Digital Empathy: How can empathy share space amid the digital incursion in healthcare?

“I do not ask the wounded person how he feels, I myself become the wounded person”

– Walt Whitman

The ongoing pandemic has ushered us into an era of digital revolution, and accelerated the pace of adoption of technology in healthcare. According to a global study conducted by the Economic Intelligence Unit (EIU), India ranked 2nd among developing countries in maturity for mHealth (defined as the provision of healthcare through mobile technology) adoption.¹ India is also among the forerunners in terms of adoption and use of digital health technology by healthcare professionals.² 

Although the interest in digital health has reached new highs worldwide, a pertinent question that remains to be answered is whether physicians can navigate this digital space and continue to uphold empathy in their practice. It has been reported that a physician’s ability to empathize leads to positive outcomes for both patients and physicians.^{3, 4} Mirror neurons, the neuronal basis for empathy stops working in stress, fear, and tension which can lead to a deficit in empathy.⁵ Besides this, various factors could negatively affect empathetic communication between individuals in an online world. These include lack of eye contact, absence of non-verbal cues,⁶ and the anonymous nature of the people involved in online communication.⁷ Given the challenges associated with technology in exercising empathy⁸, one can look to address these ahead through health technology assessments of E-health/M- health to ensure better integration into health systems.

Considering the multidimensional concept of empathy and its importance in healthcare worldwide, physicians have voiced the need for an empathy-based medical education curriculum among the Indian medical undergraduates instead of the newly introduced competency-based UG curriculum (2018).⁹ Following are some of the measures that have been proposed in various studies to integrate empathy in practice in the age of digital health.

• The concept of Digital empathy as proposed by Christopher Terry and Jeff Cains can be integrated within the curriculum of medical education.¹⁰
• Reflective writing activity has shown a significant change in empathy among medical students in 100% of studies.¹¹
• Communications training and self-reflection activities could enable learners to examine their interaction in the digital world.¹¹
• Role modeling of empathy by physicians can influence the development of empathy among medical students.¹²
• Promoting teamwork and enabling a constructive professional environment can facilitate empathy in clinical practice.¹³
• Since the well-being of physicians has been associated with greater empathy, organizations can take  measures to ensure physician well-being through rational work limits, and self-care.¹³

While technology certainly is innovative and flexible in its ways to address the vast healthcare needs of the population today, we must understand that it is the element of empathy that drives healthcare. It is high time that we take active measures to integrate digital empathy into our health systems to ensure positive health outcomes for both patients and physicians.

References:

1. https://www.pwc.in/press-releases/global-mhealth-adoption.html
2. https://www.philips.com/a-w/about/news/future-health-index/reports/2019/transforming-healthcare-experiences.html#scroll
3. Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995;152(9):1423-1433. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1337906/
4. Thirioux Bérangère, Birault François, Jaafari Nematollah. Empathy Is a Protective Factor of Burnout in Physicians: New Neuro-Phenomenological Hypotheses Regarding Empathy and Sympathy in Care Relationship. Available from: https://www.frontiersin.org/articles/10.3389/fpsyg.2016.00763/full
5. Ahrweiler F, Neumann M, Goldblatt H, Hahn EG, Scheffer C. Determinants of physician empathy during medical education: hypothetical conclusions from an exploratory qualitative survey of practicing physicians. BMC Med Educ. 2014;14:122. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080581/
6. https://www.reviewob.com/how-patients-view-us-know-your-non-verbal-cues/
7. Michail Tsikerdekis. The choice of complete anonymity versus pseudonymity for aggression online. Available from: https://michael.tsikerdekis.com/downloads/Tsikerdekis%2C%20M.%20%282012%29.%20The%20choice%20of%20complete%20anonymity%20versus%20pseudonymity%20for%20aggression%20online.pdf
8. Xiao Liu et al. Doctor-Patient Communication: A Comparison between Telemedicine Consultation and Face-to-Face Consultation, Internal Medicine, 2007; 46(5): 227-232. Available from: https://www.jstage.jst.go.jp/article/internalmedicine/46/5/46_5_227/_article/-char/ja/
9. http://www.amhsjournal.org/article.asp?issn=2321-4848;year=2019;volume=7;issue=1;spage=136;epage=137;aulast=Padmanabhan#ref1
10. Terry C, Cain J. The Emerging Issue of Digital Empathy. Am J Pharm Educ. 2016;80(4):58. doi:10.5688/ajpe80458. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4891856/#B9
11. Stepien, K.A., Baernstein, A. Educating for empathy. J GEN INTERN MED 21, 2006, 524–530. Available from: https://pubmed.ncbi.nlm.nih.gov/16704404/
12. Ahmadian Yazdi N, Bigdeli S, Soltani Arabshahi SK, Ghaffarifar S. The influence of role-modeling on clinical empathy of medical interns: A qualitative study. J Adv Med Educ Prof. 2019;7(1):35-41. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341453/
13. áKerasidou A, Bærøe K, Berger Z, et al The need for empathetic healthcare systems. Journal of Medical Ethics, 2020. Available from: https://jme.bmj.com/content/early/2020/07/24/medethics-2019-105921#block-system-main