In taking care of adult patients, we unfortunately have to have difficult discussions regarding poor outcomes, terminal illnesses, and end-of-life decisions. These conversations are inevitable given the aging patient population that we serve. Although we can't always change the outcome, diagnosis, or prognosis, our words during these discussions are certainly impactful to the patient. As the wise saying goes, “People will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
Throughout my career, I have been blessed to have mentors impose pearls of wisdom upon me by teaching the humanity and empathy that are required to handle emotional situations. I do my best in paying it forward to the students and resident learners that I have precepted over the years. Much of the teachings of humanity and professionalism in medicine take place during clinical preceptorships, in an environment complementary to the teaching of scientific and medical knowledge.
I can recall the words of attendings and mentors throughout my training and early career: “How would you want to hear this news? What would be your approach if this was your own family member?” In the hospital setting, I was advised to “sit at the patient's level and don't stand over the patient” and “incorporate some form of human touch during or at the conclusion of the tough discussion.” There are many approaches to these difficult conversations, but one concept that is clear is that of empathy, whether it is cognitive, emotional, or compassionate (or a combination of the three types), as described by psychologist Daniel Goleman, PhD.
In the field of medicine, our schedules are hectic as we manage multiple responsibilities in our daily routines. We are consumed with the limited time to perform and complete all the tasks that are required of us. Our daily routines are many times on autopilot because we perform many of our actions so often that we don't even have to think or process how to do them. However, when these difficult situations arise and we have to have “the talk” with our patients (and/or their families), we must recognize that what we say, how we say it, and the tone in which our words depart our lips will have a lasting impact on our patients in their healing process. It is at this moment that empathy and comfort become the priority, not time.
I teach learners that we should definitely become more comfortable with our verbiage but that the feeling of empathy should never become mundane. Our patients can feel our truth, sincerity, compassion, support, and solidarity through our words. In the book “Only 10 Seconds to Care,” internal medicine physician and author Wendy S. Harpham, MD, FACP, enlightens us that “the one characteristic that helps to define our humanity is our empathy. Empathy is why medicine has always been—and will always be—about people caring for people.”
I was reminded of this when I encountered a familiar face in a public setting. This person was not my patient, but I took care of her mother, who ultimately passed away from metastatic cancer. This person was always with her mother for appointments and was also present in the hospital room when I informed her mother of her biopsy result over eight years ago. We recognized each other and she hugged me. After small talk, she looked at me and said, “You know, Doc, you really helped my mother through such a tough time and she thought the world of you.” She then asked me, “Do you remember what you said to her when you gave her the diagnosis of cancer?”
Gulp! I felt palpitations, as I wasn't sure and did not recall what I had said in that moment. I was quiet and I know she recognized the contemplative and curious look on my face. She said, “You held her hand and told her that she would not go through this process alone and you would be with her through each step along the way. Those words gave my mother strength to fight the battle even though her time was short.”
Clearly, I meant those words, but I had no clue how impactful they were to the patient or her daughter. The fact that more than eight years later the patient's daughter was able to recite my words back to me and inform me how meaningful they were to her mother (despite such a difficult time and poor prognosis) was quite impactful and has made me even more conscious about my words and delivery.
Although these conversations are difficult, they offer moments when physicians can be true healers and provide empathy, compassion, and comfort through something as simple as our words. Despite our many technological advances in medicine, there is no electronic device that can provide compassion and healing to our patients—a healing that will touch and affect our patients' lives—the way that our words can. Regardless of the practice setting, I challenge us to remember to pause, take a deep breath, and place ourselves in the patient's situation before walking into the room to have “the talk.” I commonly ask myself, “What if it were me?” During that moment, it is not artificial intelligence but rather emotional intelligence and our words that will provide comfort and healing to the patient. In a Dec. 16, 2020, Freakonomics podcast titled “How Do You Cure a Compassion Crisis?,” Helen Riess, MD, director of the empathy and relational science program at Massachusetts General Hospital in Boston, described an acronym for empathy that can help us connect with our patients during these difficult conversations: E–eye contact, M–muscle of facial expression, P–posture (body language), A–affect, T–tone of voice, H–hearing the patient, Y–your response.
In the purpose of rededicating ourselves to humanity, I want to close with a quote by Abraham Verghese, MD, MACP, who stated, “We're now able to show that the words of comfort trigger biological reactions which are the very things that you want, and you can use drugs to get there, or you can use words of comfort to get there, which would make your drugs so much more effective.” Our words matter!