The importance of empathy as a healing touch

Some years ago, Rhiannon Downie-Hurst, entrepreneur and Dubai expat for 14 years, suffered a miscarriage while she was at Dubai Mall. She rushed to the nearest clinic, where she was seen by a female gynaecologist. What she wasn’t prepared for was the “complete contempt” with which she was treated. “I was obviously a bit teary because it was my first pregnancy… also, I was very scared, I didn’t know what was happening. The doctor told me to stop crying, even said ‘it was God’s will’, and then refused to examine me saying I may blame her if something goes wrong… mind you, I was vulnerable and emotional, but definitely not hysterical.”

Rhiannon, utterly confused and mentally whacked, came out of the clinic, fished out her phone, and went on a social media group, where she sought a recommendation for a doctor. She made it a point to ask for an empathetic and caring doctor. “I was immediately referred to someone who has a great reputation. When I walked into her cabin, she hugged me, and expressed sympathy… she was kind and gentle… and yet practical.”

The lesson learnt has been, “every 
doctor I have searched for since then, whether it’s a doc for my son or for myself, I look for that empathetic quality. That, I think, is so vital.”

The first doctor Rhiannon ran into exemplifies the classic case of a medical practitioner with bad bedside manners — a phrase of yore that is becoming more and more relevant these days. How reassured and comfortable a patient is made to feel by the doctor (as was displayed by Rhiannon’s second doctor) has assumed greater traction in a digital, impersonal, tech-dominated era where members of the healthcare fraternity are considered ‘untrustworthy’, and ‘uncaring’ (one recent study in the US revealed that less than 40 per cent people ‘trusted’ the healthcare system).

Bangladeshi-born Canadian physician and writer Dr Shahdabul Faraz, in a piece for npr.org (titled ‘My Bedside Manner Got Worse During The Pandemic… Here’s How I Improved’), had this to say about bedside manners: “From the very early stages of our medical training, we are taught about the importance of bedside manners. Eye contact. Smile. Perhaps a handshake or a pat on the shoulder…These gestures acknowledge a patient’s humanity. It gives them some semblance of normalcy in an otherwise difficult period in their lives. Selfishly, that human connection also helps us — the doctors, nurses and other healthcare providers — deal with the often-frustrating nature of our stressful jobs.”

Today, being emotionally invested in patients, while also being able to demonstrate that feeling is no longer a given. Like Rhiannon, one may have to, at times, actively seek out a doctor with empathy.

‘Doctors need to show you that they care’

A few years back, Umaima Tinwala was diagnosed with cancer. The diagnosis was in India, but the treatment — a slew of chemotherapy sessions — took place in Dubai, since she’s based here. The first oncologist she went to, from all accounts, “one of the best in the country for cancer treatment”, was downright “rude”. “See, the thing is, both my mother and aunt had cancer,” says Umaima. “So I know how it goes, and how treatments need to be customised. Everyone’s situation is unique, so the handling has to be unique. But in this case, there was zero effort to talk to me or understand my condition — something that turned me off completely… she clearly lacked empathy…”

For 12 weeks, Umaima went to this medical care facility, every Monday, for chemo. “Going through chemo is very difficult, it’s an extremely intensive treatment that almost kills you… it takes a toll on you physically, mentally, emotionally. At that point, what one looks for in a doctor is simple: that they be kind to you.” But each time, she ran into this doc, “she was almost mean… that was devastating, made me so insecure”.

Worse was to follow. When it was time for her to get her diagnostic tests done to figure out how well — or not — the therapy had worked, the centre didn’t have a slot for the next three months. “The doc told me she would not accept a report from anywhere else, and that I had to get the tests done there, even if it meant waiting for three months.”

That was Umaima’s breaking point. 
“I think it had become an ego issue with her, she wanted me to blindly trust her, and because I didn’t want to, because I kept questioning her, it became a problem for her.”

She immediately closed down her account with the hospital, and moved to another one to continue with her treatment. “In support groups, a lot of others had the same feedback to share about this particular doctor — but that’s a different story.”

Umaima, who, today, is cancer-free, still gets the jitters when she thinks back on those days. “When you are tackling something like cancer, you are physically, mentally and emotionally overwhelmed. Sure, you have your friends around, you have your family around, but what you need from your medical professional is the guarantee that you can trust them — and that can only come if they show you that they care, if they are able to make you feel cared for.”

These days, she has to keep popping in and out of doctors’ chambers for checkups, and one of the first things she insists on doing is to take note of how much time a doctor is willing to give her to “listen to me, ask me about myself, try and understand where I am coming from, understand the peripheral things in life that affect me… A doctor has to look at me as being someone who is a culmination of a lot of things instead of just having one health issue.”

And, “If I am not comfortable with the doctor because he or she is not treating me as a unique person, no matter how highly recommended he or she is, I walk away. I’ve even ripped up prescriptions, and started from scratch again.”

Re-imagining the doctor-patient ecosystem

Dr Sandeep Guleria, nephrologist at Indraprastha Apollo Hospitals in New Delhi — and Padma Shri (India’s fourth-highest civilian honour) awardee — runs one of the biggest renal transplant programmes in the world. In the medical profession, the human touch is the most important thing, Dr Sandeep says. He has a simple rule of thumb. When he hears a patient talk, “it is important [for me] to imagine that someone I love is going through the same torment”.

The absolute first thing a doctor needs to be equipped with is the ability to be a good communicator. “Patients may be going through a patch of trauma, so, at times, they take on a confrontational attitude… at times, they think the billing is too high… but you can’t take them head on, you should just stick to telling them the truth, and tell them exactly what is happening, be very transparent.” It’s also very important to suggest to someone that he or she is free to get a second opinion if they have any doubts.

