Can we see the empathy gap in our own practice? How do we manage the challenge of caring for patients/families we do not relate to? Do we take better care of the patients we readily identify with?


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“Magic mirror on the wall, who is the fairest one of all?” The wicked Queen in the movie “Snow White” was threatened by the beauty of her stepdaughter, so she poisoned her with an apple and put her into a deep sleep.1 Fairy tales fill a specific niche in childhood books—they teach us valuable lessons by breaking down moral teachings into understandable stories.

At a recent conference on pain management I was reminded of the Brothers Grimm fairy tale. I remembered watching the Disney movie as a young girl, and I pictured the scene where the terrible queen stood in front of the mirror asking who was the fairest of all. Why would a pain conference remind me of this fairy tale? It started with a question from a nurse in attendance. Her question was so extreme I was certain she was planted in the audience to help the speaker make her point. She stood and cleared her throat, “The video makes it seem so easy: A white nurse assessing the pain of a white patient. What happens when the patient is homeless and dirty?”

Turned out she was not a plant. She went on to explain, defend actually, her struggle caring for a patient she did not relate to and who she believed had exaggerated their need for pain medication. Was it not reasonable, she argued, to profile our patients based on their appearance? There was a collective gasp in the room. I imagine those next to her shifted their seats away. I had to force myself to keep from turning around and staring at her. The presenter re-framed the question so that the information presented morphed into a discussion about the impact of bias on nursing practice. She was polite yet direct in her response: We have an ethical responsibility to provide care to our patients regardless of the view we have of them or whether we feel a connection to them. After the conference that one question stood out in everyone’s mind as it seemed to exemplify the worst in nursing. Comments about how wonderful the conference was were quickly followed by the statement, “Can you believe that nurse asked that question?” None of us wanted our practice to be associated with her proclamation.

And yet, as extreme as her view was, it reminded me that we all have levels of bias. Each patient makes a first impression, and sometimes the impression is a negative one. We may form an impression based on the report given to us by other nurses, “her whining is kind of driving me crazy,” or “he is not what you would call a ‘happy camper’.” It would be unreasonable to expect that we would react to every patient in the same neutral way. But my internal reaction does not matter as much as my external actions. Admitting a bias is one thing; it is another to craft my practice around it. That one question made everyone a little uncomfortable, and maybe because it openly acknowledged that there are times when we are challenged to be objective in our outlook.

The second speaker at the conference discussed the impact racial bias has on pain management and tied it to the concept of the empathy gap. Many studies show that racial bias negatively impacts the care received by people of color. But the empathy gap may be created by variables besides racial bias, such as gender or age bias, educational bias, economic bias, political bias, or personality bias. Empathy is defined as the ability to understand and feel someone else’s feelings as opposed to sympathy, which means you have compassion but do not have an actual sense of sharing the other person’s experience.

Empathy is reflected by the idiom “walk a mile in my shoes.” What happens when those shoes don’t fit? What if they pinch or hurt, if they don’t suit me for some reason? What if I don’t like them?

The empathy gap exists because of the way we respond to others. All of us have people in our lives who push our buttons and we can have patients who push our buttons too. It is how we address those biases, how we acknowledge bias in ourselves and how they impact our care. Acknowledging their presence reminds us to pay attention to them.


Can you think of an instance in your practice where you realized that bias had impacted your patient care? What was the impact of that experience?

How do you handle the situation where a co-worker voices obvious bias that creates an empathy gap?

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