Apple Incorporated has grown to be among the most valuable and most envied companies on earth. Its products are ubiquitous and beloved by many of their users. Last year, the firm generated nearly $26 billion in profits on revenues of $108 billion. When physicians and others working in health care discuss the lessons that the medical establishment can learn from these types of corporate successes, the conversations almost always revolve around the promise of information technologies, such as electronic record keeping or electronic prescription writing, and the need for increased use of these in medical practice. While these technologies are important, the most valuable lesson from Apple’s success is a demonstration of the power of empathy and the subsequent need for health care providers to emotional connect with our patients.
It is widely known that Steve Jobs and Steve Wozniak built the first Apple computer in Steve Jobs’ garage; what is not as widely known is that they quickly brought in a third partner, Mike Markkula, to join and guide the company. He began by writing a one page statement entitled “The Apple Marketing Philosophy”. This philosophy stressed only three key components of bedrock company principles; the first and most important was empathy.
Mr. Markkula recognized that nothing would help Apple succeed as much as a strong emotional connection between its consumers and its products. Shortly after Mr. Markkula was brought on board, Apple’s executives chose a designer to oversee designs for the Apple brand. He was Hartmut Esslinger, and his guiding principle was not the axiomatic “form follows function”; rather, and reminiscent of Markkula’s philosophy, it was “form follows emotion”. He, too, first and foremost, attempted to design products to connect emotionally with consumers.
Health care providers share this same need to connect with our patients. Physician empathy is associated with better clinical outcomes, higher patient satisfaction rates, reduced physician burnout, and even reduced symptom burden in patients. For instance, Hojat and colleagues recently showed better diabetes management in patients treated by empathic physicians. In their study, patients of physicians with high empathy scores were much more likely to achieve good control of their diabetes than were the patients of doctors with lower empathy scores (1). Similarly, researchers have also found better diabetes control, improved drug compliance, and eating and exercise behavior in diabetics treated by more patient centered practitioners(2). Clearly physician empathy can play a large role in helping patients manage their diseases more effectively.
Not only can practitioner empathy improve outcomes, it also improves patient satisfaction. Kim and his colleagues in a study of 550 patients demonstrated an association between physician empathy and both better patient compliance and higher patient satisfaction rates(3). Furthermore, Little et. al., while not focusing directly on empathy, studied general practice patients and showed that patients treated by patient centered practitioners—generally doctors who are empathic—had a reduced burden of symptoms and lower rates of referral to specialists(4). This result is similar to that found in studying patients afflicted with cancer. Physician empathy was associated with greater patient satisfaction and lower levels of emotional distress(5). As a survivor of recurrent cancer, myself, I can personally vouch for the significance of reducing distress in dealing with the ups and downs of a long road with illness and its association with compliance with lengthy treatment plans. As a practicing physician, I can also very much appreciate how empathy also improves the physician experience.
Physicians who display empathy toward their patients are rewarded with more professional satisfaction and lower rates of burnout. Shanafelt and colleagues studied internal medicine residents and concluded “[H]igh mental well-being was associated with enhanced resident empathy”(6) . This same association has been observed in practicing physicians. Burnout among physicians has been associated with both a feeling of loss of meaning in medical practice and an inability to “be present” or, we might say, emotionally connect with patients. It’s been demonstrated that interventions to improve burnout invariably also improved physicians’ ability to empathize with their patients(7). As one might expect, physicians experiencing high professional satisfaction also have patients who feel more satisfied with their care(8). The link is empathy. Empathic physicians garner more meaning and satisfaction from their treatment of patients while these same patients feel more connected to their treating practitioner and enjoy better treatment outcomes, higher satisfaction rates, and a lower burden of symptoms. These good outcomes and patient interactions, in turn, bring more satisfaction to the treating physicians.
