It’s a core component for physician leaders trying to build a cohesive team. See how you measure up with these 10 statements.
People often talk about it, but just as often are confused about what empathy is, and yet, empathy is a critical ingredient in any helping relationship. Whether you are coaching a colleague, a junior practitioner or treating a patient, your helpfulness depends on empathetic interpersonal interactions.
In coaching, empathy creates the social glue that binds the person doing the coaching with the one being coached so that the preconditions for helping — openness and trust — are met. Moreover, empathy is considered to be a core component of evidence-based medicine because of its significant association with clinical competence and positive patient outcomes. Even a brief perusal of the research reveals that physicians with higher empathy scores are more likely to generate better patient outcomes. Consider the following example.
Dr. George Coffman was listening to colleague Marie Brown, a division manager, talk about her relationship with the chief medical officer. Brown related how the CMO apparently has ignored her suggestions for improving certain aspects of patient care. Brown previously has shown herself to be an advocate for patient care and is aligned with the hospital system's patient care strategy.
While listening, Coffman was aware of Brown's increasing pace and volume of speaking, and small changes in her physical demeanor as she talked about the CMO. When Brown paused in her account of the CMO's attitude toward her, Coffman said, "Marie, as I listen to you I hear the frustration in your voice. Are you saying that you're feeling upset because your expertise is being ignored or is there something more?"
Brown, now looking directly at Coffman, paused a moment and responded. "Wow, I hadn't realized I felt so strongly about this, but now that I think about it I haven't felt that the CMO and I have been on the same page for some time. I guess this has been building for a while."
"So it's kind of like the final straw in a whole series of events?" Coffman asked.
"Yes, that's it exactly. It's not about him ignoring my suggestions; it has to do with what I believe is a general lack of respect for me," Brown said.
Role of Empathy
This interchange illustrates the role of empathy in a coaching conversation. Empathy is a means of connecting with and engaging the other person. In the broadest sense, empathy refers to one person reacting to another in a way that demonstrates an understanding of that person's perspective or feelings — but without getting caught up in them.
The content of the person’s story is like watching a movie in black and white; listening for feeling adds the color.
For some, the idea of empathy is considered too "touchy feely." Physicians, in particular, often avoid displaying empathy because they strive for detachment so that they can care for their patients regardless of their personal feelings. However, this approach misses the point entirely.
Empathy is not sympathy. Sympathy means that you experience the same feelings and concerns as the other person. Empathy is not pity. Pity is when you feel sorry for the other person. The point of empathy is to focus on the other person, see things from their perspective, understand the person's feelings and then communicate that understanding so that the helping relationship is strengthened.
How Empathetic Are You?
In his book, Zero Degrees of Empathy, Simon Baron-Cohen published an Empathy Quotient Questionnaire. Here are some statements from his questionnaire that describe empathic behavior. How do you measure up?
- I find it easy to put myself in somebody else's shoes.
- I can usually appreciate the other person's viewpoint even if I don't agree with it.
- I am quick to spot when someone is feeling awkward or uncomfortable.
- I am good at understanding how others are feeling.
- Friends usually talk to me about their problems. They say I am very understanding.
- I can easily tell if someone is interested in what I am saying.
- I can tune into how someone feels rapidly and intuitively.
- I can easily work out what another person might want to talk about.
- I can pick up quickly if someone says one thing but means another.
- I can tell if someone is masking their real emotion.
Empathy Can Be Learned
How did you do? If you are interested, the entire questionnaire can be found in Baron-Cohen's book. Even if you responded with "No" or "Not exactly" to these statements, take heart because empathy is a skill that you can develop with practice. Here's what to do:
Pay attention! Attention is validating. It lets the other person know that he or she is important. Arguably, the most valuable thing you can offer someone — from a helping standpoint — is your focused attention because it signals that you are putting them first. You cannot fake attention. Pretending to show interest, while mentally doing other things, is very different from showing genuine interest. When you attend to the other person's perspective, it forces you to focus on what the person is saying and signals your interest in him or her as a person. When you are absorbed by the process of better understanding the other person, you have taken the first step toward being empathetic.
Paying attention also fosters elaboration. In other words, paying attention helps to draw out the other person's thoughts and ideas. This is magnified even further when you accompany your attention with gentle directives or quick, wide-open questions.
For example, invitations like "Tell me more" and "What else?" are quite effective in inducing the person to expand on what he or she is saying. It demonstrates that you are interested in and willing to pay attention to what the person has to say.
Keep in mind that you communicate your interest and attention through your body language as well as your questions. Your nonverbal communication must reinforce your intentions.
Use empathic listening. Paying attention is the gateway to empathic listening. Empathic listening is the process of reading and "resonating" to the person in such a way that aspects of his or her experience become alive for you in some way. This type of listening is not the typical listening we do when we are in casual conversations. It is listening with a purpose, which means listening with your ears, your eyes and even your body in the sense that your "gut-level" responses provide information. You are listening to the verbal and nonverbal message in the other person's communication.
Empathic listening means doing the following:
- Listen to what is being said. This is the most fundamental way of listening. Every person has a story to tell, and that story is important from their point of view. Listening to what is being said means listening to their story and what it communicates about their experience. Consciously attending to the person's story is one way of slowing down the pace of your thinking so that you do not get too far ahead of yourself.
- Listen for feelings. The content of the person's story is like watching a movie in black and white; listening for feelings adds the color. The type and intensity of feelings provide clues as to what is important to the person. Feelings can be known from what the person says (i.e., “I'm really frustrated with the CMO”), from the person's demeanor (e.g., pace and volume of speaking) and your own internal reactions (e.g., when you sense what another is feeling).
- Listen for what is not being said. Listening for what is not being said means looking for things that aren't spoken or things that are conspicuous by their absence. In other words, it is "reading between the lines" so that deeper or more relevant issues can be explored. In the earlier example, Coffman "hears" what Brown is not saying, namely, that her frustration is not just the result of the CMO ignoring her suggestions; it is driven by her belief that she is not respected. Coffman is able to respond in a way that helps Brown consider this possibility.
Express empathy: There is more to empathy than just paying attention and listening. It is demonstrating your empathic understanding to the other person. In other words, it is expressing or showing in some way your felt awareness of what the other person is thinking, feeling or experiencing. You can do this by using a technique called reflection.
Reflection is a method of acknowledging what the other person is saying. Reflection is repeating — in your own words — what you are hearing or sensing from what the person is saying. However, it is not parroting — which is repeating the identical words of the other person.
It is reflecting back to the person your version of what he or she is communicating. The other person will then either confirm to you that you have heard them correctly or correct you. Either way, reflection is proof that you have been paying attention and are trying to understand the other person. Also, it encourages the person to elaborate on what you have reflected to him or her in the first place.
In summary, even if you are not predisposed to the display of empathy, you can learn to be empathetic. It is a required skill for coaching or mentoring others. It is also useful in any helping relationship — including the one clinicians have with patients.
Robert Hicks is a licensed psychologist and a clinical professor of organizational behavior and founding director of the Executive and Professional Coaching Program at the University of Texas at Dallas. He also is a faculty associate at UT Southwestern Medical Center.