As medical students, we learn that we should be empathetic when caring for our patients. But what does this really mean? Clinical empathy is a combination of three discrete skills:
understanding the patient's circumstances, thoughts and feelings
verifying those with the patient
responding both appropriately and helpfully to the patient.1
The benefits of clinical empathy are wide-ranging. Among patients, clinical empathy can facilitate trust and engagement resulting in greater reporting of symptoms and concerns, increased education and higher levels of satisfaction.2,3 More objective benefits include increased diagnostic accuracy, improved adherence to medical recommendations and better outcomes.2,3 For physicians, clinical empathy can lead to less depression, increased quality of life and even lower medical-legal risk.2,3 The benefits of clinical empathy extend to caregivers as well. A caregiver's appreciation for the patient and their emotional situation can lead to a shared understanding of the patient's response to illness.4
Evidently, it is very beneficial to cultivate empathy among both physicians and caregivers. However, empathy for a condition and symptoms we have never experienced can be elusive and easy to misjudge. But, what if we had emulators that could transmit a patient's actual experience in real time?
Enter tele-empathy, an emerging field of technology-mediated symptom transference. A tele-empathy system can be illustrated using a Parkinson's disease (PD) example, with a wireless electromyogram (EMG) on the patient's arm and a programmable electrical muscle stimulator (EMS) on a physician or caregiver's arm (novel real-time Parkinson's disease empathy transfer through 8-channel bioimpedance and upper extremity electro-stimulation, in preparation, Fig 1). The system captures continuous EMG data from the patient's PD tremors and transmits it wirelessly via an EMS to a physician or caregiver to induce involuntary muscle activity mimicking the patient's tremors in real time (data unpublished, Supplemental Video S1). Allowing physicians and caregivers to experience the difficulty of a seemingly simple task, such as buttoning a shirt, can generate empathy and insights previously unattainable.
Fig 1.
Parkinson's disease tele-empathy device.
The tele-empathy opportunities in medicine are far-reaching. Tele-empathy can be valuable for clinical manifestations that can be seen and interpreted through the lens of data science, which includes many of our senses (Table 1). However, tele-empathy is more than just symptom simulation. It has the potential to improve our ability to control patient symptoms by allowing us to fine-tune and titrate treatments. We could, additionally, record data from patients on a specific treatment, and use machine learning to digitise the treatment through mathematical modelling. This could enable us to not only sense what the patient is experiencing, but to also predict what effect specific treatment may have on a patient via the digitised treatment. This has tremendous implications for future research and clinical trials.
Table 1.
Potential applications of tele-empathy in medicine
| Condition/symptom | Method of symptom data capture | Symptom transference technology |
|---|---|---|
| Ataxia | Motion capture | Virtual reality gait simulation |
| Gait analysis wearables | ||
| Connected insoles | ||
| Disfluent speech | Acoustic/voice recognition | Electrical larynx stimulation |
| Chronic obstructive pulmonary disease | Spirometry | Air flow restriction |
| Inflammatory bowel disease | Acoustic/vibration sensors | Electrical stimulation |
| Eye disorders | Vision test | Augmented reality |
| Autorefractometer | ||
| Amsler grid | ||
| Peripheral neuropathy | Neurological exam | Electrical stimulation |
| Psychiatric conditions | Patient history | Augmented reality |
| Dyskinesia | Motion capture camera | Electrical stimulation |
| Transcranial magnetic stimulation | ||
| Tremors | Electromyogram | Electrical stimulation |
Our research group recently initiated a study that aims to quantify the level of empathy experienced by neurologists both before and after use of the PD tele-empathy device. Future studies will measure the longitudinal retention of empathy. In addition, new tele-empathy devices for diseases where the need for empathy is great are currently in development, including diabetes (peripheral neuropathy), chronic obstructive pulmonary disease (shortness of breath) and pruritus (dermatologic and systemic diseases).
Tele-empathy can harness the power of technology to cater to specific needs within a wide range of clinical areas, stimulating new knowledge and insights in the process. This fosters invaluable opportunities such as the cultivation of empathy, more precise treatment titration, and more accurate treatment result predictions, benefitting physicians, caregivers and, more importantly, patients themselves.
Supplementary material
Additional supplementary material may be found in the online version of this article at http://futurehospital.rcpjournal.org/:
S1 – Video showing EMS inducing involuntary muscle activity to mimic a patient's Parkinson's disease tremors in real time.
Conflicts of interest
Yan Fossat, with Klick Inc, has a patent pending on the SymPulse PD tele-empathy device. The other authors have no conflicts of interest to declare.
References
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