Emotional intelligence: A new measure for MDs

By the time they complete schooling, training and establish their careers, physicians have demonstrated a high degree of intellect and gained vast clinical and technical knowledge. However, as the healthcare industry becomes increasingly concerned with patient satisfaction and care coordination, technical medical knowledge alone will not suffice.

Another type of intelligence — emotional intelligence — plays a significant role in determining how effectively physicians communicate and establish relationships with patients, as well as with their colleagues. Effectively leveraging this concept, however, requires an understanding of how emotional intelligence manifests itself, as well as tools to help understand an individual's emotional intelligence in a healthcare context.

Emotional intelligence is comprised of four components, Alan H. Rosenstein, MD, an internist, educator and consultant in healthcare management, said during a Nov. 17 webinar sponsored by Select International. The four components include self-awareness, social awareness, self-management and relationship management. 

"Emotional intelligence may sometimes be called social intelligence, empathy or mindfulness," said Dr. Rosenstein, "but it is really the ability to perceive, evaluate, understand, respond to and influence emotions."

Healthcare is perhaps the most "human" industry, as medical care has a uniquely direct and serious impact on people's lives. As the field evolves to embrace a patient-centered model, physicians who lack self- or social awareness may have a harder time establishing strong relationships with those they care for.

Empathy is another key aspect of emotional intelligence. "We can all think of a physician we've met or encountered in our careers or in personal interactions who might be high in social sensitivity, self-esteem and social awareness, but perhaps not in empathy," said Ted Kinney, PhD, director of research and development at Select International. "They might be aware of how they're perceived, they just don't really care that much."

Bryan Warren, manager of healthcare solutions at Select International, pointed out physicians don't always enter their roles with sufficient training in empathy and communication. "We are expecting physicians to go beyond clinical excellence and be leaders, but they don't necessarily come to us prepared to fill those roles, and at the same time, we don't necessarily give them the tools to succeed."

Physician performance is the fulcrum of any healthcare initiative. Some of the most pressing initiatives in healthcare today are transitioning from volume- to value-based care, succeeding under value-based purchasing and improving the patient experience. However without strong communication and coordination within the clinical care team and in physician-patient interactions, efforts to improve the patient experience and thrive in a value-based care model will fail.

According to Dr. Kinney, it is likely impossible to change an individual's level of emotional intelligence. However, when it becomes apparent that someone is unable to communicate effectively or lacks social or self-awareness, assessing his or her emotional intelligence enables leaders to identify and provide appropriate training to target various communication skills. Such interventions aim to increase awareness and the ability to modify behaviors. Improving emotional intelligence scores may occur as a result, but it is not the primary objective.

Emotional intelligence in the clinical care setting
Unpleasant interactions between physicians and patients could very well lead to lack of trust, miscommunication and diminished patient loyalty. As a result, patients might feel heightened stress ahead of medical procedures, which can negatively affect outcomes. Medication nonadherence is another symptom of negative physician-patient interactions, according to Michael J. Garren, MD, a clinical professor of surgery at the University of Wisconsin School of Medicine and Public Health in Madison. 

"As physicians, we never used to equate patient outcomes with emotional intelligence," Dr. Garren said during the webinar. "We thought if we provided expert care, that was the best patient care. Clearly, that is not always the case. Patient perception is key and relating to patients with empathy is critical. From a practical standpoint as a surgeon, if we have complex patients with complications and deal with that in a sympathetic way, there are usually better outcomes."

Mr. Warren said studies show high emotional intelligence correlates with career success and satisfaction. There is also research proving clinical care teams with strong communication have better outcomes and physicians with higher emotional intelligence more effectively manage chronic disease.

Identifying barriers to high emotional intelligence
Individuals' emotional intelligence levels are influenced by combinations of both internal and external factors. Life experiences, as well as generational, gender and cultural differences, all contribute to an individual's level of emotional intelligence. External factors specific to physicians include the isolating nature of medical training and a stressful work environment.

"The medical training process can be compared to hazing in a sorority or fraternity," said Dr. Rosenstein. "You quickly learn you don't know anything, which leads to low self-esteem and then a drive to learn independently to gain knowledge — the antithesis of collaboration." Dr. Rosenstein added that medical schools are beginning to change their core curriculum to include interpersonal relationship training.

Additionally, physicians are increasingly held accountable for quality performance while burdened by administrative work and complying with ever-changing rules and regulations. As a result, many are becoming frustrated and disengaged, with some ultimately leaving their jobs prematurely. Stress and conflict management support services can help remedy this frustration, as well as help physicians practice communicating their concerns more effectively.

Presenting an opportunity for improvement
The best way to increase physicians' willingness to change their behavior is by assessing their emotional intelligence level and then presenting an evidence-based case for improving. While there are many emotional intelligence tests out there for organizations, Dr. Kinney suggested avoiding tests that lead to a single score, as those exams don't offer enough information about how an individual tends to react across different types of situations. Instead, look for assessments that provide scores across the four different emotional intelligence dimensions.

Physicians can use emotional intelligence scores to support areas of strength and weakness. To put this in practice, Dr. Rosenstein recommended physicians engage in self-inquiry, which entails thinking back on interactions and determining effectiveness. Did the physician communicate clearly? Does he or she believe the patient was able to communicate clearly? How does the physician perceive the patient left the interaction feeling?

It is important to note the way in which administrators or other leaders approach physicians about their emotional intelligence can significantly impact physicians' willingness to change their behavior.

"Intelligence is a value-laden word in itself," said Dr. Kinney. "Physicians are not receptive to hear they are low in some type of intelligence. If you think of the nature of the construct, you wouldn't be giving negative feedback to people who have high emotional intelligence — you are trying to get people who are not self-aware to become self-aware."

Supporting physicians, empathizing with them and listening to their concerns — as opposed to just telling them what to do — will also make them more inclined to improve behavior related to emotional intelligence.

Once a physicians are onboard, diversity training, customer service training and continual check-ins can help them refine their communication skills, as well as learn to better perceive emotions and empathize with others. Such training sessions also present the opportunity to provide behavioral support and give physicians a platform to discuss their concerns.

To download the webinar as a PDF, click here.

To view the webinar on YouTube, click here.

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