Physician Empathy Training Reduces Burnout

by | Oct 3, 2017 | Physician Burnout, Physician Resilience

An Interview with Harvard Medical School’s Empathy Expert

Dr. Helen Riess’s research on empathy, based on ground breaking  studies at Massachusetts General Hospital, has been the subject of articles, radio discussions, and a popular TEDx Talk. Riess’s focus on educating physicians and medical professionals on the use of empathy in medical practice is an old yet revolutionary idea, one that ties directly to the epidemic of physician burnout. Dr. Riess’s belief that empathy can be both taught and learned has led to the creation of Empathetics,LLC,  an empathy education program for physicians, nurses, and other medical professionals, where she serves as the Chief Scientific Officer.

Dr. Riess, an Associate Professor of Psychiatry at Harvard Medical School, is the Director of the Empathy and Relational Science Program at Massachusetts General Hospital. Her approach to empathy in medicine is meant to aid physicians in cultivating a better medical experience and a sense of personal well-being for both the patient and the physician.

In the following interview, Dr. Riess explores her interest in empathy, her research, and how empathy coaching can help medical professionals.

Why is empathy so important for physicians? Why now?

As a psychiatrist, my work has been strongly influenced by the work of Heinz Kohut, who was one of the first in the field to hypothesize that empathy was the sin qua non of good medical care. Kohut believed that by taking the patient’s perspective, physicians could better understand what patients experience and thus be better positioned to effect improvement in their health. In the last decade, many of my patients have talked about difficulties in the physician-patient relationship, a sense of not being heard or understood by their physician. I found it very disturbing that patients spent therapy time talking about being dismissed by physicians around issues of importance to them.

In this same time period, understanding and awareness of physician burnout has emerged.  We are understanding more clearly that medical training seems to blunt the empathy medical students first bring with them to medical school. The confluence of seeing what was happening with my own patients with national trends in physician burnout led me to look more deeply.

I began to wonder: If empathy can be down regulated in medical training, could it be up regulated? Could increased empathy help to decrease physician burnout?

What has your research revealed overall?

That human beings are hard wired for empathy.

Being able to take the perspective of another and appreciate their suffering underlies survival of our species, through cooperation and through shared concern of one another. We have visual, auditory, tactile, and emotional resonance when we see fellow humans suffering. This calls forth our own emotional responses that make us want to help. However, this ability is quite mutable, subject to many conditions that affect medical professionals. Based on multiple  studies, people are most likely to help people who  are most like themselves, or if they are dissimilar, those who have suffered in a similar way. For example, if both have lost a child, both will have more empathy that transcends their personal differences.

Medical professionals need to be reoriented back to the humanity of each individual they care for. Left unaddressed, lack of physician empathy is only going to worsen given the increasing time constraints, emphasis on productivity, and the many other growing pressures physicians face. Unfortunately, lack of support for their own needs will lead to more and more resentment and compassion fatigue. It’s similar to trying to draw water from a drying well. It’s simply not sustainable.

What did your research reveal on an individual level?

I designed courses that address improving awareness of other, self-regulation in difficult situations, ways to open the mind to what others are experiencing, and  to shift perspectives  to evaluate all this rationally. I studied this in over 100 residents from 6 different specialties. Physicians were taught how to empathize with the person’s experience rather than the person, who may be behaving in a difficult manner that shifts attention away from their suffering. For patients that were the most challenging to empathize with, physicians were able to increase empathy. Learning how to see the person behind his or her difficult behaviors helps to bring out natural tendencies to help. With a brief, 3 hour spaced education training, there was significant improvement in taking the patient’s perspective.

Additionally, I found that once awareness heightened, physicians wanted to develop empathy even more. The demand for this training began to far exceed what one person could meet. This was the impetus for creating an e-learning training company, which led to the formation of Empathetics. We did not want there to be any impediment to creating true culture change in large organizations, so the e-learning platform was built.

Do you see empathy training as a stand-alone program?

The Empathetics e-learning platform can easily be combined with other coaching strategies. Optimally, every person could use an individualized approach. This could include live classroom facilitators when a blended learning approach is desired for group or e-learning combined with individual professional coaching. Empathy e-learning may be sufficient to move people from good to excellent but others may need more specialized attention. For example, my recent paper with Drs. Gazelle and Liebschutz addresses the use of professional coaching to mitigate physician burnout.  Physician coaching, in addition to what can be learned from the web-based platform, can help physicians find deeper satisfaction in a career that, frankly, has become very burdensome.

