1. The Role of Empathy in Healthcare Professionalism PECH 1001: The Health Professional & Society Dr. Farid F Youssef

2. Remember. Professionalism is the basis of medicines social contract with society Professionalism demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health

3. EMPATHY: WHAT IS IT?

4. Status: Look at this Picture What is happening? What are you feeling? Are you have any motor responses?

5. Status: Look at these Pictures What do you think is happening? What are you feeling?

6. Empathy: What is it? Empathy is the capacity to recognize and experience feelings that are being experienced by another. It is the intrapersonal realization of anothers plight that illuminates the potential consequences of ones own actions on the lives of others. (Hollingsworth, 2003)

7. Empathy: What is it? The essence of empathy is the ability to stand in anothers shoes, to feel what its like there and to care about making it better if it hurts. Szalavitz, M. & Perry, B.D. (2010). Born for love: Why empathy is essential & endangered. New York: William Morrow, (p. 12)

8. Empathy: What is it? Empathy is part of a wider capacity of humans which can be defined as emotional intelligence the capacity to be aware of, control, and express one's emotions, and to handle interpersonal relationships judiciously and empathetically. Often considered a predictor of success

9. NEUROBIOLOGY OF EMPATHY

10. Neurobiology of Empathy Do babies show empathy ???

11. Neurobiology of Empathy

12. Neurobiology of Empathy The discovery of mirror neurons

13. Neurobiology of Empathy Subjects empathy for the pain of others only elicits activity in ACC, not somatosensory cortex.

14. Neurobiology of Empathy Co-operation Giving to charity Fairness ALL activate the reward centres of the brain AND there is some evidence to suggest that giving produces more enduring pleasure than receiving.

15. TYPES OF EMPATHY

16. Types of Empathy Cognitive empathy The ability to recognise the emotions and feelings of others

17. Types of Empathy Affective or Emotional Empathy The ability to experience the feelings of others

18. Types of Empathy Behavioural Empathy Demonstrating behaviours that acknowledge the emotional state of others

19. Types of Empathy Moral Empathy The moral responsibility to act in accordance with the other persons emotional state regardless of personal feelings Considered highest level of empathy

20. EMPATHY & HEALTH PROFESSIONALISM

21. Empathy & the Health Professions Empathy impacts on clinical outcome in patients. i. reduced metabolic complications in a study of over 20000 diabetic patients (Del Canalee et al, 2012) ii. linked to better glycaemic control (Hojat et al, 2011) iii. reduced duration of the common cold (Rakel et al, 2009) iv. greater patient satisfaction and empowerment. (Kim, Kaplowitz & Johnston, 2004)

22. Empathy & the Health Professions Empathy impacts on clinical outcome in patients. iv. greater patient satisfaction and empowerment. (Kim, Kaplowitz & Johnston, 2004) v. Empathy reduces patients perceptions to pain, (Sarinpoulous, 2012)

23. But what we are taught in school is akin to: Alexithymia... When it comes to patients, think with your head, not with your heart. Be objective when dealing with patients and do not let your own emotions interfere in the patient- doctor relationship. Keep your own emotions at bay lest you become too involved...

24. Empathy & Health Professional Training Empirical data suggests empathy scores decline during training.

25. Empathy & Health Professional Training Doctors show decreased neuronal responses to painful stimuli in patients and increased activity in prefrontal cortex Theory suggests mental processing recruits resources away from emotional areas to allows doctors to focus However new data now shows doctors do not even appear to perceive the pain response.

26. Why Empathy Erosion Response to Authority The infamous Miligram Experiment, 1963

27. Why Empathy Erosion Dehumanization is the denial of a distinctively human mind to another person (two facets experience and agency) Used to justify slavery and other crimes against humanity Involved in the objectification of women

28. Dehumanization in Medicine Patients stripped of their uniqueness (stories, personality, culture) in service to objectivity

29. Objective Subjective How does the world work? (Ontology) There is only one reality. By carefully dividing and studying its parts, the whole can be understood. (Realism) There are mulitple realities, being socio-psychological constructions forming an interconnected whole. (Nominalism) 2. What is the relationship between the knower and what is known? (Epistemology) The knower can stand outside of what is to be known. True objectivity is possible. (Positivism) The knower and the known are inter-dependent. 3 What role do values play in understanding the world? Values can be suspended in order to understand. Values mediate and shape what is understood. 4 Are causal linkages possible? One event comes before another and can be said to cause that event. Events shape each other. There are multidirectional relationships. 5 What is the possibility of generalization? Explanations from one time and place can be generalized to other times and places. Only tentative explanations for one time and place are possible.

30. Dehumanization in Medicine Deindividuation doctors as a sea of white coats; patients as half- naked bodies in smocks, identified by their disease or procedure (the gallbladder in Room 38)

31. Dehumanization in Medicine Mechanization Breaking the body into organs and systems for training, diagnosis and treatment

32. Dehumanization in Medicine Moral disengagement: some actions require inflecting suffering

33. Dehumanization in Medicine Impaired patient agency medical staffs treatment of patients as incapable of planning their own care, which is both infantilizing and demoralizing. Dissimilarity the patient is ill; the patient is labelled with the illness; the power dynamic

34. The Role of Empathy in Healthcare Professionalism PECH 1001: The Health Professional & Society Dr. Farid F Youssef