“Brent” is not happy.
As a newly hired emergency room physician within a nationally recognized healthcare system, he has been “volun-told” to show up to a four day onsite training on “Patient-Provider Communications”, which translates in his assumption as a Colossal Waste of Time.
“At least the location is decent.” he thinks as he turns into the parking lot of a lovely retreat center surrounded by the rolling pastoral hills that surround one of America’s largest urban centers. “Maybe I can skip a session or two and check out that gorgeous pool.”
Brent’s plans are going to be significantly altered.
After he settles in, Brent opens his syllabus and glances at the descriptions filled with words like “patient perspective”, “deep listening”, and “expressing empathy”. He thinks to himself. “We need a four day training on this soft-skill stuff?”
Brent’s world is about to be turned on its ear. And to his surprise, he won’t mind at all.
For the last two years, I have had the privilege of helping skilled and seasoned medical practitioners build skill in patient communication. I and other PCA’s (patient care actors) are tasked with engaging these learners in high stakes interactions with difficult patients. We portray people suffering with a wide range of medical conditions and circumstances. and a broad rainbow of emotions: everything from anger to denial to fear to heartbreak and back again. To do this work requires not only an accurate portrayal of symptoms and personalities, but the concurrent ability to be aware of, and give specific feedback on the quality of the practitioner’s engagement and communication style.
Key to a successful encounter is the authentic expression of empathy early and throughout the encounter. Practitioners new to this kind of training, especially those in highly stressed and always changing medical environments, often come into these sessions with certain assumptions about Empathy.
“Yeah, empathy is very nice and all, but in the ER, what matters is skill and on-time treatments and I’m always running late. Always!” Brent exclaims in his first encounter. “How do I find time for expressing lots of empathy?”
“Debra”, the leader of his group, smiles in recognition. “I think you’re about to find out.”
Brent has asked me to take on the role of a patient that he finds particularly annoying: the person who has not seen a doctor for several years, and is now in the ER with multiple complaints to address, along with expectations that this doctor will fix them.
Brent has identified “Empathy” as the principal he would like to incorporate into our session. I’ve been instructed to come in with stomach pain as a central complaint, but then to mention six or seven other symptoms as well. I’ll also need to be cranky about the two hour wait to be seen, and to be aware of how Brent’s expressions of empathy, or lack thereof, impact my ability to trust him as a provider.
After he knocks, Brent walks into our intake session and introduces himself. He cordially asks me what I’d like to be called.
“Well, Doc, you can call me Pissed Off for purposes of this encounter. I mean, a two hour wait?? That’s gotta be some kind of record!”
I can see Brent swallowing his irritation. He offers a reason: “There was a car accident this morning with multiple injuries. I’m sorry you had to wait, but we’re pretty short staffed.” I cross my arms and turn away from him.
Debra stops the interaction. “So does this feel realistic Brent?”
“Oh yeah”, he shakes his head and rolls his eyes. “That was pretty much my Friday”.
Debra directs her next question to me. “How’s this feeling for you?”
I turn towards Brent. My arms are still crossed as I answer. “Not good. Not only did I wait for a long time while I’m in pain, but now it’s like you want me to feel guilty about getting angry about it. Plus it sounds to me like you’re making excuses for being late!”
Brent needs a do-over.
He receives some side-coaching first and is strongly encouraged to express empathy right from the start, no matter how much irritation the patient exhibits.
Brent knocks, enters, introduces himself and right away starts our encounter with:
“I’m so sorry you had to wait so long. Your time is important, and I truly appreciate your patience. Please tell me what brings you in today. I’ll do my best to help.”
I feel my irritation soften at his first sentence. Then as he continues, I feel my shoulders drop and I can better tune in to what he is saying. However, I’m not through yet. We still have the symptom parade to march through.
I begin with my debilitating stomach pain.
“That sounds awful!”
And then I continue on through a list that includes dizziness, heart palpitations, nausea, sweats, a rash.
When I pause, Brent shakes his head. “Wow.” He says. “I can’t imagine walking around with all of that going on!” Then he remembers a piece of his coaching: “What else?”
His posture is open and inviting.
My mind races.
“Oh yeah.” I say. “My big toe is throbbing really bad.” “On my left foot”.
He takes that in and then summarizes what he has heard “Just to make sure I’ve got everything accurately”. Once I confirm that he has, he takes a deep breath.
“I’m really glad you came in today. It looks like there’s a lot going on and I want to make sure I address your primary concerns. What is bothering you the most, right now?”
“My stomach” I reply. “The nausea has forced me to lose time at work and I don’t have that many sick days left”.
“Gotcha.” Brent nods. “So along with all this, you’re losing time at work.” I nod and look at the floor.
Brent takes charge.
”First off, we’ll get some blood tests today so I have a better idea of what’s going on. Then we can look into some anti-nausea meds depending on what the tests show. And we’ll schedule a follow up for next week to see if there’s been improvement.” “How does that sound?”
It sounds great to me. Brent has heard my symptoms, as well as my time challenges and is focused on my primary source of pain. His checking in with me about the accuracy of his summary, and his plan of action makes me feel as if he is treating me like a partner in my care, not just a clueless recipient.
Debra stops our interaction. Brent gets high praise and high fives from me as well as the three providers in the group – who will soon be in the “hot seat” themselves.
“That actually felt ok.” Brent admits. “But just so I know…
“How long did that interaction take?”
Franklin has been timing it. “One minute, twenty three seconds.”
Brent looks stunned. “You’re kidding!” Franklin shows him the timer.
“Wow. Unbelievable!” Brent is smiling and shaking his head.
Why does empathy get labelled as a “soft skill”, in the shadow of “harder” abilities?
As Brent discovered in this highly critical experiential session, empathy is the key to lowering interpersonal friction and resistance, increasing focus and building trust – all of which contributes, in these highly important conversations, to saving, not spending, time.
Where might expressing empathy save you time in your next high stakes conversation?
Intentional and genuine expressions of empathy is a key quality of “Heart” listening, and one I go into in depth in my new book: Head, Heart & Hands Listening in Coach Practice, currently available through Routledge Publishing at 20% off! Use the QR Code below to order directly from Routledge.
