Authors: Serena Barello and Guendalina Graffigna
[This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). Front Psychol. 2020; 11: 1431. 2020 Jun 9. Doi: 10.3389/fpsyg.2020.01431]
These researchers introduce the phrase “epidemic of empathy” and strongly support the open acknowledgement of workplace emotions. They found that an empathetic style of communication is most effective when attempting to avoid both short- and long-term negative outcomes. An empathetic response, and related efforts to respond sensitively to others, has been associated with potentially better sequelae during a pandemic.
An Epidemic of Empathy
Psychological research into healthcare opened the door to understanding people's emotional reactions when they experience events seen as life-threatening. The current outbreak of COVID-19 has recently been declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO). Response to an influenza pandemic has been shown to generate remarkable stress and emotional turmoil in healthcare providers who work during the outbreak. Experience with disasters, pandemics, and major traumatic events indicates that enhanced support to healthcare professionals enables them to become aware of their own emotions; and, effectively sharing this with patients can help them to remain efficient and focused during stressful events.
This COVID-19 outbreak marks a vital moment wherein healthcare systems can endorse an epidemic of empathy aimed at bringing science and humanism together to benefit patients and consolidate trust in healthcare providers during healthcare crises. Perhaps the greatest opportunity for managing people’s fears during health emergencies like COVID-19 lies in restoring our connections with each other. Today, we are all called to rebuild a sense of community and the ties that bind us together as human beings.
When coping with a large-scale emergency like this, people report a wide range of psychological needs, including out-of-control emotional reactions, as demonstrated by recent studies on the impact of COVID-19 on populations across countries (Leon, 2004; Graffigna et al., 2020; Li et al., 2020; Lima et al., 2020). This “emotional surge” has the potential to overwhelm the medical system for as long as the public health crisis lasts. People's emotions, however, are only half of the story in a healthcare crisis.
In crisis, health professionals become increasingly crucial points of reference regarding information on how to cope with the health crisis. This may make them feel so responsible for managing the situation that it impedes their ability to recognize their own human feelings, worries, and concerns (Khalid et al., 2016).
The expression of emotions by healthcare providers has been traditionally considered unprofessional and inconvenient, basically a sort of taboo (Meier et al., 2001). Research has addressed the fact that healthcare providers often have to deal with unexpected emotions arising from both the patient and themselves, and need to find strategies to manage the stresses and anxieties of confronting illness and suffering (Meier et al., 2001; Delfrate et al., 2018).
Although medical education does not explicitly promote healthcare workers’ alexithymia* and emotional neglect, still it frequently occurs in caring for patients, the so-called hidden curriculum (Cherry et al., 2014), seems to encourage clinicians to detach themselves from emotions (Shapiro, 2011b). Accordingly, clinician's socialization and implicit professional norms often foster health providers' emotional detachment (Halpern, 2001) as a strategy to cope with emotional challenges in interactions with patients (Rosenfield & Jones, 2004).
*Alexithymia refers to problems expressing emotions. From the Greek, literally “no words for problems.”
At the same time, research has established that emotional regulation and disclosure among healthcare professionals may vary by cultural context (Rakovski & Price-Glynn, 2010; Mastracci & Hsieh, 2016). Moreover, studies on professionals' emotions highlight the importance of clinicians' awareness of their emotional states during the clinical relationship with their patients (Kushnir et al., 2011), although some differences across clinical settings have been supported by various practices in this regard (Halpern, 2014).
We know that emotions play a significant role in human interactions, even those occurring in healthcare encounters; as a matter of fact, they are a “vehicle” that is able not only to communicate intentions and shape behaviors but that is also functional to build (or not) mutual trust, affect information processing, and even to determine people's health choices (Chapman & Coups, 2006).
Studies showed that unrecognized emotions in the healthcare providers' experience may prevent the adoption of a patient-centered style of care and may be associated with harmful behaviors, such as neglecting patients' psychological issues or avoiding bonding with patients to elude the burden of highly emotional contents (Ely et al., 1995; Smith et al., 2005). Failing to recognize emotions (of both patients and providers) can affect the quality of medical care and the healthcare provider's own sense of well-being, and may also lead to physician distress, disengagement, and burnout (Ekman & Halpern, 2015; Silva & Carvalho, 2016).
