EmPATHy: More Empathy Toward Patients Improves Outcomes in Their Health

Pharmacists are the third most trusted health care professionals in the United States with their accessibility and knowledge.¹ In the past 2 to 3 years, pharmacists’ honesty and ethical scores on a Gallup survey decreased to their lowest rating in 4 decades.¹ The honesty and ethical scores for nurses and doctors have also declined over the past 2 to 3 years during the COVID-19 pandemic.¹

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The COVID-19 pandemic brought an influx of patients to different health care settings, where pharmacists and other frontline health care workers encountered challenges health care teams had not previously faced. The continuous daily fatigue from triaging patients and re-allocating resources affected the empathy of pharmacists as they were continuously exposed to more emotionally draining situations with each encounter.

The COVID-19 pandemic also introduced the COVID-19 vaccines which aided in increased patient awareness of health and preventative care. Patients of all health statuses visited community pharmacies for both consultations and vaccines during this time, increasing the volume of patients seen in the community setting.

This influx of patients was met with an increasing pace of pharmacy workflow, with pharmacists trying to work as efficiently as possible to meet the demands of their schedule. However, this efficiency has decreased the time spent with patients and caused patients to perceive the increased focus on work efficiency as a lack of empathy towards them.

This perception patients have on the empathy given from pharmacists and other health care workers can affect their compliance and adherence to recommendations provided.² There is a need for an increased awareness of empathy both in training during pharmacy school and in practice during patient interactions.

Empathy and Improved Patient Outcomes

Empathy during patient interactions may lead to increased trust and cooperativeness, therefore improving patient outcomes. Australia’s Home Medicines Review service provides medication management for patients, allowing opportunities for pharmacists to counsel on medication, assess adherence, and provide individualized recommendations to both the patient and the patient’s provider based on their disease states and care plan.³

A study was conducted to assess the impact of patients’ perception of pharmacists’ listening skills and attentiveness on the patients’ willingness to continue their service with the Home Medicines Review.² Patient who had experienced the service within the last 6 months completed questionnaires.

Results showed a statistically significant association between pharmacists scoring high on the “listening” scale, and an increase in their “willingness” to re-use the service. Patients who ranked their pharmacist interactions high in listening skills also believed the Home Medicines Review patient interviews were beneficial.

When pharmacists are attentive listeners and display empathy, patient compliance and adherence to the pharmacist’s and provider’s recommendations increases.

Incorporation into Pharmacy Curriculum

Empathy is a topic and skill that is often neglected in pharmacy school curriculums and should be taught early on and emphasized throughout the program to allow pharmacy students time to master this skill and improve patients’ perceptions of pharmacists during patient interviews.

Nearly all pharmacy programs across the nation have a counseling or skills lab component to their curriculum. This is where empathy should be emphasized within the curriculum and simulation.

As pharmacy students learn about different disease states, pharmacotherapy, and patient counseling, they should be reminded to view patients as an individual, rather than as their disease states.

A prospective cohort study at an institution offering a 4-year PharmD program assessed the effect of application-based simulations and didactic learning during a course enhancement on pharmacy students’ empathy.⁴

Investigators used a pre- and post-survey and the Jefferson Scale of Empathy for Health Profession Students (JSE-HPS) to assess the empathy of the students. The results indicated that there was a significant increase in empathy after the implementation of skills-based training and didactic learning regarding empathy in the clinical assessment course.

Empathy techniques should also be introduced to pharmacy students in order to improve the patients’ perceptions of pharmacists during patient interviews. A systemic review looked at behaviors that improved patients’ perceptions of physicians’ empathy and compassion, finding that sitting opposed to standing, non-verbal communication of caring, verbal statements of acknowledgement, and responding to opportunities for compassion were all effective.⁵

These are some behavioral skills pharmacy students should be introduced to and mastered in their curriculum to better prepare them for patient interactions in actual practice.

