Empathy: Real Stories to Inspire and Enlighten Busy Clinicians

<p><br></p><p></p><u><p><br></p><p><span> Contents</span></p></u><p><span><br></span></p><p><br></p><p><span> </span></p><p><br></p><p><span>Introduction: A Case for Empathy</span></p><p><br></p><p><span> </span></p><p><br></p><p><span>The introduction begins with a story of a young mother whose cancer has become resistant to treatment. The story leads to her impossible question to her physicians, “I can’t die, who will take care of my children?” This narrative stimulates the reader to reflecton the benefits of responding with empathy and the hazards of instead offering a factual response in an attempt to fix the unfixable.</span></p><p><br></p><p><span> </span></p><p><br></p><p><span>Section 1: Weaving Empathy into the Fabric of Every Clinic Encounter</span></p><p><br></p><p><span><span> </span></span></p><p><br></p><p><span>Section 1 outlines the philosophy of the text: empathy is not just something you do when things go wrong, but rather something we do every day no matter the circumstances. </span></p><p><br></p><p><span> </span></p><p><br></p><p><strong><span>Chapter1: </span><span>A history of empathy in patient care. </span></strong><span> </span></p><p><br></p><p><span>Chapter 1 considers the changes that have occurred in medicine after the Flexner Report was published in 1910. Prior to the Flexner Report, empathy was the most powerful tool available to the clinician. Similarly, in the modern world when we reach a point when focusing on a specific disease, like end-stage cancer or cystic fibrosis, is no longer helpful, empathy is the most powerful medicine. Unfortunately, under such circumstances we all too often continue to focus on disease to the detriment of the patient. </span></p><p><br></p><p><span> </span></p><p><br></p><p><strong><span>Chapter 2: </span><span>Learning any skill takes practice, like playing tennis</span></strong></p><p><br></p><p><span>It’s easy to grasp what empathy is on a conceptual level: standing in the other person’s shoes or imagining how another person is feeling or thinking. However, practicing empathy in the clinic takes much more than conceptual understanding. Just as winning the Wimbledon tennis tournament takes much more than viewing an instructional video about forehands, backhands, and overhead serves, empathy requires coaching and practice. Mirroring the coaches’ modelling of an effective forehand, all the way from backswing to follow-through, the extensive dialogue in the Clinician’s Guide to Empathy provides a model of empathy that every student can embrace and refine. </span></p><p><br></p><p><span><span> </span></span></p><p><br></p><p><strong><span>Chapter 3: Speaking to people like people rather than as patients: How empathy looks and sounds.</span></strong></p><p><br></p><p><span> </span></p><p><br></p><p><span>Chapter 3 illustrates that empathy is not only a concept meant to be understood on the conceptual, physiological, or neuroanatomic level, but should also be embraced on the practical and operational level. Empathy is something that great clinicians weave into every conversation, not just classically difficult ones. We present an assortment of case vignettes written by expert clinicians depicting “typical” patient encounters that would not ordinarily be considered challenging, and demonstrate how to weave empathy into such conversations by speaking to patients like people rather than as patients. People enjoy knitting, bull riding, painting, and riding pontoon boats with friends and family. Brief discussions about human topics like these </span><span>builds strong bonds between clinicians and their patients.</span></p><p><br></p><p><span> </span></p><p><br></p><p><span> </span></p><p><br></p><p><strong><span>Chapter 4: Empathy as Collaboration</span></strong></p><p><br></p><p><span> </span></p><p><br></p><p><span>Daniel Epner, M.D., Laura Meyer, and others TBD</span></p><p><br></p><p><span>Chapter 4 addresses the </span><span>Parallel process of empathy: treating coworkers with empathy involves the same skills as empathy during clinical encounters. The chapter illustrates how team members can utilize empathy to collaborate to the betterment of their patients and themselves. </span></p><p><br></p><p><span> </span></p><p><br></p><p><strong><span>Chapter 5: Difficult Conversations in Cancer Care</span></strong></p><p><br></p><p><span>Previous chapters offered areal-life, operational definition of clinical empathy. Beginning with section 2, The Guide discusses how to apply the same empathic skills to emotionally charged and challenging conversations that commonly arise in clinical practice. </span></p><p><br></p><p><span> </span></p><p><br></p><p><span>Section2: Common Challenging Conversations: What to say and not to say when the patient or family throws a curve ball. </span></p><p><br></p><p><span> </span></p><p><br></p><p><span>In section 2, each chapter will begin with a narrative that epitomizes the role of empathy in responding to a particular conversational challenge in medical practice. The text will then offer specific responses and strategies that facilitate connection between providers and patients under such circumstances. These same responses are summarized in the pocket empathy-reference booklet.