The President has set out a broad agenda for health care reform, with "patient-centered" medicine as a major touchstone. His visit to the Cleveland Clinic today is a smart choice.
I recently spent more than two days with Delos "Toby" Cosgrove (pictured below), M.D., CEO and President of Cleveland Clinic, and his staff. When Cosgrove became the CEO in the fall of 2004, the hospital had long solidified its reputation for technical excellence, particularly in innovations around heart surgery. But Cosgrove was facing his new job with a new set of challenges, not the least of which was a growing competitiveness within a health-care system that was increasingly focused on wellness and new metrics around quality of care.
And Cleveland Clinic was getting poor reports from patients on the quality of their experience. "It occurred to that that I'd never cared for a healthy person before," says the one-time cardiac surgeon who saw his patients when they were laying unconscious on his operating table.
A series of epiphanies followed, setting the Cleveland Clinic on its own remarkable reform process. How Dr. Cosgrove and his team guided the Clinic into the era of patient centered medicine is the subject of an upcoming Fast Company feature story.
But the empathy piece is worth talking about now.
A recent study by the University of Chicago reveals that 75% of patients don't know their doctor's name or what their doctor does all day, at least as it relates to them. And the doctors who do show up often make you wish they hadn't. A widely followed bit of research on physician empathy from the Jefferson Medical College has begun the daunting task of measuring just how badly doctors can be at connecting with their patients. The news is both grim and oddly predictable. They're not very good at all. "Female doctors have much higher empathy scores. Docs in psychiatry, pediatrics, family, and ER medicine tend to be more empathetic," says Dr. Bridget Duffy, an internist and medical empathy and patient experience expert.
Duffy has worked with the Cleveland Clinic, among other facilities, to reorient their systems to be more patient centered. "Cardiovascular surgeons have the least." (Heart docs are joined at the bottom of the list by anesthesiologists, orthopedic surgeons, and neurosurgeons.)
Of course, not all doctors are unresponsive or imperious jerks, and there are plenty of others who would love a chance to show off their bedside manners, if only they had the time to perform their healing arts.
Now, they're going to have to.
In the last few years, Medicare has started requiring associated hospitals to collect feedback from patients about how their visits went, everything from how communicative their doctors and nurses were and how their pain was managed, to how clean and quiet the facilities are. The kinds of things that empathetic caregivers tend notice and do well.
There's a lot at stake--certain reimbursements are linked to these scores--and hospitals have already begun to use high marks as a marketing tool. And some, like the Cleveland Clinic, have gone to extraordinary lengths to value patient input, even including patient feedback in physician performance reviews. But the other bottom line is better health. "Physicians that have the higher empathy scores have better health outcomes for their patients and fewer adverse events," Duffy says.
But can bedside manner be taught?
Medical schools and hospitals may want to take some tips from the business world. DDI, a leading international consulting firm, believes that empathy has a similar importance in the workplace--and has had good results in opening even the hardest hearts in the C-suite.
"There is a clear relationship between empathy on the part of a leader and their perceived effectiveness," said Doug Reynolds, an unflappable PhD who conducts behavioral and psychological assessments for DDI that help corporate clients screen for leadership qualities in job candidates. (Which can be exactly as scary as it sounds.)
The data DDI has collected from years of assessments shows that empathy helps a leader do everything they need to do better, and demonstrably improves everything from company performance to employee tenure. It all boils down to trust. "Empathy is a component of essential leadership tasks like coaching, gaining commitment from peers," he says. And it can be taught.
Reynolds says that empathy has two parts, one of which is behavorial. That's the part that can be taught: Leaders can be encouraged to stop barking orders, listen for 'empathy cues,' ask better questions, and mirror back what someone has said to let them know that they've been heard. "We can give you a positive model for what it means to listen to a subordinate and respond empathetically to them with feedback," he says. This training, which is specific to individuals and industries, seems to work. "We saw a 32% improvement in the number of observers who reported that their leaders listened and responded with empathy "often" or "almost always" after training," he says.
What cannot be taught, however, is that deep magic, when a person is actually feeling the other person's emotions, the truest definition of an empath. "That's a personality trait," Reynolds says.
My conversations with Cosgrove, Duffy, and others at the Cleveland Clinic have left me optimistic. "I was a huge part of the problem," smiles Dr. Cosgrove. "I call myself a recovering heart surgeon." The early days of heart surgery, when a patient was as likely to die as live, hardened his shell.
The combination of the poor report card, the changing nature of medicine, and his new perspective as an administrator focused Cosgrove on an uneasy reality. Miracles in the operating room simply weren't enough. "My God, I missed it," he admits. "In my journey, I got so consumed with making people live, I forgot all the rest of it." And listening to the patient, something the Cleveland Clinic is learning to do and replicate, is the ultimate empathy cue.