'What I Wish My Surgeon Knew': A Novel Approach to Promote Empathic Curiosity in Surgery

Using curiosity to render the invisible, visible

Virtues commonly associated with physicians and other healthcare professionals include empathy, respect, kindness, compassion, trustworthiness, and many more. Building upon the work of Bortolloti, Murphy-Hollies, and others, I suggest that curiosity as a virtue has an integral role to play in healthcare, namely, in helping to make those who are invisible, visible. Practicing the virtue of curiosity enables one to engage with and explore the experiences of patients and contributes toward building a physician-patient relationship of trust. As the perspectives and experiences of patients can be too often dismissed or lost within medical settings, curiosity can allow physicians to deeply know their patients, and thus provide better care. However, caution must be exercised so as to not to venture into inappropriate curiosity, where questions are asked for improper reasons or to help satisfy the personal interest of physicians. Finally, I sketch out two cases-on chronic pain and on vaccine hesitancy-to illustrate where curiosity can play a valuable role.

Patient experiences during the planned perioperative care pathway: An integrative review

AIMS

This integrative review aimed to synthesize evidence about the patients' experiences during the planned perioperative care pathway.

DESIGN

Integrative review.

DATA SOURCES

Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline Ovid, Scopus, and American Psychological Association (APA) PsychINFO. Original, peer-reviewed studies published in English between 2012 and 2023 exploring patient experiences during the planned perioperative care pathway were reviewed.

METHODS

This review was guided by the Whittemore and Knafl method and followed PRISMA guidelines to search the literature. Twenty-two articles were selected for the final study.

RESULTS

Three themes emerged: Sharing of information is empowering; interpersonal relationships are valued by patients, and hospital systems and care co-ordination influence the patient experience.

CONCLUSIONS

The quality and consistency of the information patients receive can both support and undermine patient confidence in health professionals. The quality of relationships that participants experience and effective communication with health professionals can support or compromise the quality of the patients' perioperative experience. The nature of the hospital systems and care co-ordination in hospital has implications for the quality of recovery from surgery.

IMPACT

This review evaluates whether national and international health services and organizations, adhering to the WHO guidelines, have developed and implemented intentionally focused perioperative care with the aims to achieving effective and sustainable surgical outcomes through increased patient satisfaction.

NO PATIENT OR PUBLIC CONTRIBUTION

This article is an integrative review and does not include patient or public contribution.

Exploring student perceptions of empathy development during medical school - A phenomenological study

OBJECTIVE

Empathy is an essential attribute of a good doctor. There are multiple dimensions to empathy, yet many curricula are limited to empathy display. This study's aim was to understand the relationship between teaching, learning and development of empathy from the perspective of medical students.

METHODS

A qualitative approach was used with interpretivist methodology. Ten final year medical students from a single UK University were interviewed. Findings came from inductive thematic analysis.

RESULTS

Five major themes were identified: 'The Empathic Process'; 'Self'; 'Patient'; 'Teacher/Clinician'; 'Environment'. Sub-themes included personal qualities, patient factors, role-models and assessment. Students value authentic patient encounters, focused feedback and opportunities for debriefing. Barriers include cognitive load, time-pressures and being observed. Students can maintain empathy through self-checking and addressing biases.

CONCLUSIONS

Students are aware of their motivations and barriers towards empathy development and can describe meaningful experiences relating to this during medical school. Students acknowledge controversy surrounding assessment of empathy, but clearly value authentic patient experiences and an environment which is free from scrutiny and distractions.

PRACTICE IMPLICATIONS

In addition to teaching communication skills, undergraduate programmes should focus on students' inner growth. This may be achieved by guiding students through meaningful reflection and open dialogue with supportive mentors.

Impact of physician empathy on patient outcomes: a gender analysis

BACKGROUND

Empathy in primary care settings has been linked to improved health outcomes. However, the operationalisation of empathy differs between studies, and, to date, no study has concurrently compared affective, cognitive, and behavioural components of empathy regarding patient outcomes. Moreover, it is unclear how gender interacts with the studied dimensions.

AIM

To examine the relationship between several empathy dimensions and patient-reported satisfaction, consultation's quality, and patients' trust in their physicians, and to determine whether this relationship is moderated by a physician's gender.

DESIGN AND SETTING

Analysis of the empathy of 61 primary care physicians in relation to 244 patient experience questionnaires in the French-speaking region of Switzerland.

