] I probably didn't say those words, but I'm pretty sure that, and I've said this on the podcast before, that there's a very triggering patient for me.
And that is like a mom. It can be any mom, 35 to 45, 55, I don't know who comes in. You know, in the afternoon, in the ER, and stays past maybe bus time or pick up from school time with this chronic abdominal pain, blah, blah, blah, blah, blah, I've talked about this before. And I just always am like, who's taking care of the kids?
Why aren't you getting them off the bus, or picking them up from school, or getting them to practice, whatever. But I think I've probably said this in a way, like, you have an appointment with your doctor tomorrow, during the day, and now you're here, who's taking care of your kids, or where is Your caregiver or something, you know, just been really not overtly saying I was disappointed but like you see this choice that you made to come to the ER now and Nothing new was found today.
And so Where are we? Not any closer and your kids are home [00:11:00] alone. I don't know I make up all kinds of scenarios, but that's a triggering page for me and I can feel Myself really just feeling disappointed knowing that they're a mom And, you know, asking who's at home and they'll say no one, or whatever, and somebody's not getting taken care of, I can project my disappointment pretty easily.
So maybe something else, you know, a more appropriate response would be, I understand it must be frustrating to not know what this pain is coming from, or not always get answers, and it seems like it'd be a lot to carry. Or it seems like you're going through a lot right now or, just hearing them or even reflecting back something that they said during the appointment would also make them feel heard.
So, this empathy thing is all more about understanding where they're coming from. It's nonjudgmental. It is holding space. For them to just give their perspective, and then you allowing that without judgment, and without telling them they're right or wrong, just [00:12:00] reflecting back, just saying like, I hear you, or this must be scary, or it's just a more validating comment or a more validating space that you can hold for patients because Sometimes we're so caught up on fixing it and and problem solving That there's just not always a problem to solve. It just may be like oh that doctor heard me for once or whatever I don't know. And so that perspective can really go a long way, especially when you're going around and around with these patients, like, you're not quite understanding, what do you need here?
I'm telling you, everything got worked up. It's all negative, you know, blah, blah, blah. And then they're just, they kind of keep on and they may recruit a family member in on it too. And that, and that's super frustrating. And so, but instead of really getting too worked up about it, maybe pause and just think.
You know, it's just that curiosity thing, like, hmm, I wonder what's going on here, because really nothing that I'm saying is landing very well. And so, you know, even just reflecting back what they're saying to you, or, like [00:13:00] I said, offering to validate what they're feeling, and then helping to clarify best next steps.
Yeah it's probably helpful to, just remember that not everyone has the same resources, the same capabilities, the same values even, and so I just have to trust that the patient is doing the best that they can with what they know now to do. I mean, I've certainly come in with some not very useful defense mechanisms or useful strategies for how to deal with things because I didn't know better at the time.
And so I just have to offer that grace. To patients, also, even when it seems glaringly obvious that it could be done in a better way, but yeah, that disappointment one is like, Ugh, I just remember being a kid and that would pretty much gut me if my parents would say I'm disappointed. More than I lived back in the days when there were beatings.
Well, you know, not, I'm, I'm over exaggerating. Same. There really is. Same. Yeah. I'm, I'm not trying to, right. I, I, but [00:14:00] yeah, I've come to a new perspective on that, on the disappointing and I would offer if there's something you currently are telling your kids or people you love as you go along, you may look back and feel very disappointed in yourself.
That you said those things. It's just, yeah. It's not helpful. It can't come from anything else. It's manipulative, is what it is. It is, and it's about you. Right. Your child has disappointed you, which, like, what are you saying, really? Right. It's not, you don't own them. Again, they're probably doing the best they can with the skill set that they currently have since their frontal lobes aren't fully formed yet.
Right. And when did someone telling you they were disappointed in you ever, like, really inspire you forward in a positive way? Like maybe you're inspired forward to avoid shame again, like with curiosity and excitement and love of learning and knowing that you're on a path of development? No, it's just [00:15:00] like, I can't ever feel like that again, because that was horrible.
Yeah, I've said so many things to patients and then it came back to bite me in the butt like a perfectly healthy looking lady, young lady who was coming in with a cough, but still smoking. And I'm like, why, you know, yeah, and then it turns out to be like. A horrible lung cancer. And I'm like, God, why did I even just shut up?
