EMPATHY AND TRUST IN HEALTH PROFESSIONAL–PATIENT RELATIONSHIPS
The trust patients have in their health care providers means that they have confidence that providers will act in their best interests.
These investigators identified interpersonal (not technical) competence as the principal component mentioned by patients as key to trust in their providers. The traits identified most often were provider willingness to listen and the provider’s ability to display caring, concern, and compassion.
In addition to helping establish trust in patient–provider relationships, provider recognition of, and problem-solving response to, patient emotional distress has been found to be related to actual reduction in patient emotional distress
Nonverbal Aspects of Empathy:
In conveying your willingness to listen, your nonverbal behavior is at least as important as what you say. As discussed earlier, you can do a number of things nonverbally to convey your interest and concern. Establishing eye contact while talking to patients, leaning toward them with no physical barriers between you, and having a relaxed posture all help to put the patient at ease and show your concern. Head nods and encouragements to talk are also part of empathic communication.
A tone of voice that conveys that you are trying to understand the
person’s feelings also complements the verbal message. Establishing a sense of privacy by coming out from behind the counter and getting away from others who may be waiting help convey your respect for the patient. Conveying that you have time to listen—that you aren’t hurried or distracted—makes your concern seem genuine.
Sensitivity to the nonverbal cues of patients is also a necessary part of effective communication. Asking yourself “How is this person feeling?” during the course of a conversation will lead to the discovery that feelings and attitudes are often conveyed most dramatically (sometimes exclusively) through nonverbal
channels. A person’s tone of voice, facial expression, and body posture all convey messages about feelings. To be empathic, you must “hear” these messages as well as the words patients use.
Problems in Establishing Helping Relationships
There are countless sources of problems in interpersonal communication between pharmacists and patients. However, certain pharmacist attitudes and behaviors are particularly damaging in establishing helping relationships with patients. These include stereotyping, depersonalizing, and controlling behaviors.
1. STEREOTYPING
Communication problems may exist because of negative stereotypes held by health care practitioners that affect the quality of their communication. What image comes to mind when you think of an elderly patient?. . . a welfare patient? . . . an AIDS patient?. . . a chronic pain patient?. . . a noncompliant patient? . . . an illiterate patient? . . . a “hypochondriacal” patient? . . . a dying patient? . . . a “psychiatric” patient? Even the label “patient” may create artificial or false expectations of how an individual might behave. If you hold certain stereotypes of patients, you may fail to listen without judgment. In addition, information that confirms the stereotype may be perceived while information that fails to confirm it is not perceived.
For example, if a pharmacist has a negative stereotype of people who use analgesics, especially opioids, on a chronic basis, he may view a patient who complains about lack of effective pain control as “drug seeking” rather than as someone who is not receiving appropriate and effective drug therapy.
What does the issue of stereotyping mean for pharmacists? First, before we can be effective in communicating with patients, we must come to know what stereotypes we hold and how these may affect the care we give our patients. We must then begin to see our patients as individuals with the vast array of individual differences that exist. Only then can we begin to relate to each patient as a person, unique and distinct from all others.
2. DEPERSONALIZING
Unfortunately, there are a number of ways communication with a patient can become depersonalized. If an elderly person is accompanied by an adult child, for example, we may direct the communication to the child and talk about the patient rather than with the patient. We may also focus communication on “problems” and “cases.” Many aspects of disease management make communication narrow and impersonal.
For example, discussing only the disease or the problems a
patient might have managing treatment without commenting on the successes in treatment or even the everyday aspects of the patient’s life places the focus on narrow clinical rather than broader personal issues. A rigid communication format of a pharmacist monologue rather than pharmacist–patient dialogue can also make communication seem rote and defeat the underlying purpose of the encounter.
3. CONTROLLING
Numerous studies have found that an individual’s sense of control is related to health and feelings of well-being.
When health care providers do things that reduce the
patient’s sense of control over decisions that are made regarding treatment, they may actually be reducing the effectiveness of the therapies they prescribe.
Interventions to increase levels of patient participation and control in the provider–patient relationship have yielded positive results that include improved clinical and quality of life outcomes. Yet actual communication between health care providers and patients may decrease rather than enhance the perceived personal control of the patient .
Illness often results in disturbing feelings of helplessness and dependence on health care providers. Added to this patient vulnerability is the unequal power in relationships between providers and patients and the tendency of providers to adopt an “authoritarian” style of communicating. Patients are “told” what they should do and what they should not do—decisions are made, often with very little input from the patient on preferences, desires, or concerns about treatment.
Yet in the process of carrying out treatment plans, patients do make decisions about their regimens—decisions of which we may remain unaware. In this way, patients reassert control of the management of their own conditions. Labeling certain patient decisions as “noncompliance” is not helpful. Such labeling misses the point that the goal of treatment is to help patients improve health and wellbeing; it is not to get them to do as they are told.
Instead of blaming the patient, we must appreciate the degree to which treatment decisions are inevitably shared
decisions.
We must ensure that information and feedback are conveyed by both patients and ourselves in a give-and-take process. We must actively encourage patients to ask questions and urge them to discuss problems they perceive with treatment, complaints they have about their therapy, or frustrations they feel with progress. This encouragement requires above all else our empathic acceptance of the patient’s feelings and perceptions. Patient input is not seen as peripheral to the provision of health care. Instead, we see the patient as the center of the healing process. Establishing a relationship where patients are active participants in making treatment decisions and in assessing treatment effects is crucial to provision of quality care.