Subscribe to The Podcast by KevinMD. Catch up on old episodes!

Nicole Rochester is a pediatrician and advocate for improving the doctor-patient relationship. She shares her personal experiences and discusses the importance of intentional human connection in clinical encounters. We delve into the root causes of the empathy gap, including bias and systemic factors, and discuss how it disproportionately affects marginalized communities. Nicole provides practical strategies for health care professionals to challenge their biases and foster meaningful relationships with patients. Tune in to discover how we can collectively close the empathy gap and promote empathy, compassion, and kindness in health care.

Nicole Rochester is a pediatrician.

She discusses her KevinMD article, “The empathy gap: How a lack of understanding is fueling poor outcomes and health disparities.”

The Podcast by KevinMD is brought to you by the Nuance Dragon Ambient eXperience.

With a growing physician shortage, increasing burnout, and declining patient satisfaction, a dramatic change is needed to make health care more efficient and effective and bring back the joy of practicing medicine. AI-driven ambient clinical intelligence promises to help by revolutionizing patient and provider experiences with clinical documentation that writes itself.

The Nuance Dragon Ambient eXperience, or DAX for short, is a voice-enabled, ambient clinical intelligence solution that automatically captures patient encounters securely and accurately at the point of care. Physicians who use DAX have reported a 50 percent decrease in documentation time and a 70 percent reduction in feelings of burnout, and 83 percent of patients say their physician is more personable and conversational.

Rediscover the joy of medicine with clinical documentation that writes itself, all within the EHR.

VISIT SPONSOR → https://nuance.com/daxinaction

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://earnc.me/GVpOcV

Powered by CMEfy.

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Nicole Rochester. She’s a pediatrician. Her KevinMD article is titled “The empathy gap: How a lack of understanding is fueling poor outcomes and health disparities.” Nicole, welcome to the show.

Nicole Rochester: Thank you. It’s great to be here, Kevin.

Kevin Pho: So we’ll get to the article in a little bit. First off, briefly share your story and journey to where you are today.

Nicole Rochester: Sure. So, as you mentioned, I am a pediatrician. It’s what I’ve wanted to be since I was seven or eight years old. I am not currently practicing medicine, though. I practiced primary care for about four years, transitioned to hospital medicine, and had a great job as a medical director and assistant professor, teaching, seeing patients, and being administrative, and I thought that was going to be my career goal. I thought I was going to kind of work my way up the corporate ladder, so to speak. But my dad’s health really declined back in 2010, and it was a three-year caregiving journey with my late father that ultimately led to me transitioning out of clinical and academic medicine and starting my own health advocacy and consulting company, Your GPS Doc.

Kevin Pho: All right, so tell us about that transition. You said that you wanted to be a pediatrician since you were seven years old. So your transition out of clinical medicine, how was that?

Nicole Rochester: It was very challenging. It was very scary, but it was necessary. When I was caring for my late father, along with my sisters, I feel like for the first time I really got an up-close look at the health care system, and I hadn’t realized how shielded I had been in kind of this pediatric utopia, where everybody’s falling over backwards to take care of our patients. And what I saw really quickly with my dad is not just the dysfunction of the health care system, but that he was not receiving appropriate care, and that there were so many communication gaps between his medical providers, and just difficulties navigating the system itself. There were so many instances where I had to powerfully advocate for my dad in order for him to receive the care he needed, or in order to bridge communication gaps.

After a while, I realized that my ability to do that for him was largely bolstered by my being a physician, by my being an insider and being able to talk to the health care providers, and also just by understanding how the system worked and being able to escalate concerns. And so it started to dawn on me: If it’s this difficult for me as a doctor, and one of my sisters is a nurse, if our family is struggling, then what is everyone else doing? And so I just felt compelled to figure out how to advocate for other patients and family members the way that I had done for my dad.

So that’s how things started. It was scary leaving medicine. I loved medicine. I still love medicine. But it was really a calling that I felt like I couldn’t ignore. And since that time, it’s evolved from one-on-one health advocacy with patients and families to now focusing on health equity and doing consulting and speaking as well.

Kevin Pho: So what would be an example, or tell us a story, of some of those communication gaps that you experienced when you were caring for your late father?

