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Most doctors were never taught how to sit with a patient’s grief, anger, or fear without absorbing it. Eva Minkoff, a health care executive coach, and Kim Downey, a physical therapist and physician advocate, join Kevin to discuss their KevinMD article “How regulating clinical empathy prevents physician burnout.” You’ll hear why physicians who lean too far into patient emotion burnout, why those who shut down lose trust and treatment adherence, and why both paths end in the same exhaustion. Eva walks through her three-step framework (recognize the feeling, distinguish it from the story, address the emotion first) and explains why naming a patient’s anger or grief in five seconds builds the connection that protects both the doctor and the care. Kim brings the patient view, sharing how doctors who stay present without drowning create the kind of relationship she calls sacred. If you’re a clinician asking how to keep caring without burning out, listen for the five-second practice Eva walks through.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Kim Downey. She’s a physical therapist and a physician advocate, and she’s connecting us with Eva Minkoff. She’s an executive coach. Today’s KevinMD article is “How regulating clinical empathy prevents physician burnout.” Kim and Eva, welcome to the show.

Eva Minkoff: Thanks, Kevin.

Kim Downey: Thanks, Kevin. Happy to be here.

Kevin Pho: All right. My first question is always to Kim, and doing such great work in the physician advocacy space. How do you define Eva, and why did you guys decide to write this article on KevinMD?

Kim Downey: Sure. So Eva and I connected. I was facilitating a Medicine Forward event, and she showed up off-camera a couple years ago. She was sick. And that was our first conversation, and she quickly became part of the Medicine Forward team. So I’ve gotten to meet her in person a couple of times, and I had her on my podcast, and then I invited her to write a chapter in our second book in our series.

The first was White Coats, Courageous Hearts. The second is White Coats, Human Hearts: True Stories of Healing, Belonging, and the Courage to Stay Human in Medicine. And whereas the first book was 15 physician voices, and thank you very much, of course. You wrote the endorsement on the back. This one is 11 physicians, two physician spouses, and two patients, because there’s more voices that we need to hear from.

And Eva’s chapter, which she’ll speak a little more to, but I invited her to collaborate on this article to expand on this sentence that she wrote in her chapter. It says, “When empathy is recognition rather than absorption, it nourishes instead of depletes. It becomes sustainable.” And I just thought there was a lot more to talk about that, so here we are.

Kevin Pho: All right. So Eva, just tell us a little bit about yourself and what you do, and then we’ll jump straight into the article that you shared on KevinMD for those who didn’t get a chance to read it.

Eva Minkoff: Of course. Thank you. So, as Kim alluded, I am one of those two physician spouses. And while I would say that has led to a decent chunk, maybe even 50 percent of my education and experience, the other 50 percent is pretty unique and eclectic, where I’ve worked in almost every facet of health care, truly, like research, clinical work, media, marketing, health care startups, you name it.

And then on top of that, I am a chronic patient myself. So I’ve had chronic illness, I mean, since I was born. I have Ehlers-Danlos syndrome and everything that comes with that, lovely comorbidities. But I wasn’t diagnosed until I was 30, not properly. And so I think I don’t need to go through the story of what that was probably like. A very long journey, ups and downs, the it’s all in your head, no solutions. So I have navigated the health care system as a patient extensively. It has all led to where I am today, though, which I’m very grateful for professionally as an executive coach for health care leaders and professionals.

Kevin Pho: Excellent. In your article, you talk about regulating clinical empathy, so for those who aren’t familiar with that concept or haven’t read the article yet, just tell us more about that.

Eva Minkoff: Sure. Well, just a little bit of background, aside from the eclectic experience that I’ve had. I gave a TED Talk in 2020 called Five Minutes to Fix Our Broken Healthcare System, which is, I know, a very bold title. But the essence was about human connection, doctor-patient relationships, and that in essentially five minutes or much less, maybe five seconds, you can make or break connection, trust in a doctor-patient relationship. I could give many examples of like how a doctor, for instance, can completely change a relationship, and actually we’ll talk about that a little bit in seconds by just saying something like, “I believe you.” And especially if it’s an invisible pain, for the most part, which I have.

But I felt like there was something missing in my talk that I hadn’t addressed, which is, yes, I think connection is like the fundamental, I don’t want to say savior, but I think without that, none of the other solutions really are going to work as well. However, I didn’t explain what connection could really look like without it taking from you. And I spoke to a number of physicians afterwards, and they would come to me with that question. Like, “I understand that I should have better patient rapport and spend more time with my patients, but I can’t.”

And on top of that, and of course it addressed time in the TED Talk, but it didn’t address the emotional load when you connect. And so while I had faith that there was absolutely an answer to that, it was like always on the tip of my tongue, I finally encountered what I see as a solution ironically, as a coach, and then I applied it to medicine and tested it out with a lot of physicians.

