What’s in A Word? My Journey Toward Empathy Education and Practice at the Cleveland Clinic

When I think about empathy, examples from my personal life come easily to mind. I think of the soothing sound of my mother’s voice as she hears the break in mine as I am about to start crying. I recall looking into the kind eyes of a friend who is hearing a difficult part of my story for the first time. I see the wrinkle at the corner of my son’s eyes just before the laughter. Empathy in medicine is more complex and can be rather elusive. It is less personal because I don’t have a day to day relationship with patients, and more personal because I want to alleviate their suffering. Having been a patient myself, I have been the recipient of beautifully timed and placed empathic gestures and words. But, I have also experienced the downside of health care, the rushed, uncaring, somewhat bitter moments that probably had nothing to do with me, and everything to do with pressures on the person delivering it. Done well, expressions of empathy can be healing and much appreciated; done poorly, it feels deeply distressing and personal and is almost always something you remember vividly and talk about with strong negative emotions. Why do the negative memories often bubble to the surface first? It’s certainly not because they are more common, yet they dilute and sometimes cancel out the times when empathic gestures and words were genuine and well placed. As a physician, I hope the memories I have created with patients are positive and were communicated in a way that was healing. There is no question I have made mistakes and faltered along the way. Unlike my personal experience of recognizing and receiving empathy, there weren’t a lot of mentors in my clinical training who helped me identify opportunities and strategies for improvement. I entered the field of medicine with the intention of being a life-long learner and I enjoy learning new things. The idea of including communication skills as part of this process wasn’t on my radar until I became faculty. What I have learned through my training, first as a course participant and now as a communication course facilitator at the Cleveland Clinic, has revolutionized the way I build and maintain relationships with patients and colleagues. I now appreciate the value of reflective practice and opportunities to improve using guided feedback and repetitive skills practice. Learning new skills and having the ability to practice them has made me a better communicator and certainly a better physician. The story of how the Cleveland Clinic began and sustains communication skills training in empathy has been told several times before. What I hope to offer is a different perspective, one viewed from the lens of a trainee who then joined the Clinic as faculty. I have spent my entire training and professional career at the Cleveland Clinic. My medical school experience was probably not dissimilar to many clinicians; my communication style was an amalgam of who I am as a person, what makes up my individual personality, and the physicians I worked with who I viewed as being good communicators. There was definitely a lot of mirroring, I would take what I liked and reflect it back as well as I could. I had no idea at the time what made these clinicians “good” communicators, it was simply a feeling, an innate sense of what was right and what worked with patients. What came a lot easier was recognizing what didn’t work, both in my own actions and words and in others. In 2006, the idea of teaching empathy to physicians was brought to our CEO Dr Cosgrove’s attention after a presentation he delivered at Harvard University. Interestingly, the student involved in the story was not sharing her experience as a member of an elite few who attend the business school, rather she was sharing her experience as the family member of a patient. The question posed was around whether the Cleveland Clinic had resources to help caregivers be more empathic. At the time we had none, and this realization was a