What is empathy in medicine and how can you develop and demonstrate it?
Empathy is an essential quality for any doctor. It has been a requirement of the General Medical Council since the 1980s, and all interviewees are expected to demonstrate empathy to gain a place at a medical school.
The ability to empathise is like a muscle, and the main question you should ask isn’t ‘do I have the empathy to be a doctor?', but ‘can I develop the empathy to be a doctor?’
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Many people confuse empathy with sympathy.
To empathise with someone, you need to depart from your own worldview, whereas sympathy is feeling sorry for someone and is rooted in your own worldview.
Empathy is an essential life skill, and is only possible because humans have an incredible ability to adopt someone else’s perspective.
This is often referred to as ‘walking a mile in someone else’s shoes’, but perhaps the everydayness of that cliché makes us forget how incredible it is to empathise with someone.
There are two types of empathetic behaviour. One is ‘emotional empathy’, the other ‘cognitive empathy’.
For a medical professional, feeling someone else’s emotions - or emotional empathy - is not always productive. Cognitive empathy is the goal, as it allows you to relate to that person on a professional level and improve their outcomes.
EQ is similar to your IQ (intelligence quotient), but for emotions. Your success in life is often connected to your EQ, because so much of our good fortune is dictated by other people.
If you can understand what others are thinking and know just the right word to say, you are likely to get positive feedback.
1. Get plenty of work experience - ideally in a caring context
3. Include reflection on your experiences in your personal statement
If you are irritating someone by speaking about a certain topic, do you notice?
If a friend is unusually quiet would you?
I often drift off while someone is talking to me.
If a colleague or friend got a huge promotion, I’d be most likely to feel:
When someone is talking about their achievements are you most likely to:
When you read fiction, do you:
Which of these descriptions applies to you?
If you answered ‘1’, you get 1 point, 2 = 2 points, 3 = 3 points
(Count all your points for the 7 questions above)
7 - 9 points: You are likely to have an exceptional ability to empathise.
10 - 15 points: You are empathetic, but could still improve your skills.
16 - 21 points: You might need to develop your empathy skills. Read on to see how.
For around forty years, medical schools have required students to demonstrate empathy.
In the second part of our test, try and answer the questions to see if you respond in the correct way.
You are a GP sitting beside a patient who is deeply anxious about a condition she thinks she has. So far the tests have not indicated that anything is wrong, but the patient is demanding answers. How would you deal with this?
a) Listen carefully and actively : Why is she concerned about this problem? Could there be any underlying issues such as psychological distress?
b) Read the situation: You may know that the patient isn't likely to have this condition. The problem is that telling her might not help. You have to do more than just give informed opinions, you have to deal with the person in front of you.
c) Understand patient expectations: What does the patient imagine she will get from you? Does she want to know more about the illness, or does she want reassurance that it won't be that bad?
d) Repeat: Relay what the patient has said back to her to check you've understood. This gives her a chance to evaluate her thoughts again.
e) Advise and reassure: The patient will be more likely to follow your advice if she feels she’s been listened to. Now you can give your opinion and reassure the patient that many others share these anxieties about health and that no conclusions should be taken without testing.
How would you communicate to a patient that he had been given the wrong test results? This mistake led him to incorrect conclusions about his health, and now the test has to be repeated.
a) Listen carefully and actively. The first step is always listening to what the patient has to say, otherwise it is impossible to address their feelings.
b) Explain clearly. The patient needs to know what has happened. Indirect language or euphemism will not help this.
c) Apologise. Even when something is not your fault, do not assign blame or try to explain a mistake away, apologise in simple and direct language.
d) Show understanding. Say something like 'I realise you must be feeling very frustrated by this situation. You may also be worried about the privacy of your test results.'
e) Reassure. As far as possible, try to reassure the patient about any concerns they may have. Explain what actions will be taken to limit any further problems.
