Can Radical Empathy Fix Our Healthcare System?

— We must rethink the fundamentals of how we approach our work

MedpageToday
A photo of a male physician and his male patient looking at a tablet in the examination room.

The history of medicine has been a long story of increasingly minute specialization. When we celebrate momentous breakthroughs in healing -- authorizing the COVID-19 vaccine or performing the first successful heart transplant -- what we applaud is the ability of our researchers and physicians to zero in on one condition and deliver increasingly efficient treatments for even the most daunting of maladies.

However, we believe that we -- healthcare professionals and researchers -- have gone too far. If we want to fix our ailing healthcare system, our best hope is to reconsider how we treat and heal our patients. We need to reignite the human connection and boldly reimagine the practice of medicine as a communal and relationship-minded undertaking, spending considerable resources to ensure patients see themselves as full-fledged partners in healing.

Does this strike you as too ephemeral, too far removed from the hard-edged prescriptive formula of saving lives?

These instances of a one-sided provision of care grow much more frequent when the patients aren't privileged individuals with access to resources, education, and excellent care. Women, people of color, and immigrants with limited English-proficiency are at greater risk of misdiagnosis, under recognition, and undertreatment for many diseases. This contributed to the massive 46% spike in the gap in life expectancy at birth between the U.S. Black and white population between 2019 and the first half of 2020.

We clearly have a systemic problem. Given that 80% of our well-being is determined by factors like access to healthcare, physical environment, and lifestyle choices, we must close this gap by rethinking how we invite patients -- especially those who feel most disenfranchised -- into the conversation. We must show them that their health is their most valuable asset and encourage their partnership as active participants in their health.

Richard Carmona, MD, MPH, the former U.S. Surgeon General, once told us a story that stuck with our team for years. As a young man, he had served in Vietnam as an army medic, and happened to visit a Montagnard village where several people were in dire need of his services. However, when he tried to treat these sick villagers, Carmona noticed them retreating in distrust. For several days he did nothing but live among the Montagnard people, listening to their stories, breaking bread with their leaders, and showing them that he wanted to get to know them and their way of life. Finally, after gaining their trust, Carmona was allowed to practice his craft, and the results were immediate and positive. He prescribed penicillin pills to the patients who needed them and then left, vowing to return a few weeks later. When he did, he was greeted with fanfare and given a precious gift: A necklace with all 40 penicillin pills he'd left behind. The local leaders, beaming, told him they'd placed the necklace on the chest of sick patients, as their traditional approach to healing recommends.

For a while, Carmona considered the story as one of failure -- after all, he had limited success in educating the Montagnard villagers in the workings and benefits of western medicine. But he soon realized there was a deeper, more profound moral to his story: he was welcomed and trusted by the villagers, he realized, not because he was able to show clear and efficient and demonstrable results, but because he had taken the time to show them respect. He was there as a human being, connecting with other human beings, and this basic but all too rare approach made the villagers trust him.

How can we apply these lessons in our practice today? One simple solution is the inclusion of a more diverse workforce. For example, health systems can offer more appropriate and effective care when members of the care team speak the patient's language and understand their sensitivities. The same is true for communal partnerships: With so much of our overall health determined outside of the narrow context of clinical care, redesigning the healthcare delivery model with a more holistic roadmap to include partnerships with non-healthcare organizations, nationally and locally, can make a big difference in optimizing healthy behaviors and encouraging healthier lifestyle choices.

But the sort of radical empathy we need if we are to gain the trust of our patients and overhaul the way we offer care goes far beyond sweeping organizational measures. To reform our healthcare system, the entire medical community will need to rethink the fundamentals of how we approach our work.

Imagine a medical school class that teaches would-be physicians not only how to have good bedside manner but also how to share their own stories of hardship and loss, and how to open up about their own failings and successes. Imagine medical education -- and practice -- focused on people meeting each other not as two nodes in a highly impersonal and complex, transactional, and monetized process but instead coming together with empathy, compassion, and trust. Such an approach would fly in the face of hundreds of years of medical history -- but we can't afford not to take this turn.

With more Americans sicker than ever, and with our current way of healing no longer able to meet the cascading public health crises cutting life expectancies shorter, it's time to rewind and reconsider. It's time to reignite that most potent healing tool in our arsenal: the human connection.

Jennifer Mieres, MD, is Northwell Health's chief diversity and inclusion officer. Elizabeth McCulloch, PhD, is assistant vice president for Health Equity at Northwell's Center for Equity of Care. They are co-authors of the book, Reigniting the Human Connection: A Pathway to Diversity, Equity, and Inclusion in Healthcare.