Our diseases (actually our patients’ diseases) are more than the sum of immune biomarkers, CDAI scores, Sharpe scores, SLEDAI scores or most other commonly used metrics.
The proposed definition of empathy includes the important role of communicating our concerns back to the patient, thus emphasizing that medical communication skills are vital to expressing our empathy, but we are not focused merely on etiquette. In fact, although good bedside manner and etiquette-based medicine are associated with improved patient satisfaction scores, such skills merely characterize the transaction of the healthcare interaction, not the actual caring for the patient.8,9 Empathy is the quality that is essential for genuine caring about, and for, our patients and the underlying principle of the maxim of France Peabody, who stated the “secret to patient care is to care for the patient,” nearly a century ago.10
What Do We Know of Empathy in Rheumatology?
The short answer is not much. Although studies of empathy in non-rheumatologic healthcare providers have documented a number of reproducible findings, such as a higher degree of empathy in providers involved in people-oriented fields (e.g., primary care, psychiatry) and higher empathy scores in women than men, no formal studies have been performed in rheumatology physicians or advanced practice providers, including comparisons to other cognitive as well as non-cognitive specialties.11
There also is a complete void of studies examining empathy in our profession as a function of type of practice (e.g., private, group, academic) or in relationship to other variables of interest, including the use of electronic medical records, volume of work, types of patients or work load, or in comparison to other cognitive or procedural subspecialties.
Finally, a critical area of unmet investigation is the relationship between healthcare provider empathy and patient outcomes, including pain control, other quality-of-life domains and other variables, including adherence to therapies.
Closing the Gap
A major goal of effective anti-rheumatic therapy is the patient’s global assessment, which to achieve remission by most disease activity scales must be 1 or less on a scale of 10. This is indeed a tall task and may be limited by a variety of complaints, including persistent pain, fatigue or general lack of psychosocial wellbeing.12 Failure to recognize such limitiations is a risk for overtreatment.
An allied area of increasing interest to our field are the nearly one in three patients who differ meaningfully in their global response regarding their disease activity with that of the score of their provider.13 Although this has been most carefully studied in rheumatoid arthritis, it is also a phenomenon documented in other conditions.14
A seminal study of this phenomenon by Davis and colleagues revealed, not surprisingly, an over-representation of fibromyalgia, intercurrent mood disorders and multi-symptomatic pain.13 In an effort to further understand these discordant responders, the researchers performed a qualitative study on a subset of these patients, revealing a number of common themes, including a major concern that their provider displayed a lack of active listening and empathy during their visits.15 Importantly, these patients, while being acutely aware of the time restraints of their clinic visit, felt their provider was often mentally appearing to be moving on to their next patient and demonstrated a general lack of presence.
Clearly the prospects of enhancing empathic communication in our field may serve to help close this important gap in treatment response.