Building a rapport with patients, having good communication skills and showing Empathy all help to build trust^[5], which, in turn, is important for^[6]:

• Encouraging patient disclosure;
• Enabling pharmacists to help patients understand their medicines;
• Exploring patients’ thoughts and feelings around their medicines;
• Identifying any problems.

Furthermore, studies have shown benefits associated with having an empathetic approach, for example, more favourable patient satisfaction^[7] and improved health outcomes, with patients more inclined to follow doctors’ recommendations^[8]. Benefits associated with compassionate care include: better treatment adherence; greater satisfaction and wellbeing among patients, as well as doctors experiencing elevated meaning in their job; lower depression rates; and lower burnout^[9].

This article describes how pharmacists and other healthcare professionals can apply the principles of empathy effectively during interactions with patients to overcome potential barriers.

Empathy, sympathy and compassion

There are a variety of definitions for empathy, sympathy and compassion in the literature, and the terms are used interchangeably in everyday language.

Empathy, as defined by the Cambridge Dictionary, is the ability to share someone else’s feelings or experiences by imagining what it would be like to be in that person’s situation^[10] — often referred to as ‘walking in someone else’s shoes’. This is not to be confused with sympathy, which is when a person can understand what another person is feeling, but not feel what they feel. Compassion is considered to be one step further; it is when a person is moved by the suffering and distress of another and, consequently, feels a desire to act to relieve their suffering. Therefore, compassion arises from empathy but is characterised by action (see Figure). Compassion is considered a major motivator of altruism^[11].

An important element of a patient–professional relationship is the need to understand and be understood. Empathy has been described as the most critical element in this therapeutic relationship — it has been suggested that empathy is not just an emotion or an inherent personality trait^[6],[12], but much more complex involving emotive, moral, cognitive and behavioural aspects

How to demonstrate empathy and compassion

Traditionally, pharmacists were trained to focus on patient counselling and instruction, which was seen as checklist-ticking, rather than a two-way dialogue and consultation that involved empathy^[14],[15]. However, when there has been a focus on the principles of teaching empathy, these skills have been found to increase^[16], especially if emphasised through clinical placements^[17].

Consider the patient

It is important to take a holistic view of the patient — physically, socially, culturally and psychologically. A patient’s work, family, social life and long-term health conditions can all have an impact on them. Jubraj et al. argues that applying clinical empathy, defined as “appropriate empathy demonstrated in a clinical setting”, can most effectively make use of the short time available in pharmacy consultations, therefore optimising care^[18]. Pharmacists do not have to agree with patients to demonstrate clinical empathy, rather empower them to take ownership of their treatment.

Question the patient effectively

In order to understand the patient’s perspective, ask them about their situation and create a common goal. This can be achieved through asking open-ended questions and clarifying responses through probing questions^[19], such as “You said you haven’t been sleeping well — can you tell me more about that?”.

It is important not to make judgements about patients. For example, offering premature advice to a patient, before establishing how well informed they are about their condition and medicines, could have a negative impact and may leave the patient feeling patronised. Asking appropriate questions and listening to their answers should prevent this from happening and allow an opportunity to correct any misconceptions.

Pharmacists should summarise what patients say to check that their interpretation is accurate. In doing so, the pharmacist can contextualise and tailor the advice they deliver to the patient’s needs and capabilities. For example, this could be asking a patient “How do you feel about taking this medicine?” and “Do you have any concerns about taking it?”. If the patient expresses concerns, pharmacists should enquire further.

Listen to the patient

As well as listening to the patient, it is important to observe their non-verbal cues, such as their body language, tone of voice and manner of engagement. This will help with ascertaining their capacity, mental health, health literacy and comprehension of the exchange, along with any language issues that may be present. For example, closed body language (e.g. crossed arms or frowning) could indicate that they feel uncomfortable or challenged.

Using silence can also help — a pause in conversation may help a patient to provide more information.

Training

Various techniques have been used to teach empathy, including communication skills training, patient narratives, creative arts, drama and patient interviews^[20]. Compassion seems to be best developed through reflective and experiential learning, including learning from personal life experiences^[21]. As the pressures of work can be emotionally exhausting, it has been suggested that mindfulness interventions, such as ‘loving kindness’ meditation, have the potential to increase self-compassion, reduce stress and increase the effectiveness of clinical care^[22] (see Useful resources).

Challenges in providing compassionate care

Sinclair et al. identified several barriers to providing compassionate care across different healthcare professions, including lack of time, support, staffing and resources^[21]. Ideally, adjustments should be made at both an individual and an organisational level to alleviate pressured working environments and upskill healthcare professionals to facilitate greater empathetic and compassionate interactions with patients on a daily basis.

Workplace pressures

Lack of time:

• Heavy workload (e.g. high turnover of prescriptions);
• Low staffing levels:
  • Not enough support staff in the dispensary;
  • Not enough pharmacists to cover ward rounds;
• Being a single community pharmacist with high number of services to provide.

Organisational pressure:

• High level of targets to meet (e.g. medicines use reviews and the new medicine service);
• Limited time allocated to cover wards.

Imbalance of skill mix:

• May need accuracy-checking technicians to free up pharmacists’ time in the dispensary;
• May need a second pharmacist in community pharmacies.

Overcoming workplace barriers can be difficult — especially when the barriers are around staffing levels. However, even apologising to a patient who has been kept waiting, thanking them for their patience and providing a brief explanation for the delay can help to build rapport.

The patient

Language barriers:

• English not being their first language;
• Poor health literacy;
• Lack of understanding of medical jargon.

Disabilities:

• Hearing impairment, muteness or blindness;
• Learning disabilities.

Cultural barriers:

• Differences in health beliefs and behaviours;
• Different views on gender.

It is important to correctly tailor language to that of the patient, for example by avoiding the use of medical jargon. Providing the patient with information in a format they can read can also be useful — for example, patients with sight loss could benefit from large-print literature or Braille^[23].

Underdeveloped consultation skills

Checklist-style of giving information:

• This ensures nothing is missed, but does not facilitate exploration of problems.

Using a ‘telling’ style associated with ‘advice-giving’ rather than a ‘consulting’ style of communication:

• This risks pharmacists appearing disrespectful by assuming the patient has limited knowledge and ability to self-manage their illness;
• This also risks the patient feeling patronised and, therefore, being may be less likely to follow advice.

Lack of confidence:

• This shows difficulty dealing with sensitive and embarrassing issues.

Practising these consultation skills while demonstrating empathy and compassion should help in overcoming these barriers.

Despite the many barriers that may exist or arise, empathy and compassion should ideally be demonstrated and practised in every patient encounter. A focus on empathy and compassion should be a component of undergraduate curricula in order to start developing these skills in foundational learning. Where relevant, professional development courses could emphasise the importance of an empathetic and compassionate approach necessary in building rapport. Interacting in this way will help pharmacists reach a shared understanding with patients as equal partners, prior to any shared decision-making

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