</span></p><p><br></p><p><span> </span></p><p><br></p><p><span><strong>Chapter 6: “Denial:” </strong>what we see on the surface that covers strong negative emotions, such as fear, sadness, and grief. Under such circumstances, patients and family members often cling desperately to unrealistic expectations.</span></p><p><br></p><p><span> </span></p><p><br></p><p><span>Daniel Epner, M.D., and co-author TBD. </span></p><p><br></p><p><span> </span></p><p><br></p><ul style="list-style-type: disc; direction: ltr;"><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>"We want mother to be alert and talk to us like she did just the other day."</span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>"You're just going to let me die?" </span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>“I know he is brain dead and there’s nothing more you can do for him. Stop telling me that.”</span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>"I have faith God has a plan for me. I am sure I will be completely healed."</span></p></li></ul><p><br></p><p><span> </span></p><p><br></p><p><strong><span>Chapter 7: Prognosis</span></strong></p><p><br></p><p><span> </span></p><p><br></p><p><span>Daniel Epner M.D., andco-author TBD. </span></p><p><br></p><p><span> </span></p><p><br></p><ul style="list-style-type: disc; direction: ltr;"><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span> “How long do I have?”</span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>“Why can’t you cure him?”</span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>“Will I ever be normal again?”</span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>“I can’t believe that I have cancer. I take good care of myself.”</span></p><p><span> </span></p><p><span> </span></p></li></ul><p><br></p><p></p><strong><p><span>Chapter 8: Existential Concerns: “What comes later, and can you help me get there sooner?”</span></p></strong><p><br></p><p><span> </span></p><p><br></p><p><span>Marcia Brennan, PhD, Medical Humanities Professor at Rice University, and </span></p><p><br></p><p><span>Daniel Epner M.D. </span></p><p><br></p><p><span> </span></p><p><br></p><ul style="list-style-type: disc; direction: ltr;"><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>“Where am I going after this?” </span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>"I'm not sure what there is to look forward to. What's the point of trying anymore?" </span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>“Doc, I'm ready for this to be over. Help me end this now. I want you to help me die.”</span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>“Why are you taking away my hope?”</span></p></li></ul><p><br></p><p><span> </span></p><p><br></p><p><strong><span>Chapter 9: Family Impact: “But my family needs me…”</span></strong></p><p><br></p><p><span> </span></p><p><br></p><p><span>Authors TBD</span></p><p><br></p><p><span> </span></p><p><br></p><ul style="list-style-type: disc; direction: ltr;"><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>"What if I'm not there for my daughter’s sixth birthday?" </span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12
pt; font-style: italic; font-weight: normal;'><p><span>"I don’t want to talk to my kids about this. I need to be strong for them"</span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>“Who will raise my family if I die?”</span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>“Will my children remember me?”</span></p></li></ul><p><br></p><p><span> </span></p><p><br></p><p><span> </span></p><p><br></p><p><strong><span>Chapter 10: Empathy and Pediatric Care</span></strong></p><p><br></p><p><span> </span></p><p><br></p><p><span>Kevin Madden, M.D., </span><span>pediatric palliative specialist and Professor at M.D. Anderson.</span></p><p><br></p><p><span> </span></p><p><br></p><p><span>This chapter addresses t</span><span>he lopsided triangle of pediatric care: supporting ill children and their parents with great finesse.</span></p><p><br></p><ul style="list-style-type: disc; direction: ltr;"><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>"I can't stop life support. This is my daughter. I can't give up on her."</span></p></li></ul><p><br></p><p><span> </span></p><p><br></p><p><strong><span>Chapter11: Difficult Family Dynamics</span></strong></p><p><br></p><p><span> </span></p><p><br></p><p><span>Authors TBD</span></p><p><br></p><p><span> </span></p><p><br></p><ul style="list-style-type: disc; direction: ltr;"><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>“Please don’t tell my mother she has cancer or any other bad news.”</span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>“Oh, it doesn’t matter what he thinks. He may be the sick one, but we make his decisions for him.”</span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>“I know my daughter is suffering greatly, but she said, ‘Never give up on me.’ I have to honor her wishes, so I can’t make her DNR.”