You were convinced that a patient had a simple case of traveller’s stomach upset, due to negative test results, even when she maintained that she had a chronic irritable bowel disorder (IBD). The patient pushed for retesting, whereupon it became clear that she was right about the illness. How should you respond?
a) Listen carefully and actively: work out exactly how the patient is feeling. Is she blaming you, or is she just frustrated by the situation. What does she think her best option for moving forward is?
b) Use inclusive language: If you talk about what ‘we’ can do, it gives the sense of a team moving forward together. ‘You’ says ‘you’re in this alone’. The c) patient may already be lacking trust due to the misdiagnosis. Using the right language can start to repair things.
c) Ask how the patient feels about the diagnosis: If they are devastated, try some kind words that let the patient know there are options for treatment and that other people are going through the same thing.
d) Eye contact: Even if you feel embarrassed by your error, maintaining eye contact shows that you aren’t hiding away from the situation.
e) Advise: Walk the patient through possible treatment paths they can go down. Check at each stage how they feel about the options, without judgement.
Trying to explain away the fact that you didn’t diagnose her illness.
Jumping into explanations or plans for treatment without addressing the patient’s feelings.
Do you ever find yourself planning your next sentence when someone is talking?
What if you didn’t say what you planned?
Better yet, what if you didn’t say it and devoted all that brain power to really listening. I don’t mean listening and nodding and giving an emphatic ‘yes’ like a politician. I mean absorbing the hundreds of verbal and non-verbal cues that people give.
Active listening is when you occasionally paraphrase what someone has said and use affirmatory body language to show them that you are actually taking in what they’re saying.
You normally don’t need to think too much about active listening though. Fortunately, there’s a trick: actually listening.
It is almost impossible not to listen actively when you are fully concentrating. Like empathy, the ability to listen is a muscle, so don’t worry if you don’t get it straight away.
Empathy has an unfortunate connection with negative events. Sharing the great things that happen to other people is equally important. Try and be the sort of person who celebrates the victories of others, even if you don’t feel it at first.
The central skill is sharing emotion, not any specific type of emotion. When you observe people and really listen, finding common ground and sharing positives will come more naturally.
Literature has many benefits when it comes to empathy.
You only have one life and one set of experiences. By reading you can imagine yourself in many more situations than you’ll ever encounter.
Yes, movies work too, but they don’t take weeks to slowly absorb and they can’t go as deep into characters and their inner thoughts and desires. Films are consumed passively, whereas reading is an active process forcing you to create a reality.
According to a study examining empathy in medical students, female medical students scored significantly higher on the JSPE-S (a formalised empathy grading system) than male medical students.
This difference between genders was seen throughout the undergraduate medical programme, in years 1-5.
Reading interest was the question which saw the largest gender gap, specifically: ‘I do not enjoy reading non-medical literature or the arts’.
People can have different levels of empathy at different points in their lives. It may be that you are worried about your current situation and that distracts you from thinking about other people's emotions. It could also be that it does not come as naturally to you as some other people.
Not particularly. Empathy is a muscle, you just need to work it out. Remembering to observe and listen carefully is the main challenge.
Why might some disagree with valuing empathy so highly in a healthcare context?
Some doctors do not show empathy. We’ve all experienced this. Medical professionals are notoriously overworked, and some maintain that they just don’t have time.
One of the main arguments is that doctors would burn out if they empathised with every patient they treated. This is known as ‘compassion fatigue’. In fact, empathy is thought to decline through medical school as doctors put up barriers to protect themselves from the stress.
However, getting ‘compassion fatigue’ is not a fair excuse. This type of exhaustion results from feeling someone’s emotions, or ‘affective empathy’. Giving someone the time to be heard and showing understanding is a more distant form of empathy, and is absolutely central to healthcare and the patient experience.
We are emotional beings, and these feelings are measured out by our experiences with those around us. If a patient feels like they are on a conveyor belt, not only do they feel sad, but their health outcomes suffer.
You need to reframe the question.
Asking if you already have enough empathy shows a fixed mindset. You need to ask if you can develop the empathy.
A large part of this is the value you place on learning how to be more empathetic. If we compare it to being polite:
Sometimes showing empathy will be a massive strain and something you don’t want to do, but like manners, we can programme ourselves to respond to people in an empathetic way.
Active listening is a habit.
Reading body language is a habit.
Not planning your next sentence when someone is speaking is a habit.
The UCAT test is notoriously difficult to pass. It is designed to differentiate students who get AAA at A-level.
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