Prior experience with disasters, pandemics, and major traumatic events indicates that enhanced support to healthcare professionals enabling them to become aware of their own emotions and effectively share their lived experience with patients can help them to remain efficient and focused during stressful events (Silva and Carvalho, 2016). That's because healthcare is not simply a scientific discipline, it is a matter of empathy, and communication skills are necessary to convey that empathy (Reynolds & Quinn Crouse, 2008).
During a healthcare crisis, an empathetic style of communication is most effective when attempting to push the population to take preventive actions or to avoid harmful behaviors. An empathetic response, and related efforts to respond sensitively to others, has been associated with more frequent adoption of recommended health precautions during a pandemic (Novack et al., 1997; King et al., 2016).
In fact, empathy that involves commitment to understanding what others are feeling—by adopting their perspective and responding in supportive ways—has been associated with benefits not only for laypeople but also for health providers. Commonly sharing emotions, concerns, and worries could make all those involved in a healthcare crisis feel more responsible and more aware of how much each person contributes to coping with the stressful consequences of the pandemic (King et al., 2016). Empathy has also been demonstrated to be a core element of an effective therapeutic relationship and to be a protective factor for health professionals’ emotional exhaustion (Wilkinson et al., 2017).
On the other hand, studies have shown that, despite empathy’s being important in effective care, empathy also generates vulnerability for stress-related symptoms such as compassion fatigue and emotional exhaustion/burnout (Hensley, 2008). The cognitive and emotional effort involved in empathic responses might strain the already overwhelmed psychological resource clinicians have in periods of high stress, contributing to burnout and even causing emotional pain (Gleichgerrcht & Decety, 2013).
These contradictory effects of empathy can be explained by considering that empathy is by nature multidimensional, interpersonal, and shaped by context and settings (Lamothe et al., 2014). According to Davis (2018), a core component of empathy in the context of patient care is perspective. Empathy consists of adopting the point of view of another person and seeing things from their perspective.
Perspective taking has been demonstrated to increase patient satisfaction (Blatt et al., 2010), as well as physician's well-being (Shanafelt et al., 2005). Empathetic concern, on the other hand, which is conceptually closer to sympathy, is the emotional reaction of an individual who is attentive to others' experience and spontaneously engages in helping behaviors (Lebowitz & Dovidio, 2015). It is important to distinguish the two concepts because they may lead to different outcomes.
While perspective taking has been viewed to be always beneficial in-patient care, a too-elevated level of empathic concern could interfere with objectivity in diagnosis and treatment (Gleichgerrcht & Decety, 2013). Therefore, some effective detachment between clinicians and their patients has been considered desirable to maintain both clinical neutrality and emotional balance (Hojat et al., 2003). Moreover, other dimensions, such as personal authenticity and hope, do interact with empathy-related processes and outcomes and should be considered for training in medical education programs (Shapiro, 2011a; Ünal, 2014; Yagil & Shnapper-Cohen, 2016).
Only when health professionals and patients opt for a relationship where emotional disclosures about events may occur, could their interaction become a true partnership with shared decision-making authority and mutual responsibility for outcomes (thus reducing stress and frustration from both sides).
To gain this objective, health systems must recognize that healthcare professionals are humans too by legitimizing their empathetic response; however, we need a practical plan to strengthen the healthcare providers’ psychological resilience and work engagement during pandemic emergencies to prevent them from becoming “second victims” in this scenario (Scott et al., 2009) and to experience the “side effects” related to empathy.
In other words, during health emergencies like the one we are currently experiencing with COVID-19, health professionals need to be emotionally supported and safeguarded from the risk of forgetting their human side. If not, the consequences of the pandemic have to also take into account the psychological costs related to the increasing burnout rates among the health workforce.
This outbreak marks a vital moment where healthcare systems could begin to endorse an “epidemic of empathy” aimed at bringing science and humanism together to benefit patients and consolidate citizens' trust in healthcare providers during a healthcare crisis. Perhaps the greatest opportunity for managing people's fears during health emergencies—like COVID-19—lies, in the short term, in restoring our connections with each other.
Today, we are all called to rebuild a sense of community and the ties that bind us together as human beings.
For these references, please go to https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296111/.