So regulating empathy in this context means, I almost thought of it as redefining empathy as we know it. So I’ll speak from the perspective of doctors, but this isn’t just doctors, this is really humans. We see empathy as walking in someone else’s shoes, right? Like, oh, what are they feeling? Let’s see if I can understand what it must be like to experiencing what they’re experiencing. But I was taught as a coach, especially the type of coaching that I do, which is quite deep in what one is experiencing. We are actually taught to somewhat detach from what they’re telling us in terms of what I call story.

And really pay attention to how they’re showing up in their being and in their feelings, and address that first. Like, you keep the story in mind. You have to speak to the details that they’re talking about, but what is actually coming from them that they want solved essentially, especially in their emotions?

And I’m a very empathetic person. I take on people’s emotions a lot. And then I noticed as I practiced this, I could meet with person after person after person with really heavy stories that they’re bringing and not be affected myself. And I was like, “That’s really interesting.” And then I noticed that I did some research, and it seems like this has been expanded on before, but as far as I can tell, not applied, and I would like to change that if possible. I can go into the details of exactly what I mean by this, but I wanted to give a little bit of background there and where this came from.

Kevin Pho: Sure. So Kim, when you first heard Eva’s story and her approach to empathy, why did that resonate with you?

Kim Downey: Because as you know, and some of your audience will know that I had cancer recently, you know, like three times over a short period of time, and then I lost my doctor to suicide. So, and being a physical therapist, I’ve experienced all of this from a health care worker perspective, from a patient perspective, and now from a physician advocate perspective.

And I see now, I think 45, 46 doctors if you count all the radiologists and anesthesiologists, and I’ve had all kinds of experiences, and I changed a few doctors out, and the doctors I have now, even though the visits, the time is limited, they do manage that connection, and I feel like they are still able to resource themselves, and I’m hoping to have more conversations, you know, with them about this and how they do that.

So it resonated in that way, but also that when that doesn’t happen, I feel bad for the patient, me, and the doctor. You know, like, if they’re wheeling out before they’re wheeling in, is that there’s something lost for the doctor and the patient. So I just thought that, you know, Eva, when she expands on all of this, that if it could bring more of it consciously to mind, that we could make a real difference.

Kevin Pho: Eva, you earlier on made the distinction between recognizing empathy and absorbing empathy. So go into more detail about exactly what that means.

Eva Minkoff: Yes. So I simply call it story versus feeling. So it’s either, and naturally I think as humans, again, we tend to engage with the story versus really putting that to the side and just looking at a person being like, what is the feeling that they’re experiencing? Better yet, if you can, ask them, because them bringing it to the forefront themselves is even better than you assuming. Often it is also more than one feeling.

And this is actually an element of a tactic that a lot of doctors are aware of, which is, at least I know some, I don’t actually know how widespread it is, but de-escalation. Like say if someone is really angry, like pointing out the anger and saying like, “I understand that you’re really angry,” or like, “This is really frustrating.”

Kevin Pho: Naming the feeling, right? Explicitly.

Eva Minkoff: Exactly. Exactly. And this is like a very well-known concept in social psychology in general, especially with kids. And so doing exactly that because that, it does many things. It first of all brings a sense of understanding, validation. Like I see you, and I see what’s going on, and I want to help. I want to address it. And once you’re able to do that, first of all, there’s trust forming. There’s, I mean, there’s connection, and then you can also even get more details on what it is that needs to be addressed.

So if you address the feeling, then you can actually get to what clinically needs to be addressed faster, more efficiently. And we all physicians, I hear, have the fear of giving a treatment and then it not really landing with a patient. Like, I don’t really know what that means, or I’m not going to do that, right? Adherence and trust are very closely related. If you address whatever emotion they’re feeling, anger, frustration, sadness, grief, you’re able to better understand what it is that will have them actually follow the treatment protocol.

I actually do have a specific framework for this that I call recognize, distinguish, address. Recognize in this case means on your side, recognize what they are experiencing. Of course, I said if you can ask them, that’s even better. You can also recognize it and like ask as a question like, “Are you feeling frustrated right now? Are you feeling scared right now?” Like, “What can I do to help?” And then that is the addressing element. Like, “What can I do? I will, anything I can do to address this for you,” whether that be like reassurance, being a peer for a moment even, or like literally do you need to understand something better, right? Whatever it is that the patient themselves needs.

Oh, that was address. I skipped distinguish. Sorry. But this is actually probably the most important element, distinguishing the emotion from the story. Now, I also recognize that a lot of us may not agree with their emotion, which I know sounds weird. But let’s say a patient’s really angry, and the doctor’s like, “I really don’t get why they’re angry right now. This is unreasonable.” Maybe people have heard this before, but all feelings are valid. A person’s feeling is a person’s feeling, even if it does not make sense to you. So distinguishing that they’re having an emotion in this moment, or multiple, versus whatever is happening to them are two different things. And you address the story clinically. Like, you need to keep in mind the details, but it’s always emotion first, story second.

Kevin Pho: So Eva, in the exam room, can you give us a scenario where that framework can play out so we can get a better picture of what that may look like?