Like, please. One of my favorites was I had like this 40 year old, this was in residency, I had this 40 year old lady come in. She was being so dramatic with her chest pain. And I was like, what? And like, she had a normal NKG and, but she was like over the top. And then she arrested. Think right. Oh, yeah, she had this she had coronary artery spasm that like they took that cath lab put a little nitro in there and it opened up but That is so special.
Yeah, she taught me something that day. Yeah, you'd think I do it less frequently, but you'd think I would have cured myself of this, but I still do it, so. I [00:16:00] still do all of these, like every time I take a personality test, You do. I'm like on the like, they're like, your archetype is like Mr. Burns from the Simpsons. I'm like, great!
Not exactly what I'm shooting for, but all right, so maybe I have some room for improvement. Okay, the next one is when you minimize or avoid with, it could be worse. And boy, that's an easy thing to do when you come up with like, this is all fixable, you know, whatever, whatever. It's just another way that we try to minimize the patient's pain or whatever's going on.
When a patient is sharing a fear or concern and we respond with, well, it could be worse, it could be a much worse diagnosis. We risk disconnecting from their experience. Yes, it's important to provide perspective, but when we immediately jump to this, we aren't validating in any way their current emotional state.
So let's remember what might seem not as bad to us could still be devastating to them. We don't know what's going on in their life. This could be the straw that They just can't take one more thing, you know? And so, who are we to judge? Just hear them out and hold that space for them. [00:17:00] Next is, how you feel isn't rational.
Oh boy. Have I done this. Are you sure it's really 10 out of 10 pain? Oh lord, when they're taking selfies, yes, in the yeah. I mean, yeah, I will never forget. I had a traumatic amputee come in, motorcycle, traumatic amputee. Belt from a bystander as a tourniquet, and the dude's asking for his phone to take a selfie.
He's awake. Oh! I thought, oh my god, this guy is so delirious. His leg just got chopped off. He's delirious. He's like, no. I mean, he was insistent. I need my phone. We got to get this material. I was like, are you, I just asked him, are you a 10 out of 10? I mean, that one at least would count with him in a bag, his leg came in with him in a bag.
And I'm just thinking to myself, wow, are you serious? It's hard to imagine something worse than that. So maybe he wins the prize, maybe the selfies and the Cheetos, like could have turned out. It might've been the ketamine talking, but who knows? Yeah, I [00:18:00] do love that one when, when they're here with belly pain and they're literally eating.
Like, nuclear firecracker Cheetos. Yes, it's always those. Downing them. Okay, so back to, sorry I got us off course here. But how you feel isn't rational. Often when patients express fear or anger, especially in the face of an illness, they might not be thinking logically. That is allowed as a human experience, that's okay.
However, the feelings that the patient has are valid and real. They are having a human experience, as they're allowed to do. Telling them that their feelings aren't reliable or rational is a subtle form of invalidation. A more empathetic response would be, I hear that you're feeling scared, and let's work together to understand what we can do about that.
A lot of Simon Sinek stuff comes over my social media feeds, and he's like, the mistake that we often make in relationships is trying to approach somebody who is emotional, You meet rational with rational, you meet emotion with [00:19:00] emotion. Once they're through the emotion, then you can go back to rational.
But if someone's not in a place where they can receive your pontifications, then it's not as useful as it seems like it's a super good point because their, like, their blood flow is in the limbic system there. Yeah. They can't. Not in the prefrontal cortex. Logic is not.
You can talk at them, you're not reaching them where they are until you meet them emotion with emotion. Okay. So then the last of this section is judgment. You should. Now, hopefully, if you've been listening to this podcast for long, some red flags should shoot up immediately when the word should comes up.
It is, you could with shame on it. The SH from shame and then UD from could as physicians. We are problem solvers But sometimes our instinct is to offer solutions that get in the way of truly empathizing telling a patient Well, you should eat better or you should exercise more can feel like a directive rather than an empathic [00:20:00] response I'm having flashbacks of treating DKA while currently, like, mainlining Mountain Dews, but I don't know if I said anything out loud, but you probably could read it on my face of, like, what are we doing here?
Instead, let's take time to understand their barriers and offer supportive, collaborative suggestions, like, what do you think could help you feel better, and what has gotten in the way of that in the past? There are reasons. There are reasons why people Do what they do. And so if I can just make sense judgment out of it.
