1. Empathy
Closing the Gap 3b

2. How do you show empathy?
Demonstrates respect and interest, attends to patient’s physical comfort
Listens attentively, allowing patient to complete statements without interruption and leaving space for patient to think before answering or go on after pausing
Facilitates patient's responses verbally and no verbally e.g. use of encouragement, silence, repetition, paraphrasing, interpretation
Picks up verbal and non-verbal cues (body language, speech, facial expression, affect);
checks out and acknowledges as appropriate

3. Encourages patient to express feelings
Demonstrates appropriate non–verbal behaviour
eye contact, facial expression posture, position & movement
vocal cues e.g. rate, volume, tone
If reads, writes notes or uses computer, does in a manner that does not interfere with dialogue or rapport
Accepts legitimacy of patient’s views and feelings; is not judgmental

4. uses empathy to communicate understanding and appreciation of the patient’s feelings or predicament; overtly acknowledges patient's views and feelings
Provides support: expresses concern, understanding, willingness to help;
acknowledges coping efforts and appropriate self care; offers partnership
Deals sensitively with embarrassing and disturbing topics and physical pain, including when associated with physical examination

5. To see how paralinguistic features work, try saying this sentence: “She says she’s been in agony for three hours” in four different ways:
As a straight statement
As a question
Indicating that you don’t believe her
Indicating that you are shocked that this has been allowed to happen

6. Communication Verbal – what is said Para-Verbal – how it is said
Non-Verbal – what else happened
Metacommunication – the context that is understood

7. VERBAL AND NON VERBAL COMMUNICATION
Research by Albert Mehrabian in the late 1960s shows that communication of feelings and attitudes is:
7% What we say
38% The way the words are said (paralinguistics)
55% Non verbal

8. Scenario 1
A 42 year old man comes to see you after a routine BP check with the nurse. His BP readings are 152/92 and 154/97. He has no other medical problems. He is a smoker. He thinks that his raised BP could be due to stress, over the past year he has got divorced, had to find a new place to live and is now worried about losing his job. Shall we try a role play?

9. Scenario 2
Yasmin, 28 years old comes to see you with her 5 year old boy who has a sore throat. Symptoms and signs suggest he has a viral URTI, not needing antibiotics. You notice that Yasmin seems anxious and possibly low in mood. You are aware that her 1yr old daughter is having investigations for seizures, which have been going on for the last 6 months.

10. Scenario 3
Kim aged 28 comes to see you. The notes say Kim Smith but you notice that Kim changed her name by deed poll, from Matthew Smith. Kim is dressed as a woman but is biologically male. She would like a referral to the transgender service as she wishes to proceed with surgery.