The Empathy Factor: New Studies on Race & Gender Point to Importance of Empathy in Doctor-Patient Interactions by Shayna S. Israel
All space is tempered. There is a set of power dynamics that emerge when two bodies enter a space together. This holds true in the classroom, the boardroom and in the doctor’s office. If more than two people are involved, there is no such as thing the neutrality of space. The interchange between patient and doctor has been studied long before the advent of modern medicine. One thing that has been a consistent thread in evaluating the quality of patient-doctor interactions is: Empathy.
“The healer must become sick to understand the victim’s sickness,” is from a poem I wrote titled “Shaman’s Calabash Artifact” . In shamanistic practices, the healer seeks to gain as much proximity to what made the patient ill as possible—the healer seeks to gain increased empathy. One way of doing that traditionally in shamanistic practices is to help guide and comfort the patient, like many Western doctors do when a patient is going through terminal illnesses, as they go through a difficult process. That is called a shamanic journey. The path to empathy is very much a journey.
Alternative healing practices are found in both low income and middle income communities. The intersection of class, race and gender play different parts in how alternative and holistic medical practices are understood and utilized . In more middle class households, they “did not use it to the exclusion of medical treatment,” and viewed “alternative healing approaches as a complement and corrective to the limitations of modern medicine .
Dr. Thomas R. Egnew, in “Suffering, Meaning, and Healing: Challenges of Contemporary Medicine,” writes, “Holistic healing involves the transcendence of suffering. Suffering arises from perceptions of a threat to the integrity of person-hood, relates to the meaning patients ascribe to their illness experience, and is conveyed as an intensely personal narrative” . The narratives in Western medicine focuses on individual pathology and isolating the variable. Thus, as Dr. Sean McClean notes, “the well-documented ideology in modern healthcare of ‘individual responsibility for health,’” occasionally manifests in a “‘victim-blaming’ ideology” .
The notion of a survivor, that feminists have coined during feminism’s Second Wave, is a response to victim-blaming and shaming that often furthers illness or dissonance. Feminism is a systematic response to the social aliment of sexism. Culture, race and gender are important factors to consider in matching the right patient with the right doctor.
On shamanic journeys, “Shamans enter these altered states of consciousness in order to communicate and connect with helping spirits to retrieve information; the information attained is generally brought back for healing purposes” . The understanding is that whatever injury the patient is suffering is systemic, is connected to the internal, external and interpersonal environments. Thus, forming a narrative of what could have possibly occurred assists the patient in forming counter-narratives that strengthen and restore agency back to the body’s own natural healing process: The immune system.
"The path to empathy is very much a journey."
Knowing the cultural preferences—the cultural system—of a patient can assist with better treatment outcomes. In an article titled “Treating vs. Healing: Understanding What Wellness Means to Patients” by Johnny Hourmozdi, talks about how even after his uncle survived a heart attack he had suspicions about taking Western medicine. “In Iran, where my uncle grew up, herbal medicine was practiced in most households and generally held as a point of pride for Persian-Iranians in the face of a burgeoning Western medical industry” .
Hourmozdi’s uncle is doing alright and taking his regiment of prescriptions. Yet, Hourmozdi noticed that the fret his uncle was experiencing could have been caused by cognitive dissonance due to two different systems, two different concepts of what it means to heal.
In cultures like Iran, ones that value homeopathic medicines, “the emphasis is placed on healing, a concept intimately tied to notions of spirit and comfort—not morbidity and mortality,” Hourmozdi goes on to say, “Biochemistry, pharmacology, stents, and studies all produced discomfort for my uncle; discussions of RCTs and clinical guidelines didn’t help. All of this came into conflict with his existing beliefs and caused a considerable amount of cognitive dissonance” .
Empathy is a process of listening. There are many ways to listen. We listen to verbal as well as body language. Listening closely for the verbal and non-verbal signals patients communicate greatly assists with increasing understanding.
There are often nonverbal cues that help in establishing a rapport with patients, according to a recent study by the National Bureau for Economic Research (NBER). The NBER study of 702 black men in Oakland, California found that “black men seeing black male doctors were much more likely to agree to certain preventative measures than were black men seeing doctors who were white or Asian” . One hypothesis put forth by Dr. Amber E. Barnato, a professor of medicine at Dartmouth, was that the black doctors in the study “used more nonverbal cues to communicate empathy” .
While rewarding once it is achieved, arriving at empathy is a fraught process.
Dr. ChanRandle Jordan, one of the practitioners in the study, noted that “low-income black patients tend to be guarded in the doctor’s office” . One reasoning given by a healthcare economist at Dartmouth College, professor Johnathan Skinner, is that “if you face discrimination regularly in life, you will go into a clinic with even more apprehensions. If you see a physician who is African-American, you will feel some relief” .
Something to consider in this discussion is that—instead of pairing doctors and patients by similarities in race, ethnicity and culture, increased education about the culturally-imbued realities of the doctor-patient dynamic can benefit all practitioners. In fact, the medical community already has begun to move the needle in educating both medical students and physicians as to the nuances of race, class and gender dynamics in the doctor’s office. For example, as of 2015 there is a sociology requirement for the MCATs, the entrance examination for pre-med students to get into medical school, where they have to respond to case studies emphasizing socio-cultural dynamics in doctor-patient relations .
"The emphasis is placed on healing, a concept intimately tied to notions of spirit and comfort—not morbidity and mortality..."
In the article “Should You Choose a Female Doctor?” by Tara Parker-Pope, the question of how the identity of the physician impacts health outcomes is framed in terms of gender preferences. A 2016 Harvard University study of more than 1.5 million hospitalized Medicare patients found that “when patients were treated by female physicians, they were less likely to die or be readmitted to the hospital over a 30-day period than those cared for by male doctors” . Although the difference in effect was about half a percentage point, that equated to 32,000 fewer deaths .
For each person and his or her family, each death matters. That is not to say that all bias is intentional; it instead says that there can be some unintended consequences of unconscious bias that have real social implications.
The medical community thrives by continually educating themselves on new practices, new technologies new innovations in processes. Thus, I agree with the professor of information and decision sciences at the University of Minnesota, Brad Greenwood, when he writes, “I am hesitant to say that women should avoid male physicians or people should focus on getting a single type of physician,” because, like him I feel that the debate circumvents the issue that—“patients should, by all means, make sure that they are being taken seriously and being strong self-advocates” regarding their particular health needs .
As someone who is managing a series of chronic conditions, and has done so successfully throughout my life, I have seen first-hand the improvements in the medical community’s increased empathetic treatment of patients. For the first time, it took me less than two visits with a medical professional to finally get prescribed the necessary treatment I have been needing for quite some time. That practitioner was a woman.