Educating for Empathy: Patient versus Provider Perspectives

By: Claire Jahnke, Pharm D Candidate and Ashley Castleberry, PharmD, MEd

How do we normally think and talk about illness? 

Patient is a 19-year old female presenting to the ER with signs and symptoms of DKA (diabetic ketoacidosis) as evidenced by mental disorientation, random blood glucose of 452, persistent nausea and vomiting, and urinalysis positive for ketones. A lab panel is pending. Initiate fluids, potassium, and insulin drip. Will monitor. 

Here’s another perspective.

It was my first month at college. I had moved hundreds of miles from home when I woke up one day feeling sick.  After vomiting nearly a dozen times in a couple of hours, my orientation advisor drove me to an urgent care, before an ambulance transferred me to the hospital. The swarm of doctors and nurses talked to me, but I was just so mentally fuzzy. They needed to put an IV in my neck, because they couldn’t get one in my arm. I could barely stay conscious curled up on the gurney. I don’t remember much else until the next day.

Both statements describe the same experience – one that was mine a few years ago.  

As a student pharmacist and person living with Type I Diabetes, I have a unique perspective on both sides of the practitioner-patient relationship. Throughout my classes and practical labs on diabetes, I was concerned with the gap between how we talk about disease as clinicians and how I would want to talk about my disease as a patient.  

I believe that the key to this gap is empathy. Within the context of healthcare, determining a single definition of empathy is a challenge. It can be conceptualized as the ability to accurately understand and acknowledge the feelings and perspectives of others.¹ However, empathy is multidimensional. Traditional concepts of empathy involve cognitive empathy, a relatively detached understanding of the effect of a distressing situation, and affective empathy, which extends cognitive empathy by mirroring a patient’s emotional response.¹ Researchers have identified an additional aspect of empathy, behavioral empathy. This focuses on translating thoughts into actions aimed at alleviating challenges and the associated pain. Thus, empathy in its broadest definition is a complex dynamic that incorporates understanding, feeling, and action.²  

The idea of patient-centered care is integral to how we practice as pharmacists. But for healthcare to be truly patient-centered, we need to interact with our patients with all three aspects of empathy: our thoughts, emotions, and actions. In order to engage with our patients around medication adherence, we need to understand that managing one’s disease is not just an intellectual exercise, but often an emotional one.

One aspect that I feel that the professional curriculum misses when discussing diabetes adherence is acknowledging the challenges beyond physically taking medication. Many pharmacy institutions attempt to teach empathy through medication adherence simulations, as is recommended in literature.³ During my first year in pharmacy school, students utilized a smartphone application to simulate a complex medication regimen for a week. Students then completed reflections that were qualitatively analyzed for common themes. The most common response was an increase in empathy through greater understanding of the challenges of medication adherence, with a related outcome of recognizing their own non-adherence for the week-long challenge.⁴ While simulations are a good place to start, they do not effectively convey the true challenge of adherence. Adherence involves managing holistic diseases in all things (diet, exercise, medication, monitoring) at all times (normal life, periods of stress, vacations, even natural disasters).

Beyond my personal experience, educational literature supports the importance of empathy on improving clinical outcomes. A recent study demonstrated that patients of physicians with high empathy scores had significantly better control of their A1c than patients of physicians with low empathy scores, controlling for other factors.⁵ To me, this isn’t a surprise. It’s discouraging to be lectured, to see results highlighted in red, and to be labeled as “non-adherent” when one’s struggling. I’m personally more likely to re-engage when I feel like my provider is on my side, working with me, and understanding the challenges in my life.`

So what can be done? How can we teach and practice more aspects of empathy?

Strategies to Move Beyond Adherence Simulations

How to Teach Empathy	How to Practice with Empathy
Incorporate “pill burden” and social-emotional challenges in didactic lectures	Avoid moralizing adherence and compliance
Challenge students to rewrite cases from a patient’s point of view	Focus on small improvements rather than all-or-nothing success
Utilize social media to provide insight into patients’ “Day in the Life”	Emphasize self-efficacy and avoid infantilization
Include education regarding related mental and social challenges using narratives	Validate patient’s struggles before presenting solutions

As long as the gap between patient and provider perspectives exists, we will engage with illness and adherence differently.   How can educators help bridge this gap with empathy education?

Acknowledgements: 

Thank you to Dina Chibli for sharing her research and poster presentation.

References:

1. Sinclair S, Beamer K, Hack T, McClement S, Bouchal S, Chochinov H, Hagen N. Sympathy, empathy, and compassion: A grounded theory study of palliative care patients’ understandings, experiences, and preferences. Palliat Med [Internet]. 2016 Aug 17 [cited 2020 Oct 9];31(5):437-447. doi: 10.1177/0269216316663499

2. Moudatsou M, Stravropoulou A, Philalithis A, Koukouli S. The Role of Empathy in Health and Social Care Professionals. Healthcare [Internet]. 2020 Jan 30 [cited 2020 Oct 9];8(1),26. 10.3390/healthcare8010026

3. Lam, T, Kolomitro K, Alamparambil F. Empathy Training: Methods, Evaluation, Practices, and Validity. J Multidiscp Eval. 2011 July; 7(16): 162-200. https://doi.org/10.56645/jmde.v7i16.314

4. Chibli DM, McCrea S, Castleberry A, Pope ND. The Impact of a Medication Adherence Simulation on PharmD Student Empathy. Poster presented at: UTCOP Student Research Day; April 12, 2022; Austin, TX. 

5. Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS. Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med. 2011 Mar;86(3):359-64. 10.1097/ACM.0b013e3182086fe1

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Author Bio(s): 

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Pulses is a scholarly blog supported by a team of pharmacy educators.