The power of empathy: a tale of two prostate biopsies

I’m sitting in a windowless room in the hospital’s urology department waiting for my second prostate biopsy, feeling surprisingly calm and relaxed.

It’s a surveillance biopsy. Two years ago, the first one revealed “a few scattered cancer cells” while zeroing in on what turned out to be a harmless nodule. I’d learned then that a prostate biopsy will never make anyone’s list of fun things to do. In addition to being, eh, awkward, it was painful and invasive.

Prior to the first one, I’d been anxious, my imagination spinning worst-case scenarios of being whisked to the oncology department to schedule radiation. This time, I know we’ve caught it early and my PSA has consistently been inside the normal range at regular six-month checks.

The procedure is quick and controlled, and I’m confident I’ll be in the hands of skilled professionals who see me as a human being, not a nameless patient getting between them and the next coffee break.

I smile, recalling the nurse from Brooklyn with whom I’d slipped into my gruff Jersey vernacular as he’d prepped me for my first biopsy. He’d been kind and compassionate, using humor to put me at ease amidst the sterile and imposing technology about to be deployed on my behalf.

“Your PSA is better than mine,” he’d grinned. “You’re going to be fine.”

The doctor had knocked on the door, asked if she could enter, and waited for permission before doing so. She’d introduced herself, explained how the procedure would work, and asked if I had any questions or concerns. During the procedure, she periodically checked to see how I was doing.

I’d shown up that day feeling anxious and unprotected and left feeling supported and safe.

“Janssen, Scott.” A nurse appears at the door. I smile and say hello, assuming she’ll do likewise but she makes no discernable response. She looks bored, unhappy, or irritated. Who knows?

She turns her back to me and says in a monotone, “Follow me,” before racing down a long hallway. I jog to catch up, attempting to engage in polite conversation. She makes a few perfunctory utterances but seems impatient.

By the time we reach the procedure room I’m nervous; trust that I’m in good hands has vanished. Intellectually, I know she might be every bit as competent as the nurse from Brooklyn but sensing that she doesn’t care about connecting makes me question her skill.

As a hospice social worker, I know something about patients who feel vulnerable and afraid. Empathy, knowing how to connect, understanding what another may be feeling and reassuring them, is a basic part of the job when you work in health care. How skillful can she be if she can’t treat me with kindness and respect?

Once I’m in the hospital gown, she tells me to get onto the table where the biopsy will be performed, leaving me in a vulnerable position, turned toward a blank wall. She sits behind me and says, precisely, nothing.

I feel my temper rise and tell myself to stay cool. I’m here for the biopsy not to make friends. Muscles are tensing, heart rate elevating, palms sweating.

I take a breath and extend the exhale, something I often encourage hospice patients to do when feeling overwhelmed so they can engage their parasympathetic nervous systems and de-escalate the fight-flight-freeze response.

The doctor enters without knocking. He doesn’t bother introducing himself as I stare at the wall. He sounds rushed, talking rapidly with the nurse as though I’m not there. I imagine this guy jabbing a biopsy needle too hard and causing an internal injury. Can I really trust someone who can’t even say hello or ask how I’m doing?

Realizing I’m getting hijacked by negative thoughts, I remind myself of the pressures people working in health care face. I know dozens of competent health care professionals who’ve found ways to distance themselves from patients, believing they’re establishing boundaries or engaging in good time management. Besides, even the most compassionate doctors and nurses have days when they’re distracted and stressed out. No one can be empathic all the time.

Maybe the nurse is struggling with depression or getting bullied at work. Maybe the seemingly robotic doctor has learned to treat patients as interchangeable objects because he’s felt emotional pain after looking into the eyes of people whose biopsy results have turned out to be dire. You never know what someone is carrying inside.

Before I know it, the procedure is over, and the doctor is gone without my having the foggiest idea of what he looks like. The nurse averts her eyes as she tells me flatly to get dressed and show myself out, leaving me alone.

To someone looking on from the outside, the tale of these two biopsies might appear similar. In both cases, they got me in on time, prepared me effectively, and performed the biopsy competently. But beneath the surface, they were as different as night and day. The first time, I showed up anxious and left feeling connected to my health care team and relieved. The second, I arrived relaxed and confident and left feeling anxious and angry, ready to hammer the medical team on the patient satisfaction survey I knew I’d be getting.

The difference was empathy, kindness, and warmth. These skills transformed a potentially overwhelming experience into one that was manageable. Their absence undermined my sense of safety and left me dissatisfied with the care I’d received.

Studies suggest that when choosing a health care provider, patients often value empathy and compassion as much as they do training and experience. Although the power of empathy to enhance patient outcomes in terms of things like patient satisfaction, effective communication, trust of health care providers, and adherence to the plan of care, has been established, health care workers are often perceived by their patients as lacking in empathy.

Various factors have been cited as to why empathy may be deficient in clinical encounters, including high patient caseloads, time constraints, and lack of training in empathic attunement and communication. In fact, a recent study found that levels of empathy in medical students actually went down during their training.

Burnout, a common issue among those in health care, has also been associated with reduced empathy. So has post-traumatic stress disorder, levels of which have been found to be significantly higher in health care workers than in the general population.

Empathy is a powerful and significant factor in enhancing patient’s experiences and achieving the best possible outcomes. Unfortunately, responding empathically within the pressurized context of health care is often undermined by multiple stressors, competing responsibilities, and lack of training.

Health care institutions and settings, including those involved in medical education and policy development, should prioritize building cultures that value empathy every bit as much as they value diagnostic and intervention skills. Empathy can transform a patient’s fear into calm, lowering everyone’s stress and enhancing connection and trust. Empathy can enhance cohesion and reduce burnout within medical teams. And empathy is teachable.

Scott Janssen is a social worker.

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