The Compassionate Connection: The Healing Power of Empathy and Mindful Listening

Book Title: The Compassionate Connection: The Healing Power of Empathy and Mindful Listening

Book Author: David Rakel

Publication Information: New York, W.W. Norton & Company, 2018, 280 pp., $25.95, hardcover

How does a busy physician forge a connection with a patient to hasten healing? David Rakel, MD, empowers the heart and provides tips in Compassionate Connection. Drawing on his own encounters teaching primary care and integrative medicine, Rakel communicates the soul of presence as he takes the reader into his and others’ exam rooms.

Family physicians are all trained to practice patient-centered care, but pausing and reflecting on these skills is important if one is to maximize the power of healing, increase treatment compliance, and prevent physician burnout. This book is designed to help the reader approach problematic patient encounters with mindfulness to achieve these goals.

Rakel states that fostering a “compassionate connection” hastens healing. A high-yield way of doing this is by improving empathic listening skills. Rakel expands clinician skills with two excellent chapters on the “biology of connection” and how to “physically communicate good intentions.” For example, one can engage the mirror neurons of the patient by augmenting one’s body language in research-authenticated ways. Oxytocin may be evoked in an appropriate interpersonal connection, which may soothe both patient and clinician. Neuroplasticity can be harnessed. When physicians master the art of connecting with empathy and optimism, “they create change in the neuroplasticity potential of their own brains” (p 71). If physician burnout is to be successfully addressed, focusing on patient strengths instead of their deficiencies strengthens positive, peaceful, neural pathways in the synapses of the physician.

A compassionate connection is markedly enhanced, according to Rakel, by the understanding of physician and patient body language. A strength of this author’s treatment of this topic is how specific and research-based his coverage is. Examples useful to family medicine educators include congruency between verbal content and facial expressions, closed vs open body positions, and what percentages of eye-contact time are the most effective. Even the handshake can have an improved technique.

Strengths of this book include extensive and useful research references. The text abounds with integration of studies that the family medicine educator can use to improve teaching. An example is how negative bias can be overcome by taking time to more fully evaluate patient information. Residents were asked to rate patient scenarios in two dimensions: how likable a patient was, and how difficult a patient was; they were also asked to make diagnoses. With less likable and more difficult patients, when residents increased their time on careful reflection, their diagnostic accuracy increased. A conclusion of a related study is that there is a risk of physicians making mistakes when they are spending internal energy dealing with a patient’s disturbing behaviors, rather than “adequate processing of clinical findings.” Rakel concludes that the ability to mindfully suspend judgment or adequately recognize one’s potential biases will improve both connection and accuracy.

Another research-supported section is mindfulness training for physicians to reduce burnout. For a more extensive presentation of mindfulness, the reader may also wish to consult Epstein’s Attending: Medicine, Mindfulness, and Humanity.1 A strength of Rakel’s briefer presentation, however, is including non-Eastern meditation approaches by identifying “pause and be present” practices some Westerners may do habitually (eg, pausing before prayer or pausing before swinging a golf club). One empirical finding cited in the book cited empirical finding was that when physicians paused frequently or—more bluntly—stopped moving and speaking, patients often provided important information that they had hesitated to reveal.²

One weakness of the book is a noticeable style difference between the senior author (Rakel) and his guest nonphysician writer. It is also unclear who the intended audience is. The primary audience appears to be medical clinicians, but the text works too hard to include an overly-broad audience of nonmedical readers. Common medical terms are overexplained, which can seem pedantic. These issues would be profitably addressed in a subsequent edition.

Nonetheless, this volume is a beacon to help clinicians connect with core values in the helping relationship, and to foster patient relationships in a time-efficient way. If you are buffeted by modern institutional demands that could suck the soul out of your best intentions, keep this small book at your elbow with Rakel’s gentle reminders, wisdom, and wit.