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Empathic curiosity is a way for health care professionals to manage stress

March 22, 2022 Updated Wed., March 23, 2022 at 11:31 a.m.

Registered nurse Sandra Younan sets up a new intravenous line for a patient under her care at Providence Cedars-Sinai Tarzana Medical Center in the Tarzana neighborhood of Los Angeles on March 11, 2021.  (Associated Press)
Registered nurse Sandra Younan sets up a new intravenous line for a patient under her care at Providence Cedars-Sinai Tarzana Medical Center in the Tarzana neighborhood of Los Angeles on March 11, 2021. (Associated Press)
By Jodi Halpern and Juli Fraga Special to Washington Post

Many health care professionals have reached a breaking point as the pandemic stretches into its third year. 74% of them reported feeling depressed, while 75% said they suffered from anxiety, in a 2021 survey that included over 500 medical professionals. Even more alarming, 15% of respondents said they experienced thoughts of self-harm or suicide.

”Covid has been really hard on medical professionals,” says pediatrician Janet Perlman, an instructor at the University of California at Berkeley and the University of California at San Francisco Joint Medical Program. “We’re trying to keep patients safe while also caring for our own physical and psychological well-being.”

Health care providers can manage pandemic-caused stress by practicing a specific type of empathy that one of us (Jodi Halpern) calls “empathic curiosity.” It involves trying to understand another person’s world from the inside out. In health care, this means inquiring about the patient’s unique experiences by asking questions such as “tell me more” and “tell me what I’m missing.” Exercising this type of empathy creates space for the patient and doctor to think together and discover novel ways to improve care.

But when 49% of health care workers are experiencing symptoms of burnout, empathy might feel like another dreaded task.

“Empathic curiosity” doesn’t require providers to take on more of their patient’s suffering, however, said Johanna Shapiro, a professor of family medicine at the University of California at Irvine. Instead, “sustaining curiosity, which is already a valued part of the medical role, can be a bridge that helps physicians experience more empathy for their patients,” she said.

Stewart Mercer, a researcher at the University of Edinburgh, says “empathic curiosity may protect doctors from burnout and improve their work satisfaction.” Additional research shows that medical students who practice cognitive, in addition to emotional, empathy sustain higher levels of empathy over time.

Mercer’s research has found that empathy plays a significant role in effective patient care. One study, which included 710 cancer patients in Germany, found that physician empathy may help prevent patients’ depression. Empathy has also been shown to bolster the patient-doctor relationship and better patients’ quality of life. Mercer says empathic communication can also improve the immune system and lower mortality rates for patients with diabetes.

Perlman says empathic communication fosters trust, which plays an important role in whether patients follow through on their doctor’s recommendations. Studies also show that empathy can help decrease a patient’s stress and anxiety and help them share more about what they are feeling, a key factor to getting a correct diagnosis.

Perlman said she exercises empathic curiosity by asking her patients open-ended questions such as “How are things going at home?” and “How are you feeling about school?”

These questions invite the pediatrician’s patients to tell her about more than their physical aches. Many young people, for example, tell Perlman about their school struggles and friendship difficulties, two emotional challenges that affect adolescent mental health, which has worsened during the pandemic.

Here are some expert-backed tips to learn how to cultivate empathic curiosity:

Practice self-awareness: When Adrian Anzaldua began his psychiatry internship at the University of New Mexico in 2021 during the delta variant surge, he witnessed the anguish and exhaustion that many of his colleagues were experiencing. Like many overworked physicians, Anzaldua sometimes felt overwhelmed seeing so much death and suffering.

As a new physician, he knew that almost all residents struggle with impostor syndrome – in which people think that they are not qualified for the position they hold – and worry about making a clinical mistake. To cope with these insecurities, Anzaldua exercised empathic curiosity. “I know it can protect physicians from burnout, which is why it became my top priority,” he said. This practice led to new insights such as realizing that empathic pain can be a precursor for emotional growth and professional development, Anzaldua says.

One way to cultivate curiosity is through the practice of mindfulness, Shapiro said.

“With mindfulness, the purpose is to bring inquisitiveness to the present moment, without getting attached to the outcome,” she said. Research shows that a curious mind-set can help health care providers with self-reflection and emotional regulation. These two qualities can foster an “adaptive expertise,” which can help medical students and providers approach uncertain situations with interest instead of dread.

Find peer support: For emotional support, pediatrician Janet Perlman relies on her peers. “I’m part of a physician’s community, which is a safe space where we can give and receive empathy,” she said.

One study, which included 108 physicians, found that when faced with negative experiences such as trauma, medical errors and adverse patient experiences, 88% of the doctors felt most supported by their peers. Research also shows that receiving empathy helps physicians provide empathy for their patients. Recognizing and expressing emotions can also help health care providers avoid burnout and depression.

Perlman says it’s important to be with like-minded colleagues who face similar struggles because it reminds her that she’s not alone.

Hospitals may have physician well-being programs, which can include peer-led support groups. The American Medical Association also provides a guide for physicians and health-care providers who want to start their own support circles.

Immerse yourself in stories: Another way that health care providers can foster empathic curiosity is by reading stories and poetry or watching movies and TV dramas. Immersing themselves in other people’s narratives helps providers step away from their anxiety and self-doubts, as well as increases their appreciation of other people’s perspectives.

“Reading a story or poem about illness illustrates experiences that medical students and physicians face, but they’re not asked to solve,” Shapiro said. This learning strategy, which is called “successive approximation,” can help them think about these situations in a safer way. Doing so also can prime the brain for problem-solving and empathic responding when stressful encounters arise.

At certain medical schools across the nation, health care professionals teach an elective course called “The Healer’s Art,” which seeks to humanize medicine through storytelling and creative expression. One study revealed that teaching this course improved physicians’ professional growth, connection and empathy for their students.

Finally, Perlman recommends practicing “generous listening.” “Let your patient tell their story, and you’ll learn so much about their lives,” she says. She also encourages medical students to ask good questions. “The medicine will come, but it’s how you talk with someone that matters most.”

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