Eva Minkoff: Yes. I actually like to start with what I consider maybe the most extreme version, just to really demonstrate it. Which is, my husband’s a pediatric gastroenterologist, so in the space of pediatrics, imagine that you just learned that your child is going to die, or they are dying. From what I hear, that there’s nothing more devastating.

There are so many ways a parent could react, and maybe all simultaneously, like the grief, the anger, the disbelief, numbness even. Like, such shocking and terrible news. Regardless of what you have to tell them or what their response is, addressing their response is the key. Because I truly see that there’s no way to actually help clinically until you take care of that element first. And grief is such an all-encompassing emotion as well. Look, as doctors, you’re all dealing with often very serious scenarios. Sometimes they’re very surface level, easy to treat, and then sometimes you can’t do anything about it.

Actually, sorry, speaking of this very extreme scenario, sorry, the reason I use that is because if you have a kid, or even if you don’t have a kid, you are likely to jump to connecting to them by imagining that you’re losing your child or what it must be like to lose your child. And then unintentionally, it becomes about you.

Doctors tend to lean into the emotion and being with them in the story or completely the opposite of leaning out and disconnecting. Neither serve doctors. They’re both exhausting from different angles. Whether it be like a distance from purpose and humans, which is exhausting, or of course taking on the burden of others. Instead, a doctor can stay. Stay in the moment, stay with the feeling, be with the feeling, and stay in the room, stay in the profession.

And I have seen this. I have talked to doctors who actually naturally do this. Happy to say my husband actually naturally does this, but I’ve spoken to others as well, and those who lean too much in lean too much out, and the burden that has on them. And it’s interesting how the burden is different and then comes back ultimately to the same place of disconnection and of exhaustion, and maybe a desire to leave the profession altogether, which we, you know, if you want to leave, I unfortunately don’t blame you, but ideally we are not losing doctors. We need more of them, and ones who are not losing themselves and possibly losing their life.

Kevin Pho: Kim, as you hear what Eva’s saying and you hear her framework, speaking from the perspective of a patient, what do you think of how that approach in your physicians or clinicians, how would that make you feel as a patient?

Kim Downey: Just seen and heard and understood, and that’s all any of us want is to feel seen and heard and understood. And I ended up getting one of my physicians, because I had to switch, and when I had read a review, I know there’s good and bad things about online reviews. But speaking to her, Eva’s point exactly, this family had lost their child, lost their baby, a newborn, and they took the time, it was within one or two months of when that happened, to write my doctor a wonderful review in saying how he was there and he was present with them.

So when you’re delivering babies, and sometimes bad things happen, that you must be able to do that, right, to continue, and that he managed to do that. And he is so present when I’m with him. So, and it’s a sacred relationship. The physician, when it’s working well, the physician-patient relationship truly is sacred.

Kevin Pho: We’re talking to Kim Downey and Eva Minkoff. Kim is a physician advocate. Eva is an executive coach. Today’s KevinMD article is “How regulating clinical empathy prevents physician burnout.” Now we’ll end with by asking each of you just to share some take-home messages with the KevinMD audience. First we’ll start with Eva and then with Kim. Eva, why don’t you go first?

Eva Minkoff: I’d say my takeaway is that medicine doesn’t need physicians who shut down. And it doesn’t need physicians who are drowning. It needs physicians who can stay. And it’s not about caring less. I think of it as giving your compassion a safe place to land, a way where it can be truly valuable for both you and the patient. It’s empathy as recognition and not absorption, and that really can take five human seconds of recognizing, distinguishing, and addressing.

Kevin Pho: And Kim, your take-home messages.

Kim Downey: Sure. So Eva shares in our article that doctors are trained in anatomy, pharmacology, and pathophysiology. They are not trained in how to keep their nervous system steady in the presence of suffering. So that’s really what we were talking about today. And when I shared our article on LinkedIn, at least a couple physicians responded and shared that learning how to regulate empathy and emotions is not taught in medical school or residency, and that it’s a gap in medical education, yet it’s so central to the practice of medicine, and which is exactly why these conversations are needed.

And since I’m always trying to support physicians, I just wanted to add that there’s many resources for doctors. Everything from books on improving communication skills, and even medical improv, which I know you’ve addressed multiple times, and therapy and coaching. And either one of us could provide specific resources for any physician if they’d like to reach out.

And also, I’m hosting a physician retreat this October in New York that’s by doctors and for doctors, and one of the topics is Communication Holds a Key to Your Wellbeing: What Coaching Culture Teaches Us by Dr. Sue McClelland Tolbert. So, that you also know. And just always I feel like I need to mention that of course the system needs to change. It’s not that we’re trying to just make doctors more resilient or give them more things to learn or do. But in the meantime, as Eva said, we need doctors, so we need to give doctors real tools and resources that they can use today.

Kevin Pho: Kim and Eva, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Kim Downey: Thanks, Kevin.