Empathy Improving Outcomes

By David Ring, MD PhD 

Associate Dean for Comprehensive Care and Professor of Surgery & Psychiatry at University of Texas Dell Medical School 
‍ 
The human mind is programmed to interpret a new pain as an injury, particularly if the new pain seems to follow a specific event. The mind is also programmed to believe that painful activities will make the problem worse. However, this is often an unhealthy and inaccurate story: The more we think unhelpful thoughts, the more pain we experience and the less capable we feel. But injuries like contusions, strains, sprains and fractures heal faster when people keep moving. For example, exercise is an effective treatment for age-related changes, such as rotator cuff tendinopathy and knee arthritis. 

Next time you feel a new pain, notice your thinking. There is usually some worst-case thinking, followed by reorientation to more likely and hopeful thoughts. That process can be slowed by worry and despair and insecurity of role (job, relationship, identity) and finance (money, housing, food). These are the mental and social aspects of health. 

If a person’s not feeling better over time, the symptoms may not be due to an injury. There are specific words and actions associated with unhelpful thinking, worry, despair, and stress. Listen for injured worker references to “unbearable,” “excruciating,” “can’t even do simple daily activities” and “overcompensating.” Also look for a variety of pain-avoidance behaviors. A concerning recovery trajectory is apparent within weeks after the incident, and often at the first medical appointment. 

Put your relationship with the injured worker first, and anticipate these mental and social health opportunities. Build trust by making it clear that you hear and understand the story they are living – just like you’d want for yourself. State the facts about the pathology as the medical experts have presented them. Look for reactions that indicate unhelpful thinking, stress, and distress. Acknowledge how the facts may be counter-intuitive and clash with a person’s lived story. These are empathic opportunities. Get curious about the injured worker’s worries and hopes: “Tell me more.” Let people know they are not alone in their experience and there is a way forward. 

‍Dr. Ring is one of the most respected orthopedic surgeons in America. He and Dr. Melissa Tonn of OccMD Group collaborate on research, including recent peer-reviewed studies found here in the Journal of Orthopaedics, Clinical Orthopaedics and Related Research, and the French Journal of Visceral Surgery.