For those of us working in healthcare, we know that empathy is a fundamental part of our everyday labor. Being able to read and even feel patients’ emotions, and adequately respond to them, is sometimes as important as being able to give patients a correct diagnosis. We also know that being empathetic sometimes entails major challenges, since it can be difficult to relate and understand someone culturally, physically, or generationally different from us. Furthermore, living in the current COVID-19 era we all share an added challenge that threatens empathy and rapport: personal protective equipment (PPE). Health care providers are now wearing a large number of PPE, which clearly obstructs our human relations. How can we respond to our patients’ emotions in an empathic way if we are covered in PPE? How can we show them our empathy? The E.M.P.A.T.H.Y.® acronym and effective verbal communication may be of help. 

As healthcare professionals, we are exposed to highly infectious diseases, such as COVID-19, and are at a greater risk of contagion than the rest of the population. The main strategy to avoid this is the use of personal protective equipment (PPE). This equipment includes coveralls, hoods, masks, and eye shields, among others; to prevent inhalation and contamination of exposed skin and mucous membranes. However, PPE not only limits contamination, but also limits empathy and rapport.

Empathy is one of the fundamental abilities for a physician of excellence and has been associated with increased patient satisfaction, treatment adherence, and physician well-being; while decreasing medical errors, malpractice claims, and physician burn-out. On the other hand, empathy is complex, since it is formed by four dimensions: cognitive, affective, moral, and behavioral. The good news is that it can be learned and improved.

In 2014 Helen Riess published an article describing a new approach to enhance non-verbal communication and empathy. The intervention is grounded in the neurobiology of empathy and uses an acronym as an easy-to-remember teaching tool: E.M.P.A.T.H.Y.® This acronym can be explained as follows:

E: is for ‘eye contact,’ emphasizing the importance of making eye contact with the patient.

M: is for ‘muscles of facial expression,’ as facial expression possesses a central role in non-verbal communication.

P: is for ‘posture,’ as it is a powerful tool to express both clinician and patient emotion.

A: is for ‘affect,’ the scientific term for emotion, denoting the importance of identifying and naming the patient’s emotion.

T: is for ‘tone of voice,’ emphasizing its importance in nonverbal communication.

H: is for ‘hearing the whole patient,’ by contextualizing the patient narrative and really understanding their worries.

Y: is for ‘your response,’ denoting the clinician’s own feelings and reactions when interacting with the patient.


Since the E.M.P.A.T.H.Y.® approach improves empathic capacity, it can serve as a frame to effectively address the limitations that PPE posts on empathy and rapport, when combined with good verbal communication.

When healthcare workers use PPE, their entire body except for the eyes are covered. Hence, we have to enhance the power of the eyes to communicate our empathy to the patients. Eye contact will be more important than ever, and if we are aware and strive to look our patients into the eyes, we will effectively connect with them. As Helen Riess suggests, we can add our patient’s eye color into the medical record, to remind us to make eye contact with our patients 

To improve connection, we also need to consider our and the patient’s posture, since it is also an important factor in non-verbal communication. How are we standing when the patient arrives? Are our arms crossed sending a sign of defensiveness or are they open welcoming the patient? Are our eyes at the same level? Or, is the patient seated while we stand, which could suggest a hierarchical relationship. How is the patient’s posture? Does it suggest some specific emotional state? If we consider these details, we will be able to enhance our relationship with the patient and overcome some of the challenges that PPE imposes.

PPE also challenges our ability to express emotions, limiting expressions by covering our faces, which can be overcome by effective communication. As examples, “I am so happy you are here” can replace a smile, or “What you are telling me is surprising” can be used instead of opening your mouth and eyes. We should not forget to be mindful of our tone of voice, since it complements our verbal communication. Furthermore, effective verbal communication can be a tool to manifest and corroborate our understanding of the patient’s affect (emotion), showing a deeper understanding and achieving a tighter connection. Hearing the whole patient, actively listening without judgement, and reflecting upon our response is also a valuable tool to display empathy.

To show empathy and build rapport with our patients, both verbal and non-verbal communication are essential. Since some of their features have been affected by the current pandemic’s PPE requirement, clinicians must take action. If we apply the E.M.P.A.T.H.Y.® acronym, and combine it with effective verbal communication, we will be able to minimize PPE barriers and to connect effectively with our patients during COVID-19.


Did you know that the Harvard Macy Institute Community Blog has had more than 225 posts? Previous blog posts have explored topics including building a culture of caring, finding and defining your legacy, and making positive feedback truly positive.

Dominique M Harz Fresno

Dominique Harz Fresno, DMD/MDS, (Leaders, ’20) is an orthodontist and second-year Master’s in Medical Education student at Harvard Medical School. Dominique currently holds a position as Adjunct Instructor at Pontificia Universidad Católica de Chile. Dominique’s areas of professional interest include humanism and art-museum based education. Dominique can be followed on LinkedIn or Twitter.