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E.M.P.A.T.H.Y.: A Tool to Enhance Nonverbal Communication Between Clinicians and Their Patients

Riess, Helen MD; Kraft-Todd, Gordon

doi: 10.1097/ACM.0000000000000287

There is a gap in the medical education literature on teaching nonverbal detection and expression of empathy. Many articles do not address nonverbal interactions, instead focusing on “what to say” rather than “how to be.” This focus on verbal communication overlooks the essential role nonverbal signals play in the communication of emotions, which has significant effects on patient satisfaction, health outcomes, and malpractice claims. This gap is addressed with a novel teaching tool for assessing nonverbal behavior using the acronym E.M.P.A.T.H.Y.—E: eye contact; M: muscles of facial expression; P: posture; A: affect; T: tone of voice; H: hearing the whole patient; Y: your response. This acronym was the cornerstone of a randomized controlled trial of empathy training at Massachusetts General Hospital, 2010–2012. Used as an easy-to-remember checklist, the acronym orients medical professionals to key aspects of perceiving and responding to nonverbal emotional cues. An urgent need exists to teach nonverbal aspects of communication as medical practices must be reoriented to the increasing cultural diversity represented by patients presenting for care. Where language proficiency may be limited, nonverbal communication becomes more crucial for understanding patients’ communications. Furthermore, even in the absence of cultural differences, many patients are reluctant to disagree with their clinicians, and subtle nonverbal cues may be the critical entry point for discussions leading to shared medical decisions. A detailed description of the E.M.P.A.T.H.Y. acronym and a brief summary of the literature that supports each component of the teaching tool are provided.

Dr. Riess is associate clinical professor of psychiatry, Harvard Medical School, and director, Empathy and Relational Science Program, Massachusetts General Hospital, Boston, Massachusetts.

Mr. Kraft-Todd is clinical research coordinator, Empathy and Relational Science Program, Massachusetts General Hospital, Boston, Massachusetts, and lab manager, Human Cooperation Lab, Yale University, New Haven, Connecticut.

Funding/Support: None reported.

Other disclosures: The trademark E.M.P.A.T.H.Y. is a registered trademark of, and under exclusive license from, Massachusetts General Hospital to Empathetics, LLC.

Ethical approval: Reported as not applicable.

Disclaimers: Dr. Riess is chairman and chief scientific officer for Empathetics, LLC.

Previous presentations: International Conference on Communication in Healthcare, University of St. Andrews, Scotland, September 2012; Massachusetts Medical Society, Boston, Massachusetts, March 2013; Harvard Macy Institute, Boston, Massachusetts, January 2012; Harvard Medical School, Boston, Massachusetts, April 2009; Legacy Hospital, Portland, Oregon, May 2012; State University of New York Upstate Medical University, Syracuse, New York, May 2013; Singapore General Hospital, Singapore, April 2013.

Correspondence should be addressed to Dr. Riess, Massachusetts General Hospital, Wang ACC Suite 812, Boston, MA 02114; telephone: (617) 724-5600; e-mail:

© 2014 by the Association of American Medical Colleges