METHOD

Sixty-one physicians were video-recorded with two male and two female patients. Six different empathy measures were assessed: two self-reported measures, a facial recognition test, two external observational measures, and a Synchrony of Vocal Mean Fundamental Frequencies (SVMFF), measuring vocally coded emotional arousal. After the consultation, patients indicated their satisfaction with, trust in, and quality of the consultation.

RESULTS

Female physicians self-rated their empathic concern higher than their male counterparts did, whereas male physicians were more vocally synchronised (in terms of frequencies of speech) to their patients. SVMFF was the only significant predictor of all patient outcomes. Verbal empathy statements were linked to higher satisfaction when the physician was male.

CONCLUSION

Gender differences were observed more often in self-reported measures of empathy than in external measures, indicating a probable social desirability bias. SVMFF significantly predicted all patient outcomes, and could be used as a cost-effective proxy for relational quality.

A Systematic Review of Interventions to Improve Humanism in Surgical Practice

INTRODUCTION

Humanism in surgery is an emerging priority in surgical education. Its emphasis on the patient experience is a key component of the therapeutic relationship between surgeons and their patients. However, the documented high rates of compassion fatigue and burnout among surgical trainees and staff can serve as a barrier in delivering care with empathy and compassion. As such, this systematic review seeks to characterize the outcomes regarding interventions that aim to broadly improve humanism within surgery.

METHODS

A systematic search of 4 electronic databases (EMBASE, MEDLINE, PsycINFO, and Cochrane CENTRAL) was conducted through an independent double selection and extraction process from database inception to March 20, 2020. The inclusion criteria consisted of interventional studies aiming to improve humanism in surgery at all levels of training. A qualitative synthesis and thematic analysis were performed.

RESULTS

A total of 19 studies (1 RCT, 14 prospective cohort, and 4 cross-sectional studies), with 20 intervention arms, were included from the initial 745 studies that were eligible for title screening. Studies included a total of 1763 surgical trainees at varying levels of training. Two major strategies for improving humanism were identified: (1) directly through the development of empathetic communication skills (n = 11) and (2) indirectly through programs aimed at reducing levels of compassion fatigue and emotional exhaustion by addressing trainee burnout (n = 9). A total of 70% (14/20) of the studied interventions were successful in improving empathy in surgical trainees.

CONCLUSION

Interactive workshops around the principles of empathetic communication with patient simulations and small group learning were effective at improving empathy in surgical trainees. Furthermore, mindfulness-based training and the provision of physical resources to support trainee well-being consistently improved rates of burnout among surgical trainees. Overall, further investigation is necessary to better understand methods of improving empathy in surgery.

Patient Perceptions of Trust in Trainees During Delivery of Surgical Care: A Thematic Analysis

OBJECTIVE

Trust is an essential element of an effective physician-patient relationship. There is limited literature examining trust between trainees and patients in the surgical setting. The goal of this study was to investigate how otolaryngology patients perceive trust in trainees during delivery of surgical care.

DESIGN

We extracted trainee-specific data from a larger, qualitative interview study examining trust in the surgeon-patient relationship. We then used realist thematic analysis to explore preoperative otolaryngology patients' perceptions of trust in trainees during delivery of surgical care.

SETTING

Department of Otolaryngology-Head and Neck Surgery at Michigan Medicine in Ann Arbor, MI, a tertiary academic medical center.

PARTICIPANTS

Using convenience sampling, adults 18 years or older scheduled to undergo elective otolaryngologic surgery between February and June 2019 were invited, and 12 agreed to participate in the study.

RESULTS

All participants (n = 12) self-identified as White/Caucasian with a mean age of 60 years (range, 28-82). Participants were 50% (n = 6) female and 50% (n = 6) male. Thematic analysis of participants' perspectives about trust in trainees during delivery of surgical care revealed 3 themes. Trust in trainees is conditional based on (i) level of trainee involvement; (ii) trust in the attending surgeon; and, (iii) trust in the institution.

CONCLUSION

Trust in trainees during delivery of surgical care is conditional on types of tasks trainees perform, bounded by trust in their attending surgeon, and positively influenced by institutional trust. Trainees and surgical educators must look to innovative methods to engender trust more efficiently in the clinic and immediate pre-operative setting. Such approaches can have a positive impact on patient outcomes, facilitate stronger trainee-attending interpersonal relationships, and empower surgeons to practice the professional values integral to surgical care.