Nicole Rochester: So many, Kevin. I would say one example is that my dad had a lot of chronic health conditions, and so he had a lot of specialists, and none of them were talking to each other. One of his conditions was hypertension. So we had a primary care doctor, he also had a cardiologist, but then he also would frequently go to the emergency department or to urgent care centers. And so at one point, my dad was falling, and he was dizzy and had all these side effects. When my sisters and I started to care for him, and I, as the doctor, started to look over his medical care, we discovered that he was on seven or eight different antihypertensive medications, and it turned out that no one was really keeping up with all of it. This doctor would prescribe one or two, and then this doctor would prescribe one or two, and he was kind of caught in the middle.

That’s just one of many instances. During hospital stays, there would be very disjointed communication and just fragmentation in terms of discharge planning. He had medication allergies that were sometimes not documented properly. I could go on and on.

Kevin Pho: All right, let’s talk about your most recent KevinMD article. It’s titled “The empathy gap: How a lack of understanding is fueling poor outcomes and health disparities.” Now, how did your article come together?

Nicole Rochester: So the article really, honestly, stems from my dad, and also the work that I’m doing now in the health equity space. I gave a TEDx talk a couple of years after my dad passed away, and I talked about the invisibility that patients and their family members experience in the health care system. As I have evolved to do more work in health equity, looking at the root cause of health disparities, and just the biases that we all bring as health care providers, and thinking about the ways that individuals in marginalized communities are often receiving inadequate care, what I know is that no doctor knowingly provides bad care.

But as I started to reflect on that, I really made this connection between a lack of empathy and the ways that we are trained as physicians, the ways that we are kind of taught to distance ourselves from our patients, and even the system in which we practice, which requires us to be in and out of that doctor’s appointment in five or seven or eight minutes. So all of these things ultimately create a barrier between the doctors and their patients. And I believe that that barrier breeds this lack of empathy that ultimately leads to us not humanizing our patients, and ultimately that allows us to treat patients in a way that really doesn’t align with, sometimes, even standards of care, and certainly doesn’t align with the way that we would like to care for patients.

And so the article really just talks about what it would look like to restore empathy in medicine, and for doctors to actually have a little more time to spend with their patients, and for us to focus on the humanity of our patients, and for us to see our patients as if they were our own parents, or our siblings, or our spouses or partners, and how that could be transformative in health care.

Kevin Pho: Now, when you were practicing, you were both in the clinic and in the hospital. Give us some examples that you witnessed of this lack of empathy that you observed, in either the hospital or the clinic.

Nicole Rochester: Yeah, I will say, not that it doesn’t exist in pediatrics, but I do like to think that pediatricians tend to have a lot of empathy, just by nature of the fact that we’re dealing with children. But even in pediatrics, I can use sickle cell anemia as an example. There were lots of instances where we would have hospitalized patients, children and particularly adolescents with sickle cell disease, and there was disbelief around the pain that they were reporting. I remember senior residents and attendings, when I was in training, talking with me about, “Well, they’re on their phone, so therefore how much pain could they possibly be in?” And I remember even internalizing some of those misguided beliefs and having to kind of retrain my own brain as I was in a position where I was training learners.

So that’s just one example: patients with sickle cell anemia, where we already know that there’s a lot of stigma attached to the disease, and attached to the treatment as well. Generally, I will say most of what I observed in terms of the empathy gap honestly came from my experiences with my dad, and more in the adult medicine space than what I’ve witnessed personally.

Kevin Pho: So regarding the empathy gap, as it affects minorities and worsens health care disparities, comment and talk about that.

Nicole Rochester: Yeah. We know that, just the way that our brains are wired, we are all naturally going to be drawn to people who share characteristics with ourselves, whether it’s our gender identity, whether it’s our race, ethnicity, even our body structure. And so, again, these are things that are largely unconscious. But the reality is that in America, where racial and ethnic minorities are not well represented in the health care space, particularly among clinicians as well as leadership, they are faced with providers who may not even recognize that they have those implicit and unconscious biases.

And so the reality is that they are not always treated fairly, and often it’s very subtle, even when it comes down to treatment. Sometimes there are assumptions made about racial and ethnic minorities: that they won’t be compliant with certain therapies, or that they won’t be able to afford certain therapies, or that they won’t understand certain things. And so we know from studies that sometimes treatments aren’t even offered; there aren’t even conversations that are had. We also know from studies that even when there is clear guideline-directed therapy, sometimes Black and brown individuals are not offered transplant, as an example, or when they have a stroke, they’re not referred to neurologists as often as their white patient counterparts. In pediatrics, there are studies that show that their pain is not managed properly, and particularly when you compare treatment of pain in pediatric patients, Black patients versus white patients, there are differences, and that has been correlated with biases.

