The Empathy Gap: Revisiting the 90 Second Encounter

I recently watched a virtual screening of The Color of Care, a documentary highlighting the disparate and inequitable care received by Black and Brown individuals during the COVID-19 pandemic. During the movie, Executive Producer Oprah Winfrey opined that one of the primary issues with healthcare is the “empathy gap”. Upon hearing the phrase I shot up in my chair, as it felt eerily (and painfully) similar to what I described in my 2019 TEDx talk: Overcoming Invisibility, Improving Healthcare, and Restoring the Doctor-Patient Relationship.

In my TEDx talk I shared my experiences with the healthcare system as a pediatrician disguised as a family caregiver. While caring for my late father, some of my biggest challenges occurred in medical settings where I had to pierce the shield of invisibility in order to be seen, heard, and validated. For reference, I am a Black woman. As much as I would love to believe that my race had nothing to do with how I (and more importantly, my dad) was treated, I am certain that belief would be rooted in fantasy.

If you’re wondering what broke the invisibility spell, I invite you to watch the recording. (Hint: It involves the 2-letter credential that follows my last name.)

I issued a challenge to healthcare professionals to spend the first ninety seconds of every clinical encounter engaging in intentional human connection with patients and their families, an experience I coined The 90 Second Encounter ™️. This can be as simple as asking questions such as, “What is your favorite food/TV show/vacation spot?” or “What’s the last book you read?” If the patient mentioned a milestone event at the last visit, such as an adult child’s wedding, you can follow up by asking them how things went.

Everyone is unhappy about the current state of health care — doctors, nurses, ancillary staff, patients, families… Could it be that the erosion of the sacred doctor-patient relationship is fueling both physician dissatisfaction and burnout AND patient dissatisfaction, mistrust and disengagement? I believe that the perverse focus on efficiency and productivity at the expense of empathy, compassion, and meaningful relationships is the root cause for poor outcomes broadly and health and healthcare disparities specifically.

Empathy is defined as «the psychological identification with or vicarious experiencing of the emotions thoughts, or attitudes of another». Empathy is a required element for establishing trust and developing a therapeutic alliance with patients. A lack of empathy interferes with our ability to provide holistic care that respects a person’s intersectional identities, hopes, fears, and desires.

The empathy gap explains why Black and Brown patients were disproportionately denied emergency medical care and hospital admission at the peak of the COVID-19 pandemic and why there is a long history of health and healthcare disparities for minoritized individuals. The empathy gap illuminates the need for a more diverse workforce, not to check a box but because we are more likely to demonstrate empathy when we see ourselves in others. (If you're not a believer, there are a wealth of studies that demonstrate improved health outcomes when there is racial and language concordance between the patient and the clinician.)

The empathy gap is a powerful igniter of bias. It allows us (largely unconsciously) to disregard someone’s inherent right to dignity and respect as a fellow member of the human race. The empathy gap breeds rash, misinformed judgment against others.

So what do we do about it? Needless to say, the systems in which medical care is delivered need to be re-examined, disrupted, and transformed. However, I’m not letting my esteemed healthcare colleagues off the hook.

We must deeply acknowledge, examine and challenge our own biases. Why do we believe certain things about groups of people based on their race, ethnicity, socioeconomic status, gender identity, sexual orientation, disability, physical size, or geographic location? What is the source of those beliefs? Are the beliefs rooted in our own personal experiences or based on something we saw on TV or social media, heard from a friend or family member, or maybe even learned from a misguided teacher or culturally uninformed textbook?

What would happen if we all made the brave decision to open our hearts and to engage in a meaningful way with others?

We can each contribute to closing the empathy gap by expanding our capacity to be curious, loving and kind. At a time when gas and food prices are high, interest rates are rising and a recession looms ahead — - this, my friend, costs you absolutely nothing.

Nicole T. Rochester, MD is a pediatrician, independent health advocate, professional speaker, and the Founder/CEO of Your GPS Doc, LLC, a physician-owned health advocacy and health equity consulting firm. This article was originally published on www.yourgpsdoc.com.