Lifelong Learning Programme

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Training for Paediatricians and Paediatric Students

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This training package is addressed to students and medical practitioners in paediatrics on how to autonomously learn, develop and consolidate their soft skills for improving the quality of paediatric services.

Communication with Children

Table of Content

1.4 Empathy
Empathy is defined as the ability to understand how others feel and what they mean, and to convey these emotions to others (Richendoller, 1994). Simply put, empathy means feeling with somebody else in order to be able to help them. Empathy can help a pediatrician recognize a patient’s fear or discomfort, so that they can provide the needed support.

However, in a highly emotional situation, even saying that you understand how a parent feels may elicit a negative response such as, “No, you can’t understand.” A safer way to communicate would be, “I can only imagine what you are going through. It has to be the worst possible pain for you to see your child suffer.” Suchman et al. (1997) define empathetic communication as the clinician accurately understanding the patient’s feelings and effectively communicating those feelings back to the patient, so that he or she feels understood.

Listening to children and empathising with them involves giving them your hundred percent attention and acknowledging the emotional cues without being judgmental. Knowing that you will provide nonjudgmental advice and support encourages patients to express their fears and concerns and eases their anxiety, making them more receptive to treatment.

Analyzing physician-patient encounters, they found that all too often the physician failed to respond to the patient’s or parent’s feelings and turned the conversation in a more factual and less emotional direction.

Parent: “When he has blood in his stool and looks at me like that, my heart just goes out to him.” Physician: “Is the blood bright red or dark? How often does that happen?” Parent: “Yeah, it’s red, and it’s getting more frequent.”

In the response above, the physician either did not appreciate what the parent was feeling and expressing or chose to avoid the issue, perhaps because he or she felt uncomfortable dealing with it.

The following is an example of an empathetic response.

Parent: “When he has blood in his stool and looks at me like that, my heart just goes out to him.” Physician: “I can appreciate that. I’m sure that Marius is disappointed and discouraged that the inflammation hasn’t responded to the medication, and I can imagine how sad it must make you feel to watch.” (Acknowledgment)

Parent: “Yeah, we’re both sad and discouraged.”

Physician: “And you have every right to be discouraged, but I am convinced that we will be able to control the inflammation.” (Validation)

An empathic reaction conveys three main messages to a child: “I care how you feel,” “I am trying to understand how you feel,” and “It is all right to feel as you do.” This approach focuses on the child’s feelings, as well as the physician’s attentiveness. Timing is an important element of empathy. The empathic response should come in time of need, at difficult moments. Pediatricians should express empathy and reassurance, looking for opportunities to express them.

E.g. “You look really worried. Can you share what you are feeling?”

School aged children tend to respond better to third person conversational prompts:

E.g. “Some children are scared when they hear that they have to go to the hospital.”

Empathic statements communicate concern about the patient when talking to their parents:

“It must be scary when your daughter’s fever gets that high.”

“You must be tired after staying up all night.”

“You seem worried…. angry…. upset.”

“It must be difficult to feel sad so often.”

A helpful technique to help children reveal their feelings is to ask what they would wish for if granted three wishes. Once stated, a clear attempt should be made to explore feelings by identifying and labeling them. Clinicians should make comments clearly indicating acceptance and validation of these feelings

E.g., “I can see how that would worry you.” or “I would feel the same way.”

Pediatricians will assess psychological distress and provide help in dealing with emotions as necessary. Nonverbal behaviors that express great interest, concern and connection (e.g., eye contact, soothing tone of voice and open body orientation) should be displayed throughout the interaction.

The CARE Mnemonic is most helpful as a reminder for how to relate to patients in a caring way (Myerscough and Ford, 1996).

Comfort: to effectively comfort patients and families, the provider must be willing to discuss emotional issues and other difficult topics. The provider must show the patient and parents that he or she is not frightened or put off by sensitive matters such as sexuality, abuse and death. Acceptance: this means that the provider recognizes, understands and accepts the patient’s or parent’s feelings about the illness and therapy, even if these feelings are inappropriate or counterproductive. This does not mean that the provider agrees with these feelings, but it does mean that the provider will not respond with anger or by rejecting the patient.

Responsiveness: this includes responding to indirect and incomplete messages as well as to the direct expression of emotion.

Empathy: responding with empathy is generally the most effective way of dealing with a patient’s or parent’s emotions. The basis of empathy is understanding the patient’s or parent’s point of view and acknowledging that point of view.

The NURSE mnemonic is also useful for addressing emotions (Back et al., 2008).

Naming, labeling: “You sound sad.”

Understanding, legitimizing: “I can understand your being upset. Most people would be.” Respecting, praising: “You have been very resourceful. That’s great.”

Supporting, establishing partnership: “I am here to help you however I can.”

Explore: “How would you like us to proceed?”
Practical Applications
Scenario 7 - Empathy The scenario describes an encounter between a pediatrician and a 5-year old’s inpatient who is hospitalized with her mother. She was recently diagnosed with leukemia. She is now admitted with her mother in the Pediatric Hematology and Oncology Department in order to begin the chemotherapy. The pediatrician tries to provide the best care he can. The scenario will underline the importance of showing empathy when dealing with sick children and their parents.
The Transcript in English is available
Scenario 8 – Empathy The scenario describes an encounter between a pediatrician and Ilinca, an 11-year-old girl, who was diagnosed approximately 3 months ago with an inflammatory bowel disease. Within the first 2 months of therapy she presented a slowly favorable evolution, but unfortunately for approximately 1 week, the abdominal pain and bloody stools reappeared. Now she is admitted with her mother in the Pediatrics Clinic. They are both very scared and talking about this with the pediatrician. The scenario will underline the importance of showing empathy when dealing with sick children and their parents. The pediatrician addresses both the the parent and the child, speaking slowly so that they understand, and showing empathy for them.
Softskills in the video: showing empathy, providing comfort, reassurance of full support, simple language and repetitions.
The Transcript in English is available
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This project has been funded with support from the European Commission. This web site reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.