In discussions of physician empathy, the key question has always been: is empathy an inherited trait like their eye color, or can it be learned? Clues to this question first arose when studying the empathy of medical students. Researchers in 2007 reported that student empathy toward patients was negatively correlated with advancing years of training(9). A longitudinal follow-up study was then reported just this year. Disturbingly, this study showed that students’ ability to empathize actually declined as they progressed through their years of medical school training(10). Leaving aside the profound questions that this result raises regarding medical education, it does suggest that empathic ability, at least in part, is a learned (or unlearned) behavior. Riess and her colleagues then attempted to answer this question more fully by training otolaryngologists in empathic behavior, but her study relied on doctors’ assessment of their empathy instead of the patient’s assessment of their doctors(11), and doctors are, unfortunately, poor judges of their own empathy. However, a more recent study of residents and fellows from surgery, medicine, anesthesiology, psychiatry, ophthalmology, and orthopedics revealed that physicians who received just three 60 minute empathy training modules were viewed as more empathic physicians than were the control doctors in the study(12). While it is possible that this empathy training just taught the resident physicians the outward signs of empathy; even that would be important as patients’ deeper emotional response to treating physicians would likely change their doctors’ own emotional connection to their patients over time.
Based on these results, empathy should be regarded as a core competency of medical providers, and its training should be a requirement. This would lead to a more emotionally rewarding relationship between most physicians and their patients with its resultant increased physician and patient satisfaction rates, better outcomes, and reduced patient symptoms. Plus, these improvements can be achieved without expensive new technology, or increased patient testing or referrals. A focus on empathy will improve medical practice and should be deeply embedded in the culture of every new health care delivery organization, such as ACOs and patient centered medical homes . And, health care providers should have a relatively easy time of it. After all, Apple forges a connection to its customers through plastic and metal pieces of machinery. We can offer a sympathetic human connection to patients during their times of need.
1. http://www.ncbi.nlm.nih.gov/pubmed/21248604
2.http://www.ncbi.nlm.nih.gov/pubmed/15217167
3.http://ehp.sagepub.com/content/27/3/237.abstract
4.http://www.bmj.com/content/323/7318/908
5.http://www.ncbi.nlm.nih.gov/pubmed/22238060
6.http://www.ncbi.nlm.nih.gov/pubmed/16050855
7.http://jama.jamanetwork.com/article.aspx?articleid=184621
8.http://www.ncbi.nlm.nih.gov/pubmed/10672116
9.http://www.ncbi.nlm.nih.gov/pubmed/17653807
10.http://www.ncbi.nlm.nih.gov/pubmed/22455699
11.http://oto.sagepub.com/content/144/1/120.short
12.http://www.springerlink.com/content/hx764v7802pw4817/
James Rickert, MD is a certified orthopedist who practices in in Bedford, IN. He is also a member of the American Academy of Orthopedic Surgeons and is an Assistant Clinical Professor of Orthopedic Surgery at Indiana University. You can follow him at his website: http://www.thepatientfirst.org.
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This is great news. I am pretty excited that big corporations are finally stepping their game up and are trying to help out the health care system and also improve it. Seeing how far apple has come from nothing to where they are today, I think its a great idea to have apple give our health care system a few pointers.
Dirk, do you think that both schools of thought have some value? Personally, I believe that the issue of lack of empathy is completely avoidable. If we alter the attidtude of the source – medical training – we could easily fix the problem. Also, I think it is rather disturbing that tech industries are more concerned with “making products that feel more human” than health care professionals/systems are concerned with making health care feel more human.
Ironic, right?
Well of course anything can change throughout time, but the change that you’re asking for will simply take too much time. And excuse me, but it’s a little too difficult to explain the nitty gritty details of the med curriculum to someone who is not a med student, as I’m assuming that you are not. But yes, yes you are right, med students must have a passion to enter the field. It would be ridiculous if you could train that passion because then anyone can enter the medical field, and for obvious reasons, we simply can’t let that happen.
Why do you believe that this cannot change? Of course, it may take small steps, but doesn’t everything have to change with time? I’m curious as to what you have to say about the curriculum as you are, yourself, a current student. Also, something to consider in regards to health care professionals’ level of empathy: whether we screen for these personalities more during the admissions process or if we try to train or “indoctrinate” empathy into students already training for a medical career. After all, how much control do we have in forcing someone to be compassionate?
I agree with the article that med students’ empathy decline over the years. As a fourth year medical student, I can definitely say that I have lost some of my passion I originally had. Let me tell you, medical school is difficult and it is not for the light-hearted. But perhaps you are right, Shannon Wagner. If there was such a way that the entire curriculum could be changed, then maybe med students’ would have different outlooks on there futures. Unfortunately, I do not believe that such a change can happen any time in the near future.
