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I was part of a facilitated discussion for a charitable group, and the question posed to us was: How do we increase empathy? It was a diverse group of entrepreneurs, educators, and others (I include myself as an “other”). There were a lot of thought-provoking questions raised: How and when do you start teaching kids how to be empathetic? What’s the role of schools? What responsibility do leaders of organizations have in encouraging empathy on the part of employees? For doctors, how can empathy be incorporated into medical school curricula?

I don’t have answers to those questions, but I noted that everyone assumed that empathy is a learned skill or a personality trait. It may be – I don’t know. But it has been shown in studies such as the “Good Samaritan Study” that you can alter people’s empathetic behavior (e.g. helping another person) by changing their circumstances (e.g. introducing time pressure). 
So rather than asking how to create empathetic people, we might ask: what circumstances could increase empathetic behavior in everyone, regardless of background? Or, since we are starting with existing environments, maybe we can ask what circumstances decrease empathy, and try to remove some of those factors.

From personal experience, we might agree that settings in which we feel less empathy toward a person include:

• when we are under stress, and can’t think of anything but our own problems
• when we are far removed from the person
• when the person seems very different from us
• when we mentally classify or label the person as a type less deserving of empathy (e.g. a criminal, a bully, someone of “privilege”, etc)

When we see someone as less human, less like us, or when we don’t give ourselves the space for unselfish thoughts, we are less likely to be able to see things from that person’s point of view.

Empathy is like a generous gift. You give a gift when you deem someone worthy of it and when you have the resources to afford it. The more stress you’re under or the less worthy the recipient, the less generous you become. And we tend to think of people like us as the most worthy, don’t we?

Now let’s think of some of the circumstances in which we provide healthcare. 

• constant pressure to get through the visit or exam and on to the next one
• increasing use of telehealth
• increasing focus of doctors on the EMR interface, rather than the patients in front of them
• use of terms like “GOMER,” “frequent flyer,” and “drug seeker,” as patient descriptors, which allow clinicians to categorize and then dismiss patients.

If we create stressful situations in which there are barriers – distance, computer interfaces, negative labels – between the doctor and the patient as a person, then we will decrease the possibility of empathy. And yet what do all patients – what do we all – want? To be respected as people. That’s our most basic requirement of someone we are gong to trust with our health and bodies, isn’t it?

This effect might be most keenly felt in radiology, where the nature of the work does not expose the radiologist to the humanity of the patient and the focus on productivity has been on a constant upward ratcheting. But other specialties are right behind us.

We can’t turn back the clock, but we can design things differently going forward. If we want empathy to be an important element in the practice of medicine, then we need to design systems with that in mind. 

Here are just a few ideas that might create some small change:

• Designing better patient demographic summaries that figure more prominently in the chart and include more personal details, even ones that are not medically essential
• Using patient pictures more often, rather than just names or medical record numbers*
• Changing our personal practices of referring to patients by diagnosis (e.g. “the appendicitis in room 3”) or negative, dismissive terms (e.g. “GOMER”)

More advanced changes might include designing workflows to not only maximize productivity, but to optimize productivity, with outcome measures of quality and empathy, rather than just volume. We might also turn the empathy lens toward interactions between healthcare workers, who are often working at a distance and with less personal connection. Who knows? – These changes might even positively affect the trend of clinician burnout.

I don’t know if empathy can be taught, but we can certainly create environments in which it is much more likely.

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*There has been some early work that shows that radiologists feel more empathy toward patients after the introduction of a patient photo