So, I mean, fortunately and unfortunately, in 2023 there’s no longer a question about the roots of health disparities. There’s no longer a question that there aren’t only disparate outcomes, but there’s also disparate care. And so now I believe where we are is that we have to acknowledge the studies and the outcomes, and then we really have to all examine ourselves. And it’s not about being bad or good. We all are, or I like to believe, inherently good people, particularly those of us who chose a career in medicine.

But we have to acknowledge that we all carry these internal biases, and we have to acknowledge that they are literally harming and killing patients. And so it starts with that acknowledgment, and then education and awareness. And next, I believe there needs to be accountability, so that when there are disparate outcomes, there’s accountability for that. Because right now the numbers just keep worsening, and we keep talking about it, but despite efforts, there’s not a lot of change.

Kevin Pho: So let’s talk about a path forward. You mentioned one step is that we have to look within ourselves for these biases. So let’s go into more detail about that. What exactly would that look like, and how can we do that? What are some practical ways to move forward?

Nicole Rochester: Yeah. One thing that I encourage everyone to do, if you haven’t already, is to take the Harvard Implicit Association Test, or the IAT. If you Google it, you can find it easily. I’ve taken it several times, and even as a Black woman, I have discovered that I have biases, and this is also widely reported. But taking that test is a great first step to really begin to identify the implicit biases that we all have. And then from there, it leads to a state of curiosity and really questioning our beliefs.

So something that I do now on a regular basis is, if I’m out, whether it’s at a store or wherever, if I’m out in public, whenever I find myself having a thought that pops into my head about a particular group of people, I pause and I ask myself, “Nicole, is that true?” And so all of us can do that. If you’re in the grocery store and you see someone that doesn’t look like you, and you have this immediate thought, particularly a negative thought, but even positive thoughts (biases are not always negative; sometimes they’re positive), I stop and I ask myself, “Is that true, and where did that come from? Is that something that I believe? Is that something that I read? Is that something that was taught to me by my parents, by the media, by the books that I read in school? And what are my actual experiences with that?”

So one of the other things that we can do is to be very intentional about exposing ourselves to people with different lived experiences and with different identities. And when we do that, inevitably we find out that, you know the cliche, we’re all so much more alike than we are different.

Kevin Pho: One of the things that you also mentioned previously is that, in the context where a lot of physicians only have, whatever, six, seven, eight minutes with patients, we have to meet quotas, we have to have all these RVU pressures, generate revenue, and things like that. So how can we improve that empathy gap in that context?

Nicole Rochester: I love that question, because it’s a TEDx talk concept, which I call the 90-second encounter. And it’s 90 seconds because of what you just said, Kevin. I mean, we know that doctors’ time is limited. We know that physicians are being asked to do more and more and more in less time. But I believe that all of us can take 90 seconds out of that patient-physician encounter to just get to know our patients.

And so what I propose is, before you start with, “What brings you in today?” or before you start talking about all of their medical complaints, what would it look like for us to just have a human conversation with our patients, asking them about the last trip they took, or asking them about the best book they’ve ever read? Or maybe there’s something they told you at that last visit. Maybe they mentioned a wedding that was coming up with one of their children. So following up and saying, “Hey, I know last time you came, your daughter was getting married. How did the wedding go?”

Just little things that don’t take up a lot of time, but that can create that connection between physicians and other health care providers and their patients. And when we have that type of connection, I believe that, in that rushed encounter, it will just provide that connection and that humanity that may make us pause and may make us think differently about how we see our patients and the care that we deliver as well.

Kevin Pho: We’re talking to Nicole Rochester. She’s a pediatrician. Her KevinMD article is titled “The empathy gap: How a lack of understanding is fueling poor outcomes and health disparities.” Nicole, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Nicole Rochester: I think my primary take-home message is that health disparities are avoidable and preventable. They are not caused by biological deficiencies. And we as physicians and clinicians have a huge role to play in health disparities, because of the care disparities, because of our internal biases, and even because of structural racism and the systems. And so there’s a lot that’s out of our control, but there are some things that are within our control. So again, recognizing our own biases, and taking a few seconds of every encounter to connect with our patients and to bridge that empathy gap, so that we can be mindful about the way that we manage and deal with our patients and their families.

Kevin Pho: Nicole, thank you so much for sharing your time and insight, and thanks again for being on the show.

Nicole Rochester: Thank you for having me, Kevin. I appreciate it. Thank you.