Patients For A Day At UF: New Emergency Department Doctors Must Play The Part To Gain Empathy

February 22, 2001

GAINESVILLE, Fla. — At a time when many people view doctors as distant and unsympathetic, a new University of Florida program requires emergency department residents to walk a mile in their patients’ shoes.

In order to help train them to become more empathetic and caring, residents fresh out of medical school must spend the first day of postgraduate training pretending to be patients at a busy urban emergency room. They are assigned an illness and then must wait — sometimes for hours — to be seen by a doctor.

The program, believed to be the only one of its kind, was initially launched in 1998 as a pilot study but has become a routine part of the training. The study, reported in the December issue of the journal Academic Emergency Medicine, showed the exercise prompted residents to be more empathetic toward patients, changed their approach to patient care and caused participants to perceive themselves as better doctors.

“Students usually begin their medical school training with a considerable amount of altruism and empathy,” said principal investigator Dr. David C. Seaberg associate chairman of UF’s department of emergency medicine and chief of emergency services at Shands at UF medical center in Gainesville.

“But the isolation, long hours, chronic lack of sleep, fear of failure and constant exposure to human tragedy they experience during medical school and residency broaden the emotional distance between doctor and patient and serve to extinguish those qualities,” said Seaberg, who directed UF’s emergency medicine residency program.

Dr. Paula Rubio, an emergency medicine resident, agrees.

“The more tired and stressed you get and the more overworked you are, the less you focus on people as people and the more you view them as illnesses,” said Rubio, now in the third of her four-year residency program. She was among 25 residents who participated in UF’s two-year pilot study.

Nowhere in health care is that trend more prominent than in emergency medicine, where the conditions are chaotic, doctors have little time to establish rapport or create a relationship with the patient and everyone tends to be under tremendous stress, Seaberg said.

Throughout the health-care system, many people are dissatisfied with their doctors. Recent studies have shown that 64 percent of people say physicians lack compassion or warmth, and 72 percent think doctors spend too little time explaining prognosis, diagnosis and treatment plans or do not describe them well enough, according to a 1998 paper by the Society for Academic Emergency Medicine.

“We teach residents how to diagnose and treat disease so they become competent physicians. We teach them the research and business skills they need,” Seaberg said. “We need to focus on equipping them with the compassion, empathy and interpersonal skills they need to understand patients’ perspectives and needs.”

Those skills will translate into more satisfaction among patients, who in turn may be more apt to obtain routine primary and preventive health care, follow doctors’ advice and instructions, and ultimately use fewer medical resources, Seaberg said.

Although she said she was annoyed at the time she was forced to participate, Rubio said the exercise has helped make her a more understanding physician.

“I always tell people about my experience, and it gives us a level of mutual understanding,” Rubio said. “They realize I can empathize with what they’re going through. Even though I may not be able to change it, at least I understand how they feel.”

For the study, Rubio was assigned a complaint of urinary difficulties, one of eight different medical problems devised for the exercise. Others included headache, sore throat, persistent low back pain and upper respiratory infection.

She and the other participants were registered in the emergency room at Shands Jacksonville, a busy, academic medical center affiliated with UF that now logs 110,000 emergency department visits annually. Nurses and staff were unaware of the study.

As is often the case at emergency rooms nationwide for people seeking care for minor illnesses, Rubio waited three hours to be seen by a doctor. During that time, she didn’t undergo any tests or receive any treatments. The exercise ended when a doctor entered the exam room.

“It really helps me now when I see people who’ve waited for hours,” she said. “You can’t fake empathy. Patients need it to feel good about you as a doctor and about the care they’re receiving.”

Half the residents waited longer than two hours and 19 minutes — from triage to a doctor entering — with waits ranging from 15 minutes to nearly four hours. Sixty-four percent of residents thought the waiting times were too long.

Immediately after the exercise and again six months later, residents overall rated the exercise as helpful in fostering their ability to empathize with patients. On a 100-point scale ranging from “not at all” to “a great deal,” the helpfulness ratings were an average of 66, both initially and at follow-up. The residents ranked the usefulness of the exercise at 50 initially and 49 at follow-up.

“A couple of the residents were very unhappy with the exercise and thought it was a waste of time,” Seaberg said. “But most felt it helped them recognize what our patients have to go through just to see a doctor.”

After six months, participants also indicated that the exercise had improved their awareness of emergency department waiting times, giving it a 70 on average. On the question of whether the exercise made them better emergency physicians, the residents’ average ranking was 49. And when asked whether the exercise had an effect on their approach to patient care, the average ranking was 45.