Study finds no empathy-competence trade-off for physicians

Dr. Helen Riess, Director of the Empathy and Relational Science Program in the Department of Psychiatry at Massachusetts General Hospital

Helen Riess, MD is Director of the Empathy and Relational Science Program in the Department of Psychiatry at Massachusetts General Hospital and Associate Professor of Psychiatry at Harvard Medical School. Her research team at Massachusetts General Hospital conducts translational research utilizing the neuroscience of emotions to enhance patient-clinician communication and personal skills. She is also the co-founder of Empathetics, Inc., which provides innovative empathy and interpersonal skills training for medical professionals. Dr. Riess has become an internationally recognized speaker on empathy supported by her TEDx talk “The Power of Empathy.” Dr. Riess and her research team at Massachusetts General Hospital were supported in the following research study by the Gold Foundation.

Recently, Dr. Riess and her research team at Massachusetts General Hospital published a supporting study to her empathy training that examines how a physician’s nonverbal behavior (such as eye contact, open posture, and a concerned facial expression) affects patients’ perceptions of the physician’s warmth and competence.

Nonverbal behavior is thought to account for approximately 90% of our communication, explained Dr. Riess: “How we say things and how we come across is much more powerful than the words we say.” The team discovered that when a physician expresses empathy through nonverbal behavior, patients rate them as warmer and more competent. Their findings were published in the open-access peer-reviewed journal PLoS on May 15, 2017.

The study tested how nonverbal behaviors — displayed through photos of physicians with non-empathetic posturing, left, and empathetic posturing, right — affect perceptions of a physician’s warmth and competence.

The motivation behind the study

Since 2011, Dr. Riess has been training health professionals nationwide in empathy, sharing how critical it is for medical personal to demonstrate both empathy and competence.

One of her team members noticed previous research that showed, in some settings, a trade-off between empathy and competence — when the perception of empathy went up, the perception of competence went down. Such findings concerned the team: If they were teaching doctors how to be warmer and more connected to patients, would patients then perceive these doctors to be less competent?

No study, to their knowledge, had previously examined this possible trade-off in a medical context, Dr. Riess said.

The study hypothesis 

The team suspected that the way patients assess physicians may have changed, in part because patients come to their visits now much more informed by the medical information available online. “We believe that because of this more informed patient population, doctors are expected to not just be knowledgeable but also to have excellent people skills,” said Dr. Riess.

“We hypothesized that patients are also rating their doctors on emotional intelligence, not only on medical knowledge,” she explained. “And if doctors come across as really attuned and caring about their patients, they are actually getting higher ratings, not lower.”

The study’s method

The team used a crowdsourcing tool to recruit 1,377 U.S. participants to take a 7-minute online study. The participants were presented with photographs of real physicians that varied in certain ways — the physician was either male or female, either wearing a white coat or not, and either displaying nonverbal empathic behavior or unempathic nonverbal behavior (such as closed posture, no eye contact, unequal eye-level, unconcerned expression). The participants were asked to complete scales to rate their mood, their perception of the physicians’ empathy, and their perceptions of the physician’s warmth and competence.

The results

The team discovered that their hypothesis was correct: Nonverbal empathic behaviors do increase perceptions of a physician’s empathy, warmth, and competence. The effect may be stronger for women. The white coat seemed to have no effect on perceived warmth or level of competence. The findings are particularly exciting in a time when many hospitals are closely watching how patients rate their experience. “I think this paper lends support for the importance of teaching nonverbal behaviors,” said Dr. Riess, “because such behaviors will form stronger relationships between patients and health providers, leading to better patient experiences, better health outcomes, and may help healthcare organization receive higher ratings on warmth and competence.

Advice to healthcare professionals

Dr. Riess suggests simple adjustments to help healthcare providers display empathy while treating patients, including being fully present when speaking with patients, adjusting the tone of voice to ensure the patient can hear and becoming mindful of one’s posture. “Lean forward and close the gap between yourself and the patient,” she advised. “Leaning back or looking at the computer creates a barrier to overcome.”

Nicole Napolitano

Senior Fellow, Humanism in Medicine

Nicole Napolitano is The Arnold P. Gold Foundation's senior fellow and a 2016 graduate from Quinnipiac University where she studied biology, chemistry and psychology. Nicole has previously volunteered in child life and hospice care, and with teaching disabled children how to ski. She  is enthusiastic to work towards keeping healthcare human.