How is this tied to the future of medicine?

My dream is that all physicians will become more empathic and that there will be no barrier to empathy training. Increasing empathy can increase sense of meaning, coherence, and inspiration for physicians drowning in administrative burdens. What we offer through Empathetics is a basic CME course that is accredited by the Massachusetts Medical Society that could deeply impact how medicine is practiced. The training is available both for individual learners and large group cohorts.

Empathy makes both parties feel good. Because really, at end of the day, what could be more gratifying? As George Eliot said, “What do we live for if not to make life less difficult for each other?”

  1. Embrace uncertainty

When you stop and think about it, uncertainty and change are the only things that are certain. Impermanence is one of the basic laws of our world.

After all, everything changes. Our relationships change. Our kids grow up and change. Our bodies age and change. Our environments change. Our planet changes.

All too often, however, we forget this basic truth. We somehow expect things to be predictable and stable.

The problem is that this expectation sets us up for difficulty. It leaves us struggling unnecessarily when something shifts. It adds a layer of suffering above and beyond that caused by all the VUCA around us.

What I’m getting at is that we have a choice. We can meet uncertainty with reactivity or we can meet it with mindful understanding.

More than meditating on a remote mountainside, mindfulness helps us have the calm, steadiness, and clarity we need to work constructively with all the change and uncertainty.

At the same time, while we can find ourselves resisting change, we can remind ourselves that it does not have to mean something bad! Just take a moment right now to think of all the difficulties you have faced in your life and work that are now resolved and far behind you. This can help you see how change has actually been quite the positive.

  1. Respond to complexity with compassion

Even knowing that change is the only thing that is certain, it can still be difficult to weather. Living in such a VUCA time is difficult. You deserve compassion for managing all the challenges.

With mindful awareness, we can bring ourselves compassion for what we’re going through. There is increasing evidence that self-compassion is a powerful antidote to stress and even burnout. From where I sit, I think that it is actually one of the most powerful medicinals available to us.

  1. Take purposeful pauses

With mindfulness, we are aware of what is going on within and around us. We tune in and pay attention to our experience. We learn to utilize our breath to take us out of the fears, worries, stories, and preoccupations our minds are so good at generating about what might come next, and bring us back to the present moment. Here in the present, we leave that overly activated limbic state and can experience a sense of calm.

A pause also serves to allow our prefrontal cortex to come online. It creates a critically important space between our emotional response and conscious, intentional action.

Once we have paused, we can then see more clearly that fear had taken hold. 

With a pause, we become the witness of our experience as opposed to the one trapped by it.

  1. View VUCA as opportunity

I don’t know about you, but I can find myself reacting to the VUCA environment with something of a fixed mindset. With a fixed mindset, I am telling myself things like ‘it shouldn’t be this way’ and ‘why is this happening?’

When I can utilize mindful awareness, I can see that I’ve boxed myself in with a fixed mindset. I can challenge myself to grow. By grow, I mean challenging myself to see whatever difficulty I’m experiencing as an opportunity to learn.

Here again, mindfulness again throws us a lifeline. Mindful awareness involves leaning into curiosity.

I can flip the script and ask myself:

What can I learn from this experience?

How can I use this to be a better version of myself?

How can I help others cope in this VUCA environment?

What do I want to look back and see about how I acted?

In summary, while VUCA is definitely the order of the day in healthcare and beyond, you don’t have to succumb. You don’t have to live in fear. There are constructive actions you can take to help you cope with uncertainty, build calm in chaos, and even thrive in chaos and VUCA. While we can’t control much that is contributing to the VUCA time, with mindfulness we can control how we respond to it.

I hope you’ll try out these 4 mindfulness strategies as I have seen them help countless people. I’d love to hear how it goes.

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To learn more about how mindfulness coaching can help you cope with this VUCA time, please reach out for a complimentary consult.

6 Free Resources To Help You During COVID19 And Beyond.

  1. 14-day meditation series 
  2. Imposter No More PDF
  3. Resilience Book Chapter
  4. Leading In Crisis PDF
  5. Balance To Burnout PDF
  6. 30-minute consult

Take advantage of one or more of these valuable resources created for clinicians and non-clinicians.