Jefferson researcher seeks ways to make doctors more empathetic

It was the sort of encounter between a doctor and patient that, unfortunately, happens all the time.

This time, though, the patient was a psychologist's daughter and her experience led to research that is changing medical education.

The girl, then 13 years old, and her mother went to a pediatric cardiologist because of heart palpitations. A long wait in the exam room amplified their worry. The doctor finally arrived and, without exchanging a greeting, said the girl needed to wear a heart monitor every day for a month. He didn't explain why she needed the extra test or what he already knew about her heart. The meeting was cold and frustrating.

The mother never ordered the monitor. Instead, the girl, now 22, stopped drinking coffee. Her heart rhythm returned to normal.

But her father, Mohammadreza Hojat, a psychologist who studies physician training at Thomas Jefferson University, started thinking about what had gone wrong.

Before long, he'd helped create the Jefferson Scale of Empathy, written a textbook, Empathy in Patient Care, and begun studying how empathy changes as doctors go through medical school. (It often goes down around the time they start encountering real patients.)

Now Hojat is trying to figure out how to make doctors more empathetic.

The stakes are high. Research shows that patients of doctors with empathy - what used to be called bedside manner - are more satisfied and are likely to follow doctors' orders. Empathy also reduces the risk of malpractice suits and errors. A year ago, Hojat led a study that found that diabetic patients with empathetic doctors were more likely to score well on measures of diabetes control.

Empathy fosters trust, Hojat says, and everything else flows from that.

Hojat said medical schools rightly emphasize science and technology, but they are recognizing that the "art" of medicine, the human side, should also be taught. "I believe it is as important as the science of medicine," he said.

Paul Lanken, associate dean for professionalism and humanism at the University of Pennsylvania's medical school, said training programs are placing more emphasis on teaching "professionalism," which includes empathy. With funding from the American Medical Association, more than 30 schools, including Penn, began collecting data in 2010 about how the "learning environment" affects attitudes. They are using the empathy scale.

"I think people want to be understood," Lanken said. "They want to have an empathetic physician."

Hojat has a lifelong interest in interpersonal relationships. A popular student himself, he wrote his master's thesis on popularity. When he noticed that some of his fellow foreign students at Penn were lonely, he wrote his dissertation about loneliness.

He had planned to return to his native Iran after he got his Ph.D., but the 1979 revolution got in the way. He got a job at Jefferson and has studied how doctors interact with patients and other health-care workers ever since.

His definition of empathy is more complicated than the dictionary's. He distinguishes it from sympathy, an emotional response to others' pain that can cloud decision making. Empathy involves trying to understand how a patient thinks. An empathetic doctor can also convey that understanding and intends to help. This kind of involvement with the patient, Hojat said, always leads to better care.

The big question now is how to teach future doctors better social skills. Hojat suggests many alternatives, including having students shadow patients or undergo mock hospitalizations, exposing them to mentors who model good behavior, and asking them to read novels that explore emotions.

In his most recent study, Hojat showed students short clips from movies - The Doctor, First Do No Harm, and Wit - that portray doctors behaving badly. A clip from Wit shows medical residents crowding around Emma Thompson's hospital bed as they discuss her ovarian cancer. To them, she is more an opportunity to learn about a fatal disease than a human being who is listening and feeling.

Hojat also shows a commercial in Spanish for the Red Cross. A toddler watches television with a pacifier in his mouth. As he watches a harrowing scene of a crowd reacting to some sort of disaster, his face changes. He understands that they are in pain. He walks to the television and offers his pacifier to a crying adult on the television.

"This," Hojat said, "is very consistent with our definition of empathy."