Turning diversity from a barrier to a facilitator of empathy in health care

[摘要] Diversity is on the rise globally. To mention just a few of diversity’s dimensions in the UK, 10 million (14.5%) of the country’s citizens were born outside the UK, 9 million (14%) of the population is non-White, and there are six main religions with at least 250 000 adherents.1 A similar picture presents itself in many other parts of the world. In the US, 45 million (14%) of the population were born outside the country, 204 million (almost 40%) belong to ethnic minority communities, and there are 11 religions with at least 1 million adherents.2Within the same hour in a clinic, a healthcare practitioner may see a male farmer nearing retirement with back pain who has never spoken about his feelings, a female immigrant from Syria with respiratory problems who is worried about paying for her care, a young student using a wheelchair experiencing depression, and a transgender patient attending a routine check-up.This diversity is a cause for celebration. It can also present a barrier to empathy, which is frequently defined as understanding, expressing the understanding, and therapeutic action.3 Attempts to understand and appropriate ways to express understanding vary from person to person and culture to culture. A reassuring touch may be the expected norm in some cultures, but a violation of morals in others. Asking a patient how they feel about a proposed treatment may delight a well-informed patient, yet signal incompetence to a patient who may expect and accept that their doctor knows best. Spontaneously opening the door for an older woman may be appreciated, yet the same act could offend someone in a wheelchair who prefers to do it themselves.A BARRIER TO EMPATHIC CARE IS A BARRIER TO GOOD CARE Barriers to empathic care are barriers to effective care. Empathic care is a cornerstone of person-centred care,4 and a growing body of increasingly robust evidence is showing that lack of empathy causes harm,5 while empathic care improves patient outcomes. A cohort study of 867 people with type 2 diabetes found an association between empathic care and reduced mortality.6 Meanwhile, several randomised trials also suggest that empathic care reduces patient pain while improving their satisfaction with care.7 A parallel series of randomised trials also shows that therapeutic empathy can be taught.8 A happy side effect of empathy’s benefit to patients is that it also appears to decrease the risk of burnout among healthcare professionals.9 A caveat to the evidence on empathy’s effectiveness in health care is that most of the large studies have involved predominantly White patients. The extent to which empathic care benefits patients from ethnic minorities and other diverse groups is therefore an area where future research is required.

[学科分类] 卫生学