Yeah. Yeah, that's a great time and approached it with curiosity Then I would get a lot farther than Looking down my nose at people. Yeah. That's a good point because we don't have to understand their reasons. They're not rational to us. They're not our reasons. They're their reasons. And they may be a coping strategy they've developed over time.
I mean, I think about addicts that come in the ED all the time. I mean, their reasons don't make any sense to me, but I've also not sustained the trauma that they have growing up or whatever that has gotten them to the [00:21:00] point where they self medicate or they rely on their substance.
I have no idea about that. And so even when they try to explain their reason to me, it doesn't make sense, but it's not my reason. And so it's just so easy just to pause and be like, okay. I mean, okay, like, I mean, there are clear barriers here, like maybe undiagnosed mental illness or, you know, just a traumatic situation home.
I saw something on social media the other day this teenage girl posted, like, someone was asking her, like, why do you let your parents addictions affect you so much? And she just flipped, like, yeah. 20 photos up of them like doing their thing and it was so disturbing and Then she says that's why I mean How can you live in a household and experience that day in and day out and just the overall neglect and everything?
I mean that is why people do these things and we don't have to understand Right. We just have to say, okay, like the one of the most [00:22:00] disturbing patient interactions I ever had that has altered me forever. The only time she could spend time with her mom is if she was also doing meth with her mom. And so then Dang.
Wow. What are you going to do? I mean, there is no stronger drive if that is your sole caregiver and so just, you know, just, just maybe try to come from a place of curiosity rather than judgment. And another thing that I love from Gabbermonte is that there is nothing more understandable than addiction.
We all have short term fixes. that end up long term not being the most advantageous. It just happens that drugs tend to be looked down on more than scrolling on social media. It just so happens that overeating is a visible result that you can't see in somebody who's maybe an alcoholic secretly. It is just some of our coping mechanisms.
Are more socially accepted, but they're all achieving the same purpose of a temporary relief from whatever it is you're trying to [00:23:00] escape from. It just isn't a good long term strategy. It's so true, and interestingly, judging can be that kind of addiction. Oh yeah! Then you're okay, right? Right. We do it to avoid our own discomfort with ourselves.
Whether that be conscious or self conscious. But it definitely is. can be that kind of escape hatch. So just If you'll feel better about yourself, I don't know. I feel better about myself long term if I really try not to like I've the Cringiest moments of my career have been when I've been judging like that Thankfully most of them were the big ones were early especially in residency.
Dang. I was so judgy So another one is I don't know what to say. Well you I think We all know like I don't know when I hear I don't know what to say I like there's almost some judgment in it or like you can feel Some parent looking down on us. I don't know. It's kind of loaded [00:24:00] sounding to me So obviously there's sometimes that we really don't know what to say.
Like when someone has an unexpected life altering diagnosis And they're like sharing how devastated they are with us and we feel completely helpless. It's okay not to have the perfect response, but what's important is to simply acknowledge, their experience, acknowledge that, you know, they're sharing this vulnerability, with you.
And be present with them, something like I'm at a loss for words, but I'm here with you is more powerful than trying to fill the silence with words that might unintentionally cause harm. And that is what we do a lot of times when we're trying to manage other people's feelings and make them feel better.
A lot of times we're making them feel worse. So just like, I'm at a loss for words, words fail. I'm here with you and it totally makes sense how you're feeling. Hey, the last one here is advice, giving and problem solving. Oh boy. Yes, I do. I, you know, it's [00:25:00] interesting. Kendra, you're talking about people's upbringing and I did grow up in one of those chaotic households and this is common among people who grew up with deeply dysfunctional parents is that when you were a kid, you were trying to manage their feelings so there were no explosions and you carry it into adulthood and you're like trying to fix everything for everyone.
And it's, while it was helpful to keep the family. You know, some level of I don't know, safety. I wouldn't even call it safety, but like not gross unsafeness. As a kid, as an adult, it is totally unhelpful. So just saying, I'm sure you'll be fine. Probably is not the best thing to say. We want to reassure them, but if they have a cold, fine.
It'll be fine. It's good. But if it's something else. And we're overconfident about it. We can be wrong. I've certainly sent people home saying they'd be fine and then they come back and they were not fine. And I hesitate to say that now we [00:26:00] might be missing something if they're really fearful. This is why now I really, really listened to the moms who have anxiety about taking their kids home.
