Teaching Doctors Empahty — Some Lessons and Questions for the Legal System

The Economix blog in the New York Times has a great post on new research that shows that doctors can be taught empathy. In the experiment:

Dr. Helen Riess, director of the Empathy and Relational Science Program in the department of psychiatry at the Massachusetts General Hospital in Boston, created a series of empathy “training modules” for doctors. The tools are designed to teach methods for recognizing key nonverbal cues and facial expressions in patients as well as strategies for dealing with one’s own physiologic responses to highly emotional encounters.

In one lesson, for example, doctors watch a video of a tense exam room interaction while a striking graphic sidebar records the electrical skin conductance of both patient and doctor, the mismatched spikes peaking as each person’s frustration with the other escalates. Another lesson walks doctors through a series of pictures of a patient whose face expresses anger, contempt, happiness, fear, surprise, disgust or sadness.

To test the effectiveness of the lessons, Dr. Riess and several of her colleagues enrolled about 100 doctors-in-training and asked their patients to evaluate their empathy, based on the doctor’s ability to make them feel at ease, show care and compassion and fully understand patient concerns. Half of the doctors then took part in three one-hour empathy training sessions.

Two months later, the researchers asked a second group of patients to evaluate all the doctors again. They found that the doctors who had taken the empathy classes showed significant improvements in their empathetic behavior, while those who had not actually got worse at empathizing with patients.

.  .  .

Compared with their peers, doctors who went through the empathy course interrupted their patients less, maintained better eye contact and were better able to maintain their equanimity if patients became angry, frustrated or upset. They also appeared to develop resistance to the notorious “dehumanizing effects” of medical training. After the empathy classes, one physician who had complained about being burned out said, “I feel as though like I like my job again.”

The doctor who wrote the post concluded:

Curious to know whether the empathy course worked, I decided to try out what I had learned in researching this column. The next day at the hospital, I took extra care to sit down facing my patients and not a computer screen, to observe the changing expressions on their faces and to take note of the subtle gestures and voice modulations covered in the course. While I found it challenging at first to incorporate the additional information when my mind was already juggling possible diagnoses and treatment plans, eventually it became fun, a return to the kind of focused one-on-one interaction that drew me to medicine in the first place.

Just before leaving, one of the patients pulled me aside. “Thanks, Doc,” he said. “I have never felt so listened to before.”

This raises so many great possibilities and fascinating questions:

  1. Could we teach judges empathy?  Surely from this, yes.
  2. Should we teach judges empathy?  I think so, because I think empathy is just a form of engagement and that empathy is fully consistent with neutrality.  Understanding the feelings of all sides makes you better able to understand their positions, motivations, behavior, and context.  It should therefore lead to more insightful decisions that are more likely to work for all the parties.  It should not lead to bias toward the more sympathetic side, in fact it might even help prevent such unconscious bias.  But there is likely to be opposition to the approach from those who feel that empathy is equivalent to improper and biased sympathy.  (Remember the fuss about Obama’s empathy on the Court remarks.)
  3. Does this mean that we might be able to teach assessments of credibility and sincerely.  After all, many of the same “changing expressions on their faces and .  .  . subtle gestures and voice modulations” are regarded as indicia of truthfulness or lack of it.  Moreover, such training might make it possible to distinguish those such clues that are the product of courtroom stress, from those that are the result of lack of candor.  (Compare the TSA’s Behavior Detection Officers.)
  4. Should we be teaching this — only if it increases accuracy, rather than increases confidence in what remain inaccurate decisions, and only if judges can put these skills into context, rather than use them to avoid more comprehensive determinations.  I’d like  lot more research here.   I’d also want to be sure that such education served to undermine, rather than reinforce unconscious racial bias related to such clues.

It’s a whole new world.


About richardzorza

I am deeply involved in access to justice and the patient voice movement.
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