What is empathy? 

A dictionary will tell you that empathy means "the ability to understand how someone else feels because you can imagine what it is like to be them." 

In other words, it means to put yourself in someone else’s shoes; to think and act from someone else's perspective. 

Empathy is a key part of patient-centred healthcare* and can be shown through  

1. the way you demonstrate you are listening to your patient  
2. the language you use in your response or questions  
3. how you say this language. 

Because OET is tied to real healthcare practices, the Speaking test assesses your ability to show empathy through your communication. 

*patient-centred healthcare is the model used in Western settings. The patient’s opinions and preferences are respected and treatment pathways are negotiated between the patient and healthcare professional to incorporate these preferences

1. Active Listening

In patient-centred healthcare, professionals start a consultation by asking open questions, which allow the patient to explain the situation in their own words and sometimes at length. Open question examples include: 

• Can you tell me more about your symptoms? 
• Is there anything you think might have caused your current condition? 
• The healthcare professional might already have suspicion about the cause but is prepared to have this confirmed or denied by listening to the patient’s explanation. 
• Non-patient centred approaches to listening make use of leading questions, such as: 
• You’ve had these symptoms before I believe 
• What medication did you try to stop the pain? 

In leading questions, the professional is suggesting to the patient a particular answer, perhaps to confirm the diagnosis they have already decided upon. They are specifically mentioned as something to avoid in the Clinical Communication Criteria you are assessed on in the Speaking test.  

How to actively listen to your patient 

Here are four suggestions: 

1. Give the patient your full attention. Look them in the eye. Don’t use this time to review the role card
2. While the patient is talking, show them you are listening by using appropriate gestures or ‘noises’: mmhmm, OK, I see, nodding or shaking your head etc.
3. Don’t interrupt the patient. Allow them to finish so you don’t cut them off from including anything important.
4. When the patient has finished, demonstrate you have been listening by asking a follow-up question or making an appropriate response, for example:

• Did you talk to your family about how you were feeling? 
• I’m sorry to hear that. 

Your patient knows if you’re not listening 

If you haven’t been listening while the patient is talking, it will be really obvious to them (and the assessor) because you will likely say something inappropriate when they stop e.g. 

Patient: I haven’t slept properly since my bag was stolen as I walked home from work 2 weeks ago. 

Healthcare professional: Can you think of any reason why you’re not sleeping properly? 

The result of this type of exchange, where the lack of listening is really clear, is that the patient feels confused and unimportant to you. 

 2. Standing in the patient’s shoes

Sometimes, you can literally put yourself in someone else’s shoes because you have experienced the same thing. At other times, you can’t so easily imagine what it must be like to be in that person’s shoes because you have not experienced the same thing for yourself. You might have treated other patients with similar conditions and prognoses but it’s not the same as having the experience personally. 

Choosing between direct or indirect empathy language can make the patient feel more respected and validated rather than just one of a crowd of patients you are treating. 

Direct empathy language 

Here are two scenarios for when direct empathy language would be appropriate: 

1. a midwife who is also a mother can put herself in an expectant mother’s shoes because she has experienced pregnancy. 

I understand your concerns about choosing whether to opt for pain relief during labour. I faced the same decision myself before I was due to give birth. 

2. a physiotherapist treating a patient with tennis elbow having experienced tennis elbow themselves. 

In my experience, the best relief for the symptoms of tennis elbow is complete rest from the action which caused the injury in the first place. 

Indirect empathy language 

Here are two scenarios for when indirect empathy language would be appropriate:

1. a doctor who needs to tell a family that they have not been able to save the life of a family member involved in a car accident. 

I can’t begin to imagine how you are feeling to receive this news. Please know we did everything we possibly could to save your family member. 

2. a dentist treating a person scared of needles who needs local anaesthetic before root canal treatment. 

I can only appreciate* that the idea of the anaesthetic is scary for you. Before using it, I will numb the gum and ask you to close your eyes, so you shouldn’t see or feel anything. 

*using appreciate, which has the meaning of ‘awareness that something is possible’, instead of understand, which suggests knowledge of something, is a small but significant language choice that demonstrates empathy. 

3. Soften your language

In English, we often soften language to avoid offence or discomfort. It’s also a way of demonstrating empathy. In healthcare, it's important to be able to make your patient feel respected and safe when they're with you. 

Soft language tends to involve two specific aspects: Non-judgemental language and softening words. 

1. Choose language which is not judgemental e.g. overweight, rather than too fat or obese.

It can be hard to determine what is and what is not judgmental. One way to approach this conundrum is by using neutral language that doesn't make assumptions or make accusatory statements. 

2. Add words that soften the meaning e.g. a bit, quite, just, please, should/could etc.

Healthcare professionals have a tendency to be concise and precise when talking to patients. Unfortunately, this can lead to blunt and unempathetic conversations. 

One way to overcome this is to introduce softening words that cushion the meaning of the sentence or conversation.  

Example 1 

Instead of saying: You are too fat. You need to lose weight. 

You could say: 

You are quite overweight. You need to try to lose some weight. 

Example 2 

Instead of saying: Why haven’t you taken the medication as instructed?  

Please, can you explain how you have been taking your medication? 

[This option avoids any judgement that the patient hasn’t been taking their medication correctly and gives the patient opportunity to explain what has been happening] 

Finding out more about empathy 

Showing empathy for feelings/predicament/emotional state is one of the indicators in relationship building, the first of the Clinical Communication Criteria. 

Read the Ultimate Guide to Speaking Part 2: Clinical Communication Criteria for additional good and bad examples of OET candidates trying to show empathy to their patients.