Empathic History-Taking: A Specific Understanding and Analysis of Our Patients

One does not need to be a psychiatrist or therapist to show compassion, understanding, and care. 

This presentation was given by Arnab Datta, MD, a psychiatrist, at the APPA National conference at the Marriott Marquis in Times Square, New York City, in 2023. Arnab Datta, MD is the Medical Director Revcore Revcore Center and Silverlake Behavioral Health and is representing them in this presentation. 

This presentation is about how to take an Empathic history – how to understand a patient or a person with compassion. An Empathic history pays attention to the nuances of the personality and character of the patient. We all need to improve our skills of empathy, understanding and conveyance. For the betterment of our patients and ourselves. Everyone wins.

This is also an exercise in improving the patience, tolerance and empathic skills of the provider, thus improving the inpatient and/or outpatient institution and the skill set of each employee. So this is a meditative exercise for the provider as well. It begs the question, “Who is this patient?”

A patient’s life story can be obtained in various ways. Sometimes, when a history is taken, there’s a checklist, this often feels cold for the patient. There’s a warmer way to understand a person’s life story. If the patient’s history is taken in this way, then the patient will feel better, feel understood, want to open up more and possibly have an objective reflection of their life story. Which might inspire them to change for the better or realize something they didn’t before about themselves.

Some patients have been neglected and not loved at a certain point in their lives. Many of our patients’ pathologies trace back to some derivative of this. This perspective also allows the provider to have an empathic perspective on the patient. This kind of compassion is what mental health and substance abuse treatment should be founded on.

Side note: The correct word is Empathic, not Empathetic because there’s nothing ‘pathetic’ about listening, understanding and showing compassion to another person.

The Basic Structure of the Empathic History Gathering and Conveyance:

1. Who the patient is regarding their diagnosis and circumstances that led to their psychiatric hospitalization or detox or rehab?
2. Pertinent past history regarding a number of psychiatric hospitalizations as well as a number of detoxes and rehabs
   • Any self-injurious behavior
   • Substance use, abuse, and addiction history
3. Family history
4. Social history
   • Education is huge in preventing or reducing recidivism.
   • Work is huge in preventing or reducing recidivism.
   • Married or children
   • Interesting hobbies and interests
5. Intangibles, something unique about the patient, or even their relatedness, charm, or demeanor. Technically, this can be written in the mental status exam, i.e., objective impressions of the patient by the provider or interviewer. The mental status exam is after HPI in a technical medical history.
6. Anything regarding the functionality of this patient