The Perils of Feeling Others’ Pain

Several large hospital systems emphasize how much they value empathy and train their staff accordingly to feel more for their patient. But is this actually a good idea? Yale psychologist Prof. Paul Bloom admonishes about the empathy trap. Her argues that “trying to feel the pain of others is a bad idea” and that “empathy distorts our reasoning and makes us biased, tribal, and is often cruel”[1]. He bases this insight on studies that showed that ethnicity and affiliation of the other person as compared to one’s own tribe, and how the belief about how a patient acquired the disease shade how much or little empathy one feels. Even worse, in some experiments, greater empathy resulted in inappropriate medical decisions that were not made when the same case was presented without instructions for the participants to put themselves in the patient’s shoes.

Most definitions of empathy imply a sense of knowing or mind-reading what the other person goes through [2]. Seeing another person in pain stimulates empathy regions in one’s own brain, but what one does with it can go either way [3]. Responses range from ignoring the distress, compassion, and inclinations to comfort or help [2]. The crux is twofold: First one really cannot read another’s mind. The “I know what you are going through” is likely to be countered by “No, you don’t,” because everyone’s experience is unique. Secondly, all this pain is really not good for you nor your patient if you are a healthcare professional and now you are both suffering.

The lack of feeling empathy all day long may just be the defense mechanism needed when facing suffering in one’s job on a daily basis. This has been well researched among medical students, whose empathy declines over the years of their training, and particularly so when they come in contact with patients [4].

So what if you have more empathy than your colleagues? Your patients should do better, shouldn’t they? Well not necessarily so. A study with acute care nurses showed that greater levels of empathy did not affect how much medication they gave patients and patients did not rate their attention to their pain as positive [5].

We observed a similar phenomenon in a clinical trial: in an empathic control condition, patients did so poorly that we had to halt the study. Expressive mothering or wanting to be extra nice without knowing how to do this turned out to be deleterious for the hemodynamics during procedures [6].

Behind many of the new empathy trainings is the idea that one can teach empathy. Even if one could, wouldn’t that be sort of cruel if then one also wouldn’t teach how to manage this heightened sensibility, and more importantly how to express empathy correctly? I believe this is one of the situations where actions speak louder than feelings. And the good news is that actions and behaviors can definitely be taught. But they have to be authentic. That is what we aim for with Comfort Talk® all the time. I might even go so far to say that it doesn’t matter how much empathy someone has inherently since we were able to reliably associate defined, teachable, observable behaviors with patient outcomes and patient satisfaction in several large scale clinical trials.

Our focus is on rapid rapport and feeling comfortable oneself, particularly with a difficult patient. Once rapport is established, the words do flow more easily and what comes across sounds more empathic too. Sometimes a quick guidance in self-hypnotic relaxation or reframing of distressing thoughts helps. And all that can be taught, regardless of where your empathy barometer points.

References

1. Bloom P. The empathy trap. The Wall Street Journal. 2016 3-4 December 2016.
2. Goubert L, Craig KD, Vervoort T, et al. Facing others in pain: the effects of empathy. Pain 2005;118:285-8.
3. Coll MP, Tremblay MB, Jackson PL. The effect of tDCS over the right temporo-parietal junction on pain empathy. Neuropsychologia 2017.
4. Chen DC, Kirshenbaum DS, Yan J, et al. Characterizing changes in student empathy throughout medical school. Med Teach 2012;34:305-11.
5. Watt-Watson J, Garfinkel P, Gallop R, et al. The impact of nurses’ empathic responses on patients’ pain management in acute care. Nurs Res 2000;49:191-200.
6. Lang EV, Berbaum KS, Pauker SG, et al. Beneficial effects of hypnosis and adverse effects of empathic attention during percutaneous tumor treatment: when being nice does not suffice. J Vasc Interv Radiol 2008;19:897-905.