A Lesson In Empathy & Being Heard

A lesson in Empathy & Being Heard (written for providers…. but consumers/patients too)

“I have a really high pain tolerance, so when I say something hurts, it REALLY hurts”.

One thing that I have observed in my brief 6-year career as a physical therapist is that it is extremely important for patients to feel validated by healthcare providers. It is very common for patients to place a strong emphasis on their pain symptoms (rightfully so..) in the interview process, because they want to ensure they are being heard. They want their provider to understand that their problem is really affecting their quality of life and they want to do something about it.

Early in my career, I found this ‘exaggeration’ by patients to be annoying and misleading. Whenever I had a patient with a high pain report, when they looked to be sitting comfortably in the chair across from me, I couldn’t help but pass a bit of judgement. The thought of secondary gain always crossed my mind and this created a subconscious barrier between my patient and me. I can vividly recall one patient encounter that I had after returning from maternity leave with my first son. I remember this patient – a tall, fit, male soldier between 30-35 years old, seeing me for chronic low back pain. He seemed down, or agitated. He was slouched in the chair. I remember our exchange:

Me: “what’s your current level of pain just sitting here right now, 0 is no pain at all and 10 is the worst pain of your life?”

Patient: “I have a high pain tolerance and I would say it’s about an 8 right now”

Me: (annoyed, recalling my recent experience of natural childbirth without drugs, and generally feeling dissatisfied with my career and work peers at that point) “So you’re currently in close to the worst pain of your life, like as intense as childbirth?”

Patient: (provoked, probably a little pissed at me for calling him out like that) “Well, ma’am, I’ve never been through childbirth, so I don’t really think I can use that as a reference”

Schooled. He schooled me good. At that moment in time, a light bulb switched on for me and it hasn’t shut off since. I actually remember taking a moment to reflect and apologized for my insensitivity, to which he graciously forgave me. We ended up having a very pleasant patient/provider relationship and he did well, restoring a good percentage of the functional activities that he had abandoned because of his back pain.

How quickly that encounter could have gone wrong…. My lack of empathy could have sent this young soldier into a downward spiral of healthcare provider distrust and into the horrific chronic pain continuum – the straw that broke the camel’s back, so to speak. I wanted no part in that. I took a small vow to never make comparisons or draw conclusions about a patient’s report. Who am I to judge how someone feels or should feel?

That encounter was the beginning of a turning point in my career. I started to become much less focused on me and the results that I was producing for patients and much more focused on how I could help the patient feel that they are in control. I was just there to listen, validate their concerns/feelings, and provide tools for them to achieve their goals. Something cool happened when I made this change – I was happier, and my patients were happier. Even the ones that didn’t completely improve or had a tough time in therapy were grateful for the time that I spent with them, grateful for the bond we had developed, and grateful for the advocacy.

Empathy is an art and a practice. In my opinion, properly demonstrating empathy to your patient and ensuring they know that you are listening and that they are being heard is one of the most important things in establishing a foundation of trust, from which comes progress and healing. Giving patients the space and time that they need to explain their concerns in a way that they will be validated, not judged, is step #1. So even though we’ve heard the “I have a high pain tolerance” situation 1 million times over, the patient in front of you hasn’t had this much pain ever before. So Listen. Validate. Educate. This is why we do this.