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?”
How much time do you spend on mental comparisons? Looking on Facebook and thinking everyone else has better relationships and is much happier than you? Thinking that everyone in your peer group is smarter than you? Or fretting about how much fitter, thinner, smarter, or more successful you were at a different point in your life? Much of our stress, frustration, disappointment, guilt, and regret is the result of comparing ourselves to preconceived ideas about how we should be acting, how we should be looking, and how our personal successes are perceived by others. Theodore Roosevelt once said that comparison is the thief of joy. Indeed, comparisons often keep us in a mental hamster wheel of self-doubt and lack of confidence. To combat physician burnout, it is critical to decrease the tendency toward comparisons.
But comparison allows me to improve my performance
You may believe that comparisons keep you on your toes. Let’s test this out. Think about any times you’ve compared yourself to someone else in the past week. Did the comparison help you feel good about yourself and your circumstances or did it send you into a spiral of self-critical thoughts? Did you feel energized and optimistic about your circumstances or did you feel defeated, inadequate, and that your life would be forever deficient?
Like advertisements, comparisons hold us in the belief that if we only had product or service X, we’d be happier, feel and look younger, and be the king or queen of our world. While it’s always good to work toward life improvement, comparisons typically leave you unable to focus on the satisfaction inherent in your current circumstances. Comparisons push your focus onto either the past or the future, or simply what’s wrong with the present. Comparisons keep you from being content and perhaps more able to accept what is. Right now.
How to stop comparing yourself to others
As a physician coach, here are four steps I teach to overcome the pull to comparisons:
- Start tuning in to your own thought processes. Simply begin noticing when you are going into comparison-oriented thinking. Try not to judge yourself. Jot these instances down so you can begin to see how often this occurs.
- Once you’ve noticed that you’re making a comparison, name it to yourself. Say to yourself “there I go comparing myself again.” Doing this begins to create a distance between the comparison you’re focusing on and the reality of the situation. Having that distance and separation is vital in having choice and control over your own thoughts.
- Now ask yourself: What is the cost of this thought process? What would I gain if I spent less time on these mental comparisons? Journal about these questions.
Now for the challenge. When you find yourself making a comparison and coming up short, push yourself to think of at least three ways you, your circumstances, your thoughts, and your actions are right and adequate just as they are. Your mind will call you back to the land of comparison and self-criticism. Your job in this step is to exert equal and opposite force in the other direction! Definitely take notes here.
These steps take a lot of practice. What you will gain, though, is the ability to see your own strengths and accomplishments. You’ll find yourself experiencing more calm and a stronger sense of your own self-worth. Harkening the words of Theodore Roosevelt, you may even find yourself experiencing more joy.
Gratitude is something you may not pay much attention to. It’s easy to take the good things in life for granted. If you’re like most people, the focus is often on the glass half full, on the things you don’t have or the things you want to be different. Both internally and externally, you can be overwhelmed on a daily basis by negativity, challenges to overcome, and by all that seems to be going wrong.
For many, it is those moments where something occurs that shake you out of the bubble you live in, and brings you into the awareness of true gratitude. For example, when you hear about a bad outcome, a colleague diagnosed with advanced cancer, or a friend’s teenager getting into a significant car crash. For that moment, you may find yourself overcome with gratitude so intense that it overshadows all negatives. You realize how fortunate you truly are, and experience a strong wave of relief and calm, thankful that you and your loved ones are safe and in good health. In that moment, your worries melt away. Perhaps you tell yourself that you’ll always feel appreciation for the good things you have in your life. But, no sooner have you had this realization then your focus shifts to something in your life that you find wanting.
Yet, if you can tap into these brief interludes of gratitude you may find a powerful antidote to many negative states of mind, including worries, fears, resentment, and anguish. The power of authentic gratitude can give you centeredness and balance that staves off feelings of overwhelm. The power of thankfulness is almost like a magic wand! And, it doesn’t even matter what you’re grateful for.
Research shows how gratitude can benefit your life
How do we know that gratitude is so powerful? Much research has been done to determine the effects of gratitude.
For example, a 2009 study of 400 adults found that grateful people had better sleep quality, were able to fall asleep faster at night, and also had less daytime tiredness. A 2013 study of 1000 Swiss adults found that gratitude correlated with improved psychological health that then translated into greater likelihood of engaging in health-promoting activities. There are dozens of other studies, well catalogued at a University of California, Berkeley site.
Give gratitude a try
What are some ways to see the benefits of gratitude in your life? One way is when you find yourself fixated on a worry, ask yourself what you’re grateful for right in that moment. Stop for 10 seconds and focus on that sense of gratitude. Another way is to start or end every day with a gratitude list. Ask yourself: What 3 things am I grateful for today? Try each of these exercises for 7 days in a row. What do you notice? Any decrease in your sense of burnout?
You didn’t learn about it in medical school and you probably rarely talk about it. But you need to be aware of a syndrome that’s all too common among physicians all over the world. It strikes regardless of specialty, income, or years in practice. Although there is no definitive data, it’s believed to have reached epidemic proportions.
What am I talking about? It’s the Impostor Syndrome! If you have Imposter Syndrome (IS), you may fear that it’s only a matter of time that you’ll be “found out” as a fraud. Despite abundant external evidence of success and accomplishment, you regularly find it difficult to believe that you are, indeed, a success. You may attribute your accomplishments to luck or chance, not believing that you actually have the intelligence, fortitude, and skills required to get to your current place in your career. You likely also have an inflated sense of the success and aptitude of others.
When the Imposter Syndrome Strikes
Whatever your professional status, you can still get IS. Listen to what Dr. Margaret Chan, Director of the World Health Organization, says about herself: “There are an awful lot of people out there who think I’m an expert. How do these people believe all this about me? I’m so much aware of all the things I don’t know.”
The emotional drain of IS is significant. It erodes your sense of confidence, and contributes to the emotional exhaustion and lack of sense of accomplishment emblematic of physician burnout.
The syndrome does not only strike physicians but is particularly common among this group. Why?
1) There are simply too many technological advances to keep up with. No matter your specialty, the body of knowledge is growing rapidly.
2) Medical training emphasizes perfection. You’re taught early on that you should know the answer to everything related to our field, and, if you’re not perfect, you’re a failure.
3) Physicians tend to be their own harshest critic, focusing much more on negative qualities than their strengths.
So, how do you make the diagnosis of IS in physicians? The criteria include all of A, B, and C:
A. The patient must be a physician.
B. On at least a weekly basis, the patient believes they will be “found out” as a fraud.
C. The patient believes that all other physicians in their specialty know more than they do.
Do you or someone you love suffer from Imposter Syndrome? If so, you can take comfort knowing that it affects almost all physicians. Once a diagnosis is made, knowing how to manage the syndrome is key. Stay tuned for Part II to find out more about treatment of this common disorder.