A 68-year-old man presented with weakness and a 30-lb weight loss over the past three months. Chest radiograph shows a large left hilar mass. CT scan shows a 12 cm left hilar mass with multiple bilateral pulmonary nodules, concerning for metastatic disease. The emergency department (ED) is full with boarding and critical patients, and 25 patients are in the waiting room. How should this information be communicated to the patient and family? What is the emergency physician’s role?

Evidence for Empathy

The medical literature includes numerous commentaries and opinions about the importance of compassion and empathy in the practice of medicine. More than 100 years ago, Sir William Osler said, “To serve the art of medicine as it should be served, one must love his fellow man.”¹ According to the ACEP Code of Ethics: The physician-patient relationship is the moral center of medicine and the defining element in clinical ethics.²  Is compassion merely a touchy-feely perspective? Is there scientific evidence supporting compassion in emergency medicine?

A recent systematic review found that greater empathy and communication was associated with improved patient outcomes, including reduced pain and shorter duration of hospital stays.³ Other studies have found that greater empathy is associated with improved health care outcomes, including patient satisfaction, pain, adherence to therapy, and reduced litigation.^4-10    

Empathy among physicians is highly variable.^11,12 There is a well-documented decrease in empathy during medical school.¹³ Although disturbing, the reasons for this decrease in empathy are not well understood. Several factors have been implicated, including work environment, stress levels, and lack of leadership.¹⁴

Improving Empathy

What then can be done to improve empathy? Educational interventions and improvements in the hidden curriculum have demonstrated benefit in demonstrated empathy.¹⁵ 

Some specific interventions to improve communication in the ED include a seated position, eye contact, reflective listening, and physician self-disclosure.^16-20 Most importantly, caring about the patient is paramount. The Golden Rule—do unto others as you would have them do unto you—is a valued perspective in many cultural and religious traditions. Recently, authors have proposed The Platinum Rule, where we should do unto patients as they would want done unto themselves.²¹ This standard requires communication and knowledge of patient-centered values in addition to empathy.

Knowing and applying evidence-based medicine may seem easier than taking the time and effort to show empathy, compassion, and kindness in a busy ED. It may be a more tangible reward to obtain return of spontaneous circulation after cardiac arrest, than to hold a hand and show empathy during a challenging time. As emergency physicians, we are constantly stressed by patient volumes and acuity. We may be tempted to think, “I don’t have time for a compassionate counseling session. Isn’t that the oncologist’s job?” Empathy may be driven to the back burner by the ED environment. It is up to each of us to bring empathy to the forefront, despite the challenges that the ED brings.