Get smart about emotional intelligence

Evidence is emerging that emotional intelligence is as important for patient outcomes as it is for business and relationship success. Senior Medical Educator Dr Lynne McKinlay explains.

Emotional intelligence … if you raise this topic in a hospital tea-room you may see eye rolling and hear muttering about new age pseudoscience. Your more polite colleagues may ask, “Is that really a thing?” Well, I have cautiously joined the believers, encouraged by the emerging literature and by the indicators that emotional intelligence (EI) is good not only for my success in relationships at home and at work, but that emotionally intelligent clinicians and health managers are good for patients.

Intelligence may be defined in a number of ways but most still agree with the definition coined by Wechsler in 1944 that intelligence is ‘the aggregate or global capacity of the individual to act purposefully, to think rationally, and to deal effectively with his environment.’¹

Peter Salovey and Jack Mayer coined the term “Emotional Intelligence” in 1990²; subsequently Dan Goleman, a