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.
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.