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A Mnemonic for Empathy!

E.M.P.A.T.H.Y.: A Tool to Enhance Nonverbal Communication Between Clinicians and Their Patients. Riess H et al. 2014 Academic Medicine (89):8 pp.1108-1112

Reviewed by Michael Barone

What is this article about?
In this “Perspective” piece, authors who work in the Empathy and Related Relational Science Program at the Massachusetts General Hospital (MGH) note that nonverbal communication (NVC) is insufficiently stressed in health professions education. They point out that much of empathy and humanism training has been focused on the verbal skills of “what to say” rather than “how to be.” The authors provide a framework to help teach and reinforce the critical elements of NVC based on social psychology observations and the neurosciences.

The framework, called E.M.P.A.T.H.Y., has been used to both train health professionals and as part of a randomized clinical trial at MGH.

E - eye contact
M - muscles of facial expression
P - posture
A - affect
T - tone of voice
H - hearing the whole patient
Y - your response

What’s interesting about this article?
The authors acknowledge cultural differences in the way that patients may receive NVC techniques. For example, certain elements of NVC, such as touch, were specifically not included in the E.M.P.A.T.H.Y. framework due to cultural differences in which touch is inappropriate. And while the same could be said for eye contact, the authors stress how some eye contact is important particularly in a clinical setting replete with technology and distractions.

The article also provides extensive referencing to the neurobiology of NVC, an area of expertise for the lead author. We all probably know that a clinician’s “posture” during the patient encounter can impact empathy ratings. But did you know that dominant postures can directly stimulate the neuroendocrine (stress) cells of patients? Or that neuroimaging studies have shown empathy to be correlated with a patient’s ability to decode a clinician’s facial expressions? The authors also posit a neuroscience pathway for the way physicians reflect on their own response to the patient encounter (the “Y” in E.M.P.A.T.H.Y.). They emphasize how critical it is for physicians to respond to patients in reflective ways.

How can I use this article in my teaching / practice?
Many of us who contributed to this October Journal Club on humanism firmly believe that humanism can be taught. Steve Miller’s framework for the “Habit of Humanism” is an example of such a teaching tool. This E.M.P.A.T.H.Y. framework is another tool to use with trainees, either one-on-one or as part of a broader curriculum. E.M.P.A.T.H.Y. anchors the critical elements of NVC, and can provide discussion points for debriefing direct observation or a video review of a learner.

(The footnotes to this article mention that E.M.P.A.T.H.Y. is a registered trademark of MGH and that the lead author is the Chairman and Chief Scientific Officer of a Company known as Empathetics.)

Editor’s note: Any tool to assist teaching and learning humanism is most welcome. Perhaps someone from COMSEP would like to evaluate how effective this tool is in the pediatric medical student setting (SLB).

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