Abstract
Summary box
Building relationships, expressing empathy, care and compassion results in measurable differences to all health outcomes. Active listening and empathic reflection of the patient’s expressed feelings and emotions Non-judgemental exploration and acknowledgement of the patient’s own perceptions about their situation Showing care and concern for the person as an individual This approach builds trust which enables all phases of the consultation to proceed more smoothly
Skills that build effective relationships include:
Introduction
When empathic communications create an effective relationship with the patient, all phases of the consultation become easier. Empathy helps both parties to feel understood, and patients tend to repeat themselves less, which saves time. Trust develops more easily, the effectiveness of information gathering is improved and the negotiations in explanation and planning run more smoothly. When the clinician has understood the patient’s personal situation, trust increases adherence to care plans and the effectiveness of safety netting advice.
There is now compelling evidence that kindness, empathy and compassion have major benefits in healthcare, well beyond patient satisfaction. This includes substantial impacts on many physical outcome measures (for example, reduced mortality, faster wound healing and better blood sugar control), better psychological health outcomes, and enhanced self-care. Improved relationships result in better clinician wellbeing, higher standards of healthcare delivery and fewer errors or complaints (Trzeciak and Mazzarelli, 2019).
Summary of the skills you need
Effective relationship building skills include:
Accepting the patient’s views and concerns in a non-judgemental way Using empathic statements and reflections to show understanding and appreciation of the patient’s situation and feelings Providing support and expressing concern and understanding for the patient as an individual
Active listening and empathic reflection of the patient’s expressed feelings and emotions
How are empathic consultations brought about? What matters, is really listening to what matters to the individual patient; what do they say about their own specific experiences? Then clinicians can respond to the patient as an individual. Inexperienced clinicians sometimes use rather generic statements to express their empathy, for example, ‘I am sorry to hear that’. Empathy is much more powerful when reflecting back the exact experience of the individual. Compare these statements: ‘It sounds like this is very difficult for you’ and ‘It sounds like you are scared you are getting cancer like your Mother’. The former could be said to almost anyone in any situation, the latter acknowledges the specific facts and feelings of the individual. The clinician must listen carefully for information about the patient’s feelings, which may be expressed indirectly. All sources, (words, body language, tone of voice, clothing, the context) can help clinicians to deduce the actual feelings of a patient. This involves both thinking processes (cognition) as well as feeling (emotional) processes. Note that the empathic statement is preceded by the words ‘It sounds like’. Using qualifying phrases before the empathic statement (for example, ‘This sounds as if …’ or ‘I am wondering if …’) allows the patient to disagree. They can then say, ‘not exactly, it is more that ….’ This empowers the patient to clarify the situation and helps the clinician to really understand what the patient is experiencing.
Non-judgemental exploration and acknowledgement of the patient’s own perceptions about their situation
When the patient expresses their own perceptions and feelings about a situation it helps if the clinician can explore these using facilitating phrases such as ‘go on’ or ‘I am interested to know more about how this is affecting you …’ If necessary, the patient’s experience can be explored further, especially if they are distressed. Usually, when a clinician names the patient’s feeling accurately the patient will say ‘Yes that’s it’ and the consultation can then proceed Teaching and Learning the Consultation (TALC).
Showing respect for the speaker by accepting and naming their feelings in a non-judgemental way can be very healing for patients. When clinicians give expressions of support, using positive words, encouragement and hope for improvement, this can help even further.
Showing care and concern for the person as an individual
Recognising and reflecting back the patient’s feelings creates the opportunity to show understanding, care and concern, which supports the patient. This process may be quite brief, while the impacts of such approaches can be far reaching, reducing pain, reducing anxiety, improving wound healing and many other outcomes (Trzeciak and Mazzarelli, 2019). Expressions of concern and commitment to help, such as, ‘We will do our best for you’ or ‘you are not facing this alone’ have been shown to have long-lasting effects while increasing clinician satisfaction. Overall, as little as 30 to 50 seconds spent in empathic communication is enough to make a significant impact (Trzeciak and Mazzarelli, 2019).
Putting these skills into practice
Aysha P has just started University and attends for some vaccinations. The nurse asks about college and is empathic when Aysha talks about feeling overwhelmed. Asha relaxes, feels more trusting and mentions a vaginal discharge she was too embarrassed to talk about initially. Appropriate assessment and treatment follows.
When effective relationships are established with patients, information gathering is often easier and more effective. Look out for the article in this series called ‘The ear is as mighty as the scalpel; improving listening skills for more accurate diagnosis’.