It seems as though we have two parts of a discussion at hand here, then. One, of course, is how to incorporate technology such as the Apple’s iPhone effectively (while not overestimating its abilities). However, I suppose I agree that you do make a point: both technology and doctors are important, and the benefits of such new innovative Apps may not be so far-reaching as to count as an easy solution to say, the physician shortage. Yet, we cannot deny that although the specific long-term effect of technology in health care is currently unknown, there will indeed be an effect:
https://thehealthcareblog.com/blog/2011/01/31/physician-executives-should-not-ignore-how-smartphones-will-transform-healthcare/
However, I’m going to bring up another part of your article here – the part stating how medical students’ empathy declines throughout their years of their training. How terrible! However, this is not the first time that the medical school curriculum has been criticized, has it? I’m with Lewis Thomas when he says that would-be physicians must possess an “innate capacity for the understanding of human beings and affection of the human condition”. And so the question remains…how do we promote such a holistic approach to medicine? We just may have to resort to complete reformation of the entire medical and pre-medical curriculums, it seems.
This is a basic question in health care. Would sufficiently advanced diagnostic and treatment algorithms, married to technology, ever be able to replace physicians? if not, what services do doctors offer that can’t be replicated technologically?
I see great utility in the type of service that Dr. Topol advocates–quick diagnostic feedback for urgent situations, but it’s another question if any quantity of data can replace a physician or team of physicians in long-term care of complicated illnesses, such as recurrent cancer or problems involving multiple organ systems.
Then there is a large and growing body of evidence showing the healing and other salutary effects on patients of patient centered care.
http://www.thepatientfirst.org/understanding-patient-centered-care.html
Neither technology nor old-fashioned medicine will ever replace the other. A great challenge is to make each work in complementary fashion.
This is a very interesting article complete with solid scientific research to show and explain the need for an increase of quality of patient-doctor interaction. If one is to face a long road of recovery, he or she should be equipped with the proper support, especially by the doctor striving to hand over good health once again. Most interesting of all, though, is how you tie in Apple’s company philosophies to empathic health care; however, it does make me think of a link to an article I stumbled upon recently on Apple’s homepage – an article that instead links Apple to less reliance on patient-doctor interaction:
http://rockcenter.nbcnews.com/_news/2013/01/24/16677207-the-key-to-better-health-care-may-already-be-in-your-pocket-and-its-not-your-wallet
While the types of health issues that may be addressed by our iPhone-doctors certainly are not on the same level as illnesses such as cancer, Dr. Eric Topol does present an idea up for discussion. Has the do-it-all Apple iPhone finally decided to infiltrate into health care? Does the empathic patient-doctor interaction prove to be so important that these new, up and coming health care apps – apps that can turn any normal person with an iPhone into an intensely trained doctor in a matter of seconds – will become a detriment rather than a beneficial technological advance? While the consequences of this potential innovation are indeed complex, the article shows us an intriguing almost-counterargument to the question of practicality and efficiency versus valuable person-to-person empathic care.
Isn’t it awfully disturbing that empathy for others declines as students move through medical school? Something is fundamentally wrong with the curriculum.
There is resistance to empathy training from medical school, to residency training, to continuing medical education.
Technical training is much more highly prized. Obviously, we all need to be good technicians, but lack of empathy is expensive in more ways than one
You’re right, the business is totally people specific–as much as any business can be. Health care providers serve people. Improving the interaction will help both the patients and the doctors who serve them.
Physician empathy improves results, satisfaction rates, and it is free with no big barriers to entry. Providers just need to learn it and practice it.
We need big companies to expect more from healthcare providers, first and foremost; they pay the bills and do have the power. Everyone should be at least as happy with their health care interactions as they are with their Ipods.
great piece, and he makes a great point about physician burnout. It’s so easy to forget that this business is centered around people. I wonder how much better we would all be if physicians just spent a few more minutes with patients in the exam room, or referred to them as people instead of cases.
Great article. Lots here to work through.
The fact that there are two distinct schools of thought here – loosely the “it’s-impossible-its-just-the-way-it-is-school” and the “this-is-the-one-big-thing-we-need” school should tell us a lot about the way medicine works
This says a lot:
“Disturbingly, this study showed that students’ ability to empathize actually declined as they progressed through their years of medical school
training
Our challenge is similar (but different) to the one faced by the tech industry – which faced the challenge of making products that felt more human
Great food for thought
This is good news. I am glad that these giant corporations are finally going to play a role in healthcare. They have the power that needs to be utilized correctly.
Things like these will improve the overall system, helping Apple as well. Way to go!