Learning to express empathy

Helen Salisbury, GP, discusses how you can better express empathy

CREDIT: This is an edited version of an article that originally appeared on The BMJ

I spent many years as a medical teacher attempting to coach students in the art of empathy. Some needed very little prompting, instinctively knowing what to say and when to say nothing while just sitting quietly. Others were on a longer journey, needing pointers about what to actively avoid and practice in being comfortable with silence.

This theory recently became reality for me from the other side of the divide. I found myself on the receiving end of a lot of sympathy and empathy and am bracing myself for more to come. As an intellectual exercise (always a useful retreat when times are hard) I have been trying to analyse what makes some expressions of empathy comforting and welcome whereas others make me inwardly cringe. Each person will have different rules, but mine go something like this:

• Do not use stock phrases. ‘I’m sorry for your loss’ makes people sound as if they have escaped from an American police drama. ‘I’m so sorry’ is enough.
• ‘I understand this is a lot for you to take in right now’ suggests that someone is feeble-minded as well as distressed and should be avoided at all costs. They might be too upset to remember every detail so, if they’re going to need the information, write it down and give it to them to read later.
• Have the confidence to be yourself; try to drop the formality and shrug off your metaphorical white coat. ‘I am so sorry that you are having such a difficult time,’ is okay, but the simpler, ‘Sorry, this is really horrible’ goes down better.
• When it comes to the amount of medical detail you share, do keep checking what the patient or relative does or doesn’t want to know, as people have very different needs and comfort levels.
• And when you don’t know what to say, that’s ok. Silence is fine, as long as you don’t look uncomfortable with it. If they want to talk, they will, but you don’t have to encourage them to do so, or explain that there is no hurry, or tell them that you are there to listen. Don’t say it, just do it.
• The ritual of use of tea in the British processing of shock and grief should be respected – preferably in proper China mugs rather than flimsy plastic cups that scald.

If this sounds too hard, don’t worry. What comes through most strongly in every interaction is the underlying intent. Even if your words are clumsy, and you look a bit uncomfortable, your wish to be kind will show – and, in the end, that is what they will remember.