And then, you have to learn to be tolerant, and very patient — with your patient. They have questions and counter-questions at all odd hours, so “my phone is 
always ringing and I need to address 
their concerns”.

At times, bedside manners extend to beyond a doctor-patient relationship. “You have the patient’s loved ones getting in touch with you to find out details. You give some of them the case details, but then 10 others come back to you asking the same questions. But you cannot afford to lose patience.” There have been cases when a critically-ill patient passed away, and it felt like a personal loss for Dr Sandeep, “I’ve come back home and wept”. He makes it a point to stay in touch with family members and take time out to explain what exactly went wrong. Often, he has to repeat himself, but he gets that because “it takes time for the family to come to terms with the loss”, and he goes back to what he said earlier: “it is important [for me] to imagine that someone I love is going through the same torment.”

The art of listening

“When I was a kid, good bedside manners were ascribed to a doctor who would speak to you gently,” says Jessica Combes. “And if he was giving you an injection, he would try and make it a pleasant experience rather than being perfunctory.”

But as she got older, and started going to the doctor by herself, she felt bedside manners are much more about a doc actually listening to you and taking into account everything you are saying: “Looking at your family history, your pre-existing conditions, your lifestyle… being able to treat a case holistically.”

Jessica had a freak accident in 2013, and she broke my leg and ankle. “It usually happens to soccer players — but I was only walking from my bathroom to my bedroom!” She had to go for emergency surgery, where, among other things, a metal plate was inserted into her tibia. Months of rehab later, she made a full recovery — but her surgeon said that metal plate could just stay put in her leg indefinitely “unless there’s any complication”.

In 2015, Jessica moved to Dubai; soon after, she realised that something was “not quite kosher” about her leg. “Every time I ran or did high-intensity exercises, I was aware of the plate, and the muscles against it, and there were these muscle cramps.” This went on till 2017, when she decided to see a doctor. “He just was not listening to me while I tried to explain the timeline of my injury, explain symptoms and what I was experiencing… he didn’t say it in as many words — but I know he was implying that I was bonkers, crazy.”

His verdict on her leg was adjudicated without much discussion with her. He told her she’s flatfooted, and therefore needs insoles in her shoes. Jessica went along with that, but it turned out to be a wasted — and wasteful — expedition: her leg remained troublesome.

In 2018, she says, she was “fed up with doctors”, convinced no one is going to really listen to her. That’s when she saw a doctor, recommended by a contact, and she came straight to the point: that her story is something of a saga — but she needs to be heard out.

He heard her out. He then recommended some X-rays, based on which he advised surgery. “I had a condition that happens to very few people when they have hardware inserted in their body: the muscles are aware of the implant and don’t like it, and revolt. I had to take out the plate.”

Everything worked out well after that, but Jessica keeps returning to — “I almost cried in front of this man, because he listened to me, he took into account every single thing I told him…”

Dr Ruhil Badiani, family physician at Cornerstone Clinic, has had many patients who have chosen to come back to see her for a variety of reasons — among them the fact that “they feel I listen to them and do not brush off any concerns that they have”. There was a young boy who once came to see her; his mother had seen a few doctors before, who they felt did not listen to their concerns, and he had been given antibiotics for various bacterial infections, which at the time was the correct treatment. “However, they were never given the chance to speak about their concerns with his various symptoms,” points out Dr Ruhil. “Because I took the time to listen, I was able to get him the investigations he required which resulted in a cancer diagnosis — which he fully recovered from. After this, the whole family, including the boy’s grandparents, only came to see me as they trusted me 
and felt comfortable that I would listen to their concerns.”

Doctors’ prescriptions

Medcare Camali Mental Health Clinic’s Sneha John, says that, for her, as a clinical psychologist, the simple act of naming the patient’s affect or emotional expression (eg, “You sound sad”) is helpful, as it lets patients know they have been “heard”. “Validate the client’s feelings by saying, ‘You’re angry with me because…’ and asking ‘Am I hearing you right?’ Validating patients by stating that their emotional reactions are legitimate, praising them for how well they have coped with difficult symptoms and acknowledging the complexity of their situations can be helpful.” Communication can also be non-verbal, such as thoughtful nodding or a timely therapeutic silence. The function of empathy, adds Sneha, is not merely to label emotional states, but to recognise what it feels like to experience something. “Compassionate healthcare entails physicians going that extra mile to ensure that patients understand them, even when running a busy clinic. Doctors can take time out to ensure that the patient has understood them well. Building empathy includes small, non-verbal actions, like where the doctor places his/her hands or where they position their seat. Making eye contact, speaking at a slow pace, and showing respect for patient decisions are also important for compassionate care.”

Meanwhile, putting herself in the patient’s shoes helps Dr Ruhil understand how they are feeling and helps her build the relationship she has with them. “It helps me to provide the emotional support they will need while they are unwell.”

The first thing she does with a difficult patient is to not think of them as being difficult: “they are frustrated and feel unheard — so I take my time with them, make sure they see I am listening to their concerns and addressing them appropriately.” The worst thing a doctor can do, 
Dr Ruhil feels, is brush aside a patient and describe them as difficult — it does a disservice to them and breaks down the doctor-patient relationship.

Many patients have complex diagnoses or multiple medical problems. She breaks down the diagnosis and explains to them as much as possible in non-medical terms. “I often send my patients home with leaflets or websites to read in their own time to try and absorb the information slowly and leave my door open to them to return for me to answer any questions they may have. If there is a complicated diagnosis or a grim verdict, I advise my patients to come to the clinic with a loved one so that they can also get the information from me instead of the patient as much can be lost in translation.”

• Dubai