</span></p></li></ul><p><br></p><p><span> </span></p><p><br></p><p><span> </span></p><p><br></p><p><strong><span>Chapter 12: Dealing with Anger and Blame </span></strong></p><p><br></p><p><span> </span></p><p><br></p><p><span> Laura Meyer and co-author TBD</span></p><p><br></p><p><span> </span></p><p><br></p><ul style="list-style-type: disc; direction: ltr;"><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>“Of course, I’m depressed! Wouldn’t you be if you were told you are going to die?”</span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>“This place has failed me miserably.”</span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>“You can’t possibly understand how I feel. I’m dying, and I’m only 36! You are perfectly healthy. Don’t try to convince me to feel better with your psychological mumbo jumbo.”</span></p></li></ul><p><br></p><p><span> </span></p><p><br></p><p><span> </span></p><p><br></p><p><span><strong>Chapter 13: The question of opiates and uncontrolled pain.</strong> </span></p><p><br></p><p><span> </span></p><p><br></p><p><span>Joseph Arthur M.D., Assistant Professor at M.D. Anderson and <span>Daniel Epner, M.D.</span></span></p><p><br></p><p><span> </span></p><p><br></p><ul style="list-style-type: disc; direction: ltr;"><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>“Doc, I know where you’re going with this. I hate to be asked all these questions all the time. You’re talking to me like I’m a criminal and you think I’m taking these meds and trying to sell them.”</span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>"I've been giving my son some of my pain medication."</span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>“I've been coming to this clinic for 2 years, and every doctor has given me the meds I need. You are the first doctor who has denied me.”</span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>"You don't know how I feel. I may not look like I’m hurting, but I have a high pain tolerance. I need meds."</span></p></li></ul><p><br></p><p><span> </span></p><p><br></p><p></p><strong><p><span>Chapter 14: Empathy and Culture</span></p></strong><p><br></p><p><span> </span></p><p><br></p><p><span> Laura Meyer and Daniel Epner, M.D. </span></p><p><br></p><p><span>Using a case to exemplify person-centered care, the authors demonstrate how to engage with and respect patients of all cultures and backgrounds. This chapter outlines </span><span>universal truths about empathic practice with patients and coworkers from all over the world: we all want the same things, and we are all deserving of empathy. </span></p><p><br></p><p><span> </span></p><p></p><strong><p><br></p><p><span>Chapter 15: Empathy and <strong><span>Spirituality</span></strong></span></p></strong><p><br></p><p><span> </span></p><p><br></p><p><span>Marvin Delgado, M.D., Associate Professor at M.D. Anderson and </span></p><p><br></p><p><span>Alejandro Chaoul PhD, Assistant Professor at M.D. Anderson</span></p><p><br></p><p><span> </span></p><p><br></p><p><span>In chapter 15, the authors demonstrate how a clinician can hold respectful space for the patient’s spiritual needs or practices. The authors reflect on how empathy can be expressed effectively in encounters where spirituality (or a lack there of)emerges.</span></p><p><br></p><ul style="list-style-type: disc; direction: ltr;"><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span>“Do you believe in miracles?”</span></p></li><li style='color: rgb(0, 0, 0); font-family: "Times New Roman",serif; font-size: 12pt; font-style: italic; font-weight: normal;'><p><span> “I can’t believe God would abandon me like this.”</span></p></li></ul><p><br></p><p><span> </span></p><p><br></p><p><strong><span>Chapter 16: Empathy and Technology</span></strong></p><p><br></p><p><span> </span></p><p><br></p><p><span>Ali Haider, M.D., Assistant Professor at M.D. Anderson and</span></p><p><br></p><p><span>Kimberson Tanco, M.D., Assistant Professor at M.D. Anderson</span></p><p><br></p><p><span> </span></p><p><br></p><p><span>Chapter 16 illustrates how </span><span>empathy is adapted to overcome the modern realities where there are computers in every exam room and the electronic medical record sometimes pulls the clinician’s attention away from the patient. </span></p><p><br></p><p><span> </span></p><p><br></p><p><strong><span>Chapter 17: Focus on process rather than rainbows</span></strong></p><p><br></p><p><span> </span></p><p><br></p><p><span> Author TBD &amp; Laura Meyer</span></p><p><br></p><p><span> </span></p><p><br></p><p><span>Describes unresolved predicaments, such as those involving patients with personality disorders, who sometimes do not respond to empathy, or those who have no spiritual foundation in their lives and therefore are never able to process the various stages of grief.</span><span> Sometimes it is impossible to connect with patients or families despite our best efforts. This chapter reinforces the premise that learners should continue to shape and refine their own “art of medicine” through all encounters, positive or negative. </span></p><p><br></p><p><span> </span></p><p><br></p><p><span>Section 3: Compact Empathic Responding Summary</span></p><p><br></p><p><span> </span></p><p><br></p><p><span>An abbreviated version of Chapters 6-17. </span></p><p><br></p><p><span> </span></p><p><br></p><p><span> </span></p><p><br></p><p><span> </span></p><p><br></p><p><br></p><p><br></p>