15 odd conversations that you should not start when visiting a kidney patient
Sympathy Vs. Empathy
As a nephrologist, I have witnessed numerous patient-clinician encounters and heard even more from kidney patients during their clinic or dialysis visits. A recent conversation with one of my patients, who has a kidney disease, brought to light how she felt by the reactions and comments of her friends and relatives.
Even with the best of intentions, we can sometimes say something that can genuinely hurt a patient. These remarks can come in any form and even from loved ones. This highlight the large differences between being sympathetic and being empathetic. The latter shows your concern whereas the former may make a troubling situation worse, all motivated by good intentions. The key is reflecting on how those words may affect us if heard in a similar situation.
Empathy is putting you in the shoes of another person while sympathy is just feeling sorry that his feet hurt.
Here are some highlights. Our aim is to broaden understanding and to enhance caring in these turbulent situations.
Sympathy: What happened? How did you get diagnosed?
Why: Although you are showing your concern, every person visiting a patient inevitably ask these questions. The patient or his attendant has to repeat the same story again and again, which may drain them emotionally.
Empathy: It must have felt like a shock being told of the diagnosis (dialysis treatment).
Sympathy: How did you get it? You look so healthy?
Why: Patient might perceive that you are blaming him or her for getting this disease. Looking well and having” a medical diagnosis are two different things. There are instances where cancer isn’t detectable until the last stage. No one wants to be ill, so asking them why they got it or why they didn’t know earlier is a way to blame them for the disease.
Empathy: I am just as surprised as you are to hear this news.
Sympathy: Just let me know what you need
Why: Don’t say it if you don’t mean it. And, if you genuinely want to provide any assistance, be proactive and take the initiative.
Empathy: Tell him the time slots or days you can help him. You can also list the tasks that you want to do with him, such as driving him for dialysis the second week of every month.
Sympathy: Look at the bright side, you could have cancer
Why: Comparing one disease with the other doesn’t help in giving assurance.
Empathy: Nobody really knows what it’s like living with this disease day to day.
Sympathy: Drink more water, your kidneys will start to function normally. I know someone who was cured like that.
Why: Snap recommendations of a cure or treatment, especially when not reasonable, is more about treating our own anxieties rather than the patient’s.
Empathy: This illness has a lot of complicated issues, including diet and treatments. There is a lot to keep in mind.
Sympathy: Why didn’t you tell me about your condition earlier?
Why: It takes time for a patient to come to terms with his/her disease and everyone has a different way of handling a situation. While one patient may want to email even his distant relatives and their friends, others may just want to shut themselves away from the world for some time.
Empathy: I am glad you shared this news with me, and you can count on me to share/not to share anytime. Either way, I am with you.
Sympathy: Did you take your medicine? Tell me what medication you are taking?
Why: Let him, or his caretaker takes charge of the situation. They are already overwhelmed with this new event in their life. Further advise and suggestions can make this time even more difficult for them.
Empathy: Do you have enough information with all the treatments. Can I help in any way?
Sympathy: Have you got a kidney donor? What are your chances of survival? Or it’s a long wait to get a kidney donor, isn’t it?
Why: Speaking of survival may aggravate anxiety.
Empathy: Don’t ask them intrusive questions. The patient will let you know what and how they want to share the information with you. Perhaps a gentle opening line might be helpful, e.g. I heard that transplantation is an option.
Sympathy: I couldn’t control myself from crying over your situation.
Why: We visit patients to talk about his and not our emotions. Though we may be deeply troubled with the complications of the patient’s disease, it is usually best to let the patient share his feelings with you rather than the other way around.
Empathy: I had a feeling you would be upset when you heard the news.
Sympathy: My father’s brother’s son-in-law’s friend was diagnosed with kidney failure. Let me tell you about his treatment and experiences in detail.
Why: Even with the same level and type of disease, the emotional and physical effects on each patient are unique and thus no two patients can be compared.
Empathy: Would you like to speak with someone who has similar issues?
Sympathy: I just couldn’t believe you could have kidney failure? I just saw your Instagram profile, where you were vacationing in Bali, and you looked so “healthy.”
Why: Not everyone wants to publish a Facebook, Instagram or a Twitter post about their diagnosis. If they do, it is perfectly reasonable. Don’t judge a person by how he behaves, looks or updates his online profile. Every disease brings psychological and physical changes that may not be noticeable by others.
Empathy: It must have come as a shock after that wonderful trip you documented on your post.
Sympathy: Why don’t you show your reports to Dr. X for a second opinion?
Why: The bond of a patient with his or her caregivers is profound, filled with all kinds of confusing feelings, ranging from the deep trust to outright mistrust. The offer of a second opinion may aggravate any of these feelings.
Empathy: If you ever feel that you would be interested in a second opinion, I can help you arrange it.
Sympathy: You will be fine
Why: With significant kidney failure, life will never be the same. It will be a “new normal” and the life will be different that before. Cultivating dismissal of the facts doesn’t change the facts.
Empathy: Life will have a lot of ups and downs, but I am here for whatever you may need.
Sympathy: I know how you feel
Why: No one but the patient knows how he feels.
Empathy: “I can’t imagine how you feel.”
Sympathy: Have you made out your will? The power of personal care?
Why: It is best to wait for the patient to start discussing this topic with you if he wants to. Otherwise, it may feel like an intrusive comment.
Empathy: Have you discussed your condition with close family members?
In an animated video, Brené Brown highlights the difference between empathy and sympathy.
Do you want to share your experience as a kidney patient or a caregiver with us? Email us at admin@psychonephrology.com to share your story with us.
About the Author
Dr Gavril Hercz
Dr. Gavril Hercz is a nephrologist at Humber River Hospital and Associate Professor of Medicine, University of Toronto. He completed his psychoanalytic training at the Toronto Psychoanalytic Institute and is a member of the Canadian Psychoanalytic Society. His major area of interest is the impact of physical illness on patients, families, and caregivers.
Sympathy Vs. Empathy As a nephrologist, I have witnessed numerous patient-clinician encounters and heard even more from kidney patients during their clinic or dialysis visits. A recent conversation with one [...]