I will sit on that patient, give them more fluids. Recheck them a bunch of times and sometimes they do deteriorate while I'm kind of trying to reassure the mom. I'm like, Oh, okay. I guess it was good that I listened to you. We don't want to dismiss real fears that they have. We can acknowledge the uncertainty that they have and reassure them by saying, I can't promise you exactly how things will unfold, but we're going to take it one step at a time together.
Or I can't this, I do this a lot with bronchiolitis kids. I, you know, sometimes these kids have to come back. I can tell you right now, everything looks good. And we're here all, I do say this to them. We're here all the time. We're here 24 seven. If you need us, we're here. And most of the time they don't come back, but
knowing that we care and we want them to come back if they're worried does a lot to help them feel safe. [00:27:00] So, why does it matter? Why does empathy matter in medicine? We are often in positions where our patients are vulnerable, scared, or in pain. And the words and actions that we do or say can foster deeper connection, or they can unintentionally shut down communication empathy.
Isn't just about saying the right thing. It's about being present, acknowledging the patient's emotions and building trust. And for me, and I'm sure Amanda and Kendra would agree with this. One of the biggest reasons why we want to feel empathy and why we want our listeners to learn about empathy is because it will improve our own lives.
It will improve our own experience as physicians. When we have this skill and know how to use it, because a lot of times we're trying to do things and make things better and people get mad at us and if they leave us a bad review, we're like, and it really just. Drives, you know, job dissatisfaction, and burnout that much more.
[00:28:00] So it does help our patients. It also helps us consider this case. A patient comes in for routine checkup, but during the visit, they express fear about a family history of heart disease, rather than reassuring them with, you don't have to worry about it. We could ask what worries you the most about your family history.
Let's talk about steps we can take to feel more in control of your health moving forward. This acknowledges their fear and opens up space for collaboration and it opens up space for them to think about what it means and what they can do and what they want to do, what they're willing to do to help mitigate that risk and work together.
With us as their health care provider, as their doctor to help them have the best outcome. And then we feel great. We feel great because we're not just bossing them and them not doing it and us being mad that they don't do it and bitter and hating our job. Instead, we get reviews like This doctor really listened to me and I felt like all [00:29:00] my questions were addressed and it was such a great experience.
And while we don't want to live for that external validation, it is evidence that we're, being the kind of doctors we want to be. At least the kind of doctor I want to be. It's a good point. I mean, we've talked about this now for two episodes, this empathy thing. We all can get better at it. But I will also say you can do all of these things and they still leave you a one star review and that's okay because they also are adults and they can choose to behave how they want and they choose to fill out the survey.
Just know that even if that happens, you still can feel good about that interaction at the end of the day because you're flexing these new muscles that you have here. You have these new tools. You're using them on the daily. They're becoming a lot more easier. You're becoming more aware of how you can address a situation different.
You are feeling good when you leave the room, when the patient gets discharged, whatever it is, you still can feel good about yourself and the way that you are caring for patients. If you are doing all the things that align with your values [00:30:00] and really giving it your best, And trying to use these empathetic techniques, you still get a plus at the end of the day and I'll never forget you know, some of these patient cases where I felt real good and, you know, they come back and I'm getting an alert cause I got a one star and you're like, huh, that was interesting.
I, I totally saw that going a different way . And so just to encourage you, it didn't subtract anything that I did, in that patient interaction. It was just interesting you know, at first I was definitely like, hmm, that went down differently.
But then it just does matter the, the situations that they're going through at home. They probably got that, you know, survey a day or two later and their husband pissed them off and then they got the survey. They took it out on me. I don't know. Maybe they just didn't like the turkey sandwich. I mean, it's very possible.
I mean, the blankets were not warm enough and the oxygen tank was, our truck was behind their car when they tried to pull out and they had to wait 30 minutes. That's a real story. But anyway, all of these things [00:31:00] are just helpful to create a connection with our patients. Do the best that you can. We are proud of you for any of these that you attempt at any given time, and you are still doing the greatest job ever.
So, we hope that this has helped. Please leave us a review and help us. To, you know, get out there and other doctors find us and if you have any experiences with this thing or have any suggestions or things that you found that work in different patient interactions or you felt like was really empathic, share it with us.
We'd love to hear about it. Email us at podcast at thewholephysician.com and check out our new free video how to crush physician burnout for good without cutting back hours. Quitting medicine or sucking it up in silence. Scroll down now in the show notes for the link and check it out today. Until next time, you are whole, you are a gift to medicine, and the work you do matters.