The PATH to EmPATHy

In practice, pharmacists can implement the following techniques to improve patients’ perception of empathy during visits:

1. Present yourself with attentiveness. By making eye contact with patients while counseling or asking questions, pharmacists can improve the perception patients will have of them. Rather than having a health care professional that focuses their attention on the computer screen, patient chart, or medication bottles, eye contact allows the patient to engage their focus and attention on the pharmacist. A randomized trial compared empathy ratings in patients’ telehealth visits where physicians looked at the webcam compared to when physicians looked at the computer screen.⁶ Results showed that video visits with the physician looking at the webcam, which perceived to be looking directly at the patient, scored higher on empathy when communicating appreciation of the patients’ feelings and providing support by expressing concern, understanding, and willingness to help.
2. Ask open-ended questions. Asking closed-ended questions with “yes” or “no” responses result in limited information. Patients may also feel interrogated rather than engaging in a helpful conversation. However, asking open-ended questions allowed patients to provide details that may be expanded on to develop insight into any concerns they may have. A Japanese study analyzed the amount of information received from patient interviews by medical students and found that asking open-ended questions resulted in a positive impact on the amount of information elicited from patients.⁷
3. Tailor the interaction. Whether a pharmacist is meeting with a familiar face or a new one, it is always important to build rapport with the individual. Rapport allows patients to trust and be comfortable in an otherwise uncomfortable environment. Making notes about interests or topics of concern discussed in previous encounters to bring up in future encounters will allow patients to feel important and remembered. Sharing one’s experiences while relating to the patient and their concerns allows patients to open up as they engage in more friendly conversations. A longitudinal qualitative study conducted 61 hours of patient interviews, showing that most patients described feeling anxious when meeting with a new provider.⁸ Tailoring the patient interview to the patient based on their history and individualizing expectations based on the patient’s preferences had the potential to help mitigate the patient’s feelings of vulnerability.
4. Here and Hear to Help. We often go into an encounter with a plan or checklist; however, patients are not meant to be contained in simple checkboxes. Listen to patients’ main concerns and address them. If there are questions that are better suited for other health care professionals, acknowledge the concerns, and inform the patient who the appropriate health care professional to reach out to is or discuss these issues with that health care provider and let the patient know. McGill University Health Centre interviewed 58 patients regarding their patient-physician interactions. The study concluded that physicians listening to patients was considered a healing and therapeutic agent and a means of fostering the physician-patient relationship.⁹

Conclusion

At the end of the day, patients are not just numbers nor a chart of notes to be documented. By empathizing with patients and creating an environment where patients feel comfortable and open to sharing, pharmacists can increase compliance and adherence. Presenting oneself with attentiveness, asking open-ended questions, tailoring the interaction to the patient, and being here to help are all strategies that should be taught in training and applied in practice to work towards improving patient outcomes.

References

1. Brenan M. Nurses retain top ethics rating in US, but below 2020 high. Gallup.Published January 10, 2023. Accessed January 11, 2023. https://news.gallup.com/poll/467804/nurses-retain-top-ethics-rating-below-2020-high.aspx.
2. Carter SR, Moles R, White L, Chen TF. The impact of patients' perceptions of the listening skills of the pharmacist on their willingness to re-use home medicines reviews: a structural equation model. Res Social Adm Pharm. 2015;11(2):163-175. doi:10.1016/j.sapharm.2014.07.002
3. Pharmacy Programs Administrator. Home Medicines Review. Accessed January 11, 2023. https://www.ppaonline.com.au/programs/medication-management-programs/home-medicines-review.
4. Robertson AD, Moore M, McFadden L, Steere EL, Barnes J, Shrader S. Implementation and evaluation of simulations in a required course to improve empathy of pharmacy students. Curr Pharm Teach Learn. 2022;14(11):1404-1410. doi:10.1016/j.cptl.2022.09.021
5. Patel S, Pelletier-Bui A, Smith S, Roberts MB, et al. Curricula for empathy and compassion training in medical education: A systematic review. PLoS One. 2019;14(8):e0221412. doi:10.1371/journal.pone.0221412
6. Helou S, El Helou E, El Helou J. Physician communication skills in telemedicine: the role of eye contact. Stud Health Technol Inform. 2022;290:849-853. doi:10.3233/SHTI220199
7. Takemura Y, Sakurai Y, Yokoya S, et al. Open-ended questions: are they really beneficial for gathering medical information from patients?. Tohoku J Exp Med. 2005;206(2):151-154. doi:10.1620/tjem.206.151
8. Dang BN, Westbrook RA, Njue SM, Giordano TP. Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study. BMC Med Educ. 2017;17(1):32. doi:10.1186/s12909-017-0868-5
9. Jagosh J, Donald Boudreau J, Steinert Y, Macdonald ME, Ingram L. The importance of physician listening from the patients' perspective: enhancing diagnosis, healing, and the doctor-patient relationship. Patient Educ Couns. 2011;85(3):369-374. doi:10.1016/j.pec.2011.01.028