Getting your patient to go to the hospital: Evoking empathy
When the patient sees their emergency through the eyes of someone who cares for them, they can act for that person
Joseph was stubborn and proud. He didn't call for the ambulance and he was determined not to be transported to the hospital. He also desperately needed to be evaluated in the emergency room.
Joseph (or Joe as his wife referred to him) had experienced a syncopal episode while sitting at the dinner table with his family. The event had sent his body sliding from its chair and sent his family rushing for the telephone to call 911. Upon my initial evaluation, Joe's heart rate still hung in the bradycardic range and his systolic blood pressure barely crested 100 mmHg.
And yet there he sat on his couch, arms crossed and pale brow furrowed, insisting that he needed no further medical attention. And, it seemed that nothing I could say would budge him. But I decided to give it one last try before calling the doctor and requesting an against-medical-advice refusal. I decided to try a powerful technique that I call "evoking empathy."
The logic behind the evoking empathy technique is simple. If the patient does not care enough about their own well-being to consent to transport, can we get them to care about someone else instead? Often, people will do for the ones they love what they will not do for themselves.
I knelt in front of Joe, coming to eye level with him and said, "Joseph, I know that you feel like you're doing OK now and that you don't need any further medical attention, but could I ask you to consider a different perspective?" Joe looked partially intrigued and nodded yes.
I then said, "I'd like you to look over at your wife and noticed how scared she is right now. Not only am I worried about you; I can see that she is deeply concerned as well. Let me ask you this. If you won't go to the hospital for your own health and well-being, will you at least go for your wife's well-being? Will you go get checked out so that your wife doesn't have to sit here for the rest of the night terrified that you are going to lose consciousness again?"
Joe smirked. He knew I had him in a corner. Was he willing to say that he wouldn't even consent to transport even to spare his wife the fear that she was experiencing? It was this moment, looking at his wife and recognizing her fear, Joe relented and agreed to transport. He loved his wife. He was no longer asking for our help, he was helping someone else. He went to the hospital, not out of fear for his own health, but out of love for his wife and a desire to do right by her.
Evoking empathy is a powerful tool. I share it with some trepidation, knowing that it could be used inappropriately. I ask you to use it and develop it with respect, knowing that it is an emotionally charged technique that should only be applied when you are convinced that transport to the emergency room is truly the in the patient's best interest.
I save the technique of evoking empathy until I have no other alternatives. I know that it is my most powerful weapon of influence and needs to be reserved for worst-case scenarios.
Also, note that the patient's family or loved ones do not necessarily need to be present to be used to evoke empathy. They can be merely referenced to shift the patient's mindset.
"Mrs. Rosetta, if your husband were here right now, what would he want you to do?"
"Margaret, is this your son in this picture on your nightstand? Could I ask you a question about him? If he was standing in this room right now and you asked him if he thought you should go to the hospital, what do you think he would tell you?"
"You mentioned that you were on your way to pick up your daughter, Mr. Jones. I've never met your daughter, but I imagine that she loves you very much and that she would want her father to be safe and healthy. Why not take the time to come in and get checked out so that she doesn't have to worry about why her father is having chest pains."
There are many different ways to utilize the technique of evoking empathy. The key to using the technique successfully hinges on getting the patient to step outside of themselves and consider the effect that their emergency is having (or might have) on their loved ones. If the patient can see their emergency through the eyes of someone who cares for them, then they can act in that person's best interest instead of their own.
It is often much easier to do the right thing for someone that we love than it is to do the right thing for ourselves. This dynamic makes evoking empathy a powerful tool of influence. Use it wisely.
This article, originally published on April 17, 2013, has been updated