The Empathy Effect
7 Neuroscience-based Keys for Transforming the Way We Live, Love, Work, and Connect across Differences
Helen Riess, MD
Sounds True, Boulder, Colorado, 2018
Reviewd by Johny Van Aerde, MD, PhD
Dr. Helen Riess, a neurologist, uses elements of psychology, emotional intelligence, sociology, and organizational culture in her book, The Empathy Effect. The construct of empathy is best understood as a human capacity consisting of different but integrated elements that enable us to be moved by the plights and emotions of others. Our empathic capacity requires a specialized brain circuit that allows us to perceive what others feel, process the information, and then respond effectively. Our brain is primed to experience others’ pain for two reasons: to teach us what to avoid ourselves and to motivate us to help the injured person. Empathy uses the same neuronal circuits as mirror neurons, allowing us to vicariously experience others’ pain by understanding and feeling what others are experiencing. Top
There is an emotional and a cognitive component to empathy. For the longest time, experts believed that empathy was something you were born with. Recent evidence proves that, just like leadership skills, the cognitive component of empathy can be learned. Specific training can increase perception, perspective-taking, and self-regulation skills so that we are not overwhelmed by the suffering of others, which might lead to our own distress and burnout. To facilitate that learning, Riess developed and tested a tool with the acronym EMPATHY.
The seven elements of EMPATHY are linked with non-verbal communication: E for eye contact, M for muscles of facial expression, P for posture, A for affect, T for tone of voice, H for hearing, and Y for your response. Their conscious use triggers awareness by engaging the prefrontal cortex. In one study, the tool caused physiologic parameters, like skin conductance and heart rate, to resonate between physician and patient. Unfortunately, the model is trademarked and the book does not provide much information about the required training. However, in a telephone conversation with Dr. Riess, this reviewer found out that much has to do with practising the skills of self-awareness and management, communication, and change leadership. Top
After its introduction in such hospitals as the Cleveland Clinic, patients’ experience improved when they were treated with empathy, which led to greater trust, more compliance with treatment, and better outcomes. Dr. Riess has some evidence that practising the EMPATHY tool as individuals and embedding its use in the structure and culture of collaborative organizations improve working conditions.
For physicians, implementing the tool systemically led to more job satisfaction and less burnout. Physicians who displayed these mostly non-verbal behaviours were rated as warmer and more competent by their patients. It is interesting that practising basic people skills and portraying empathic emotional intelligence make us appear more competent. Although there is some indication that the tool helps manage emotional overload and reduce the risk of depression and burnout, further research is needed.
The book is not only important in helping us in relationships with patients, but also in seeing how we view the world primarily from the perspective of the various clans or guilds to which we belong. We are less likely to feel empathy toward others who do not fall into our in-groups or tribes. If humanity truly wants to live by the principles of diversity, it has to try to understand “the other” and the other’s perspective, as it is difficult to withhold empathy when you get to know somebody.
In the heavily fragmented Canadian health care system, we need the skills of empathy as part of a strategy to integrate all silos. Similarly, as we move more and more into multidisciplinary teams, we need to master the skills of empathy.
Riess also addresses self-empathy, self-care, and how empathy starts with self. Before we can offer empathy and compassion to others, we need to practise self-kindness and mindfulness when we experience our own emotions, and remember that humanity is a shared experience. This book covers several capabilities in the L, E, and S domains of the LEADS framework. The Empathy Effect is a good read if you are interested in how empathy can benefit individuals, teams, hospitals, and the entire health care system.
Johny Van Aerde, MD, PhD, FRCPC, is editor-in-chief of the Canadian Journal of Physician Leadership and executive medical director of the Canadian Society of Physician Leaders.