Some experts see empathy scores as a barometer of organizational and clinician wellness, although empathy training is no quick fix for burnout.
Like his colleagues across the country, Steven Strongwater, MD, the president and CEO of Atrius Health in Newton, Massachusetts, is working to mitigate burnout among the organization’s physicians and other medical employees. It’s a big organization — 825 physicians, more than 300 advanced-practice clinicians, and some 4,000 other employees working in 32 clinical locations.
One of Strongwater’s strategies: asking all staff members, including physicians, to participate in empathy training.
“It seems like a soft topic because everyone in health care, at least in theory, would be empathetic to start with,” he says. “But it turns out there are some very concrete things that people can do that convey to patients and their families that they are listening, and that they are being responsive to their concerns.”
Strongwater’s focus on empathy as a wellness tactic is grounded in research. Higher scores on the Jefferson Scale of Empathy are associated with lower scores on burnout assessments, says Mohammadreza Hojat, PhD, a research professor of psychiatry and human behavior with Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania.
In 2016, Atrius Health conducted 251 empathy forums throughout the organization. It was a huge effort, requiring 131 facilitators. More than 4,000 employees — 92 percent of the entire staff — participated in one of the 90-minute forums.
Subsequently, Atrius Health embedded a two-hour workshop on empathy into its new-employee and new-clinician orientation programs and developed empathy videos and online learning materials.
Formal training programs are among many approaches people and organizations are using to improve empathy levels. Others include intentionally organizing small groups of peers who can allow individuals to discuss the stresses of medical practice in a safe space, while encouraging mind-body practices like meditation or yoga.
Whatever the approach, two concepts must be recognized:
- There is no quick fix to the complex nest of factors behind physician burnout. “Embedding cultural shifts into an organization like this takes time and practice, so one intervention is not enough to make substantial lasting change,” Strongwater wrote in an NEJM Catalyst summary of Atrius Health empathy forums.
- Physicians cannot be blamed for — or expected to fix — burnout by improving their empathy level. “I can tell you that mindfulness meditation is a way to build empathy,” says Leonard Calabrese, DO, a Cleveland Clinic rheumatologist and empathy researcher. “But if you take a burned-out physician who is already overworked, told to see more patients faster and make their patients happier, and tell them to go meditate, they will be angry — and I would be, too.”
If an organization has an empathy deficit, organizational factors — electronic health record systems, documentation hassles, workload and others — should be prime suspects.
“I always say that any of these practices that buffer empathy might reduce your burnout score by maybe 10 percent,” Calabrese says. “That's good, but it's really a much more comprehensive treatment that is required, involving both personal change and institutional change.
Other insights from the experts:
Co-workers are people, too. Psychiatrist Helen Riess, MD, is co-founder and chief scientific officer of Empathetics, which provides empathy and interpersonal skills training for medical professionals. The curriculum is rooted in her belief that empathic skills need to be part of the fabric of an organization.
“It’s important for physician leaders to recognize that how professionals talk and treat one another is just as important as how they relate to patients,” says Riess, author of The Empathy Effect: Seven Neuroscience-Based Keys for Transforming the Way We Live, Love, Work and Connect Across Differences, to be published by year’s end.
Being empathetic might actually save time. Physicians often cite the lack of time as the primary cause for a decline in empathy. Riess’ training makes the case that being empathetic makes a physician more efficient. “Very few patients talk a long time, but doctors tend to interrupt patients within 18 seconds,” she says. “If they even listened for one minute, they would probably learn a whole lot more than cutting off the patient and starting to fire their own questions at them.”
She cites the example of a patient accepting a prescription order with no intention to get it filled. “Since the doctor didn't notice a disgusted look on the patient’s face, he may not disclose that the last time he took that medicine, he started vomiting,” Reiss says. “So, if you miss that, you haven't really saved any time. You've probably made sure a person isn't going to get better and is going to be back for another visit, which is really wasting your time.”
Empathy training is for everyone. Focusing empathy training only on individuals who have low scores is a bad idea, Riess says. “In the institutions that contract for our training just for people who are supposedly in need of remediation, we have noticed that it is seen as more of a punishment than an opportunity,” she says. “Everybody can improve — even people who are A can move to A-plus.”
Empathy scores can be seen as a barometer of organizational well-being, Calabrese says.
“It’s not ‘fix the empathy and we’ll fix the problem,’ ” he says. “You have to really take care of your people, believe it, act like it and provide institutional resources and space for individual self-care to foster this. If you have a healthy workforce, empathy will come forth naturally.”
Lola Butcher is a freelance health care journalist based in Missouri.