The Health Psychologist

Society for Health Psychology

Patient-Provider Interactions Lacking in Empathy Can Contribute to Ableism in Health Care and Have Negative Impacts on Patients with Disabilities

2023 Fall, Conversation corner, The Health Psychologist

Chandra Char, Ph.D., MPH
Department of Family Medicine
Georgetown University Medical Center
Washington D.C.

Empathy vs. Pity

Empathy plays an important role in building relationships with others. Empathy is the ability to share and understand another person’s personal experiences on an emotional, cognitive and behavioral dimension (Moudatsou et al., 2020). An example of empathy is when we are able to match a friend’s level of excitement when they share with us, they just got engaged. Empathy is important in helping us connect with one another and build rapport with others (Empathy | Psychology Today, n.d.). Perspective taking is part of the cognitive aspect of empathy in which we see issues through the eyes of others and are able to develop a deeper understanding of that person’s experiences and feelings as a result (Empathy | Psychology Today, n.d.).  

Pity, sympathy, and compassion are often confused for empathy. Sympathy is feeling care or concern for someone and having a desire for that person to feel better, but not necessarily being able to understand their suffering (Burton, 2015). Pity can be a form of sympathy; however, pity reflects a person taking a superior stance in a relationship by “feeling sorry” for someone whereas empathy is standing side-by-side with another person’s feelings (Davis, 1990). An example of empathy is, “I understand where you are coming from.” Empathy differs from compassion as compassion is defined as “the concern of the wellbeing of others” (Cosley et al., 2010; Stanford Medicine, 2023) 

How Does Pity Contribute to Ableism?

Healthcare provider perceptions of patients with disabilities can play an important role in empathy vs. pity. Eighty two percent of doctors believed that patients with disabilities had a poorer quality of life than their non-disabled counterparts (Sohn, 2021). 

Pity occurs when we see a person with a disability and think, “poor thing” or “bless their heart.” When healthcare providers interact with patients in pity, it creates an unequal power dynamic with the provider as superior and the patient with a disability as inferior. When patients with disabilities are in an inferior role in a relationship, they are less likely to advocate for themselves, ask questions, and feel like an equal partner in their care. 

There is growing evidence to support the existence of physician implicit and explicit biases towards patients with disabilities, which can contribute to healthcare disparities (Lezzoni et al., 2021). Providing equitable care is, in part, related to a physician’s self-efficacy. There is a strong association between physician confidence in being able to provide equitable care and welcoming patients with disabilities (Lezzoni et al., 2021). A study by Lezzoni et al. (2021) indicates that approximately half of physicians “strongly agreed” that they would welcome a patient with disabilities into their practice. Additionally, approximately one fifth of physicians surveyed “strongly agree” that the healthcare system treats patients with disabilities unfairly. The findings of this study suggests that physicians in the US hold bias or stigma toward patients with disabilities. Physician self-efficacy can be enhanced through confidence in providing culturally competent care to patients with disabilities. This can be achieved through attending trainings and simulations with patients with disabilities.

The Americans with Disabilities Act of 1990 (ADA) requires that state, local governments, businesses and nonprofit organizations effectively communicate with people who have communication difficulties (ADA Requirements: Effective Communication, n.d.). The ADA defines “auxiliary aids and services” as communication methods used with people who have hearing loss, hard of hearing, and deaf-blind. These services included providing a “qualified” interpreter and/or note taker, in addition to other accommodations. The ADA defines “qualified” as an interpreter who is impartial, accurate and effective in the way they interpret what the person with the disability is saying and expressively (i.e., having the skills needed to convey information back to that person). 

The Importance of Empathetic Care for Patients with Disabilities

Empathy is important to healthcare because it can help build a deeper connection between people. Body language and facial expression can help reinforce an empathetic patient-provider interaction. Patients can recognize when their provider is motivated and practicing empathy (La Monica, 1981; Norfolk et al., 2007). Making eye contact and focusing on the patient while communicating can help increase empathetic communication. 

Cultural competency plays an important role in the healthcare experiences of individuals who are deaf and hard of hearing. The U.S. Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with Disabilities (2005) (Office of the Surgeon General (US) & Office on Disability (US), 2005) involves four suggestions for providers: 1) give each patient the information needed; 2) listen and respond; 3) communicate clearly; and 4) take the time needed to meet patient’s healthcare needs. 

A common myth of empathic healthcare practice is that it can put the provider at risk of being biased. “I resist feeling empathy with my patients because I fear I will lose my objectivity” is a common sentiment from healthcare providers (HCPs). This approach to providing care is a decent attempt at objectivity but removes empathy; illustrating why sympathy and empathy are  essential skills to possess as a healthcare provider. Empathy, unlike pity, does not demean patients and does not interfere with patient-provider relationships. Instead, it enhances rapport and lets patients know that they are understood. 

How Can We Improve Empathy?

A combination approach of training and mentorship from those who effectively practice empathy can help increase the practice of providing empathetic healthcare. Role models play an important role in modeling empathetic behaviors. Role modeling is particularly important for early career HCPs and medical students who are learning how to develop their style of clinical practice. Incorporating an empathetic approach into their practice can help rationalize the importance of empathy in healthcare practice. Some examples include speaking directly to patients with hearing loss or using visual aids to help explain diagnosis for patient with intellectual or developmental disabilities. If no mentors are available, it is important to practice observational learning from peers, professional and social environments. Sometimes it can be as easy as asking a patient their preference, regardless of disability. Discussions and conversations in healthcare settings around the importance of empathy is also essential in reinforcing these actions to help solidify understanding for early career healthcare providers. Incorporating and emphasizing empathetic care can help create a higher standard for care.

Amplify voices and experiences of patients with disabilities by recognizing the diversity within the disability community and not providing a “one-size-fits-all” healthcare approach. Creating safe spaces where patients with disabilities can have their experiences valued is an essential part to the healthcare process. An empathetic approach to healthcare can help improve the health and wellness of people with disabilities and create a culturally competent environment for patients. Lastly, improving physician knowledge about the ADA and how to adequately provide accommodations can improve empathy. It is essential for HCPs to have a baseline knowledge of patient rights and services covered under the ADA and how to provide these services/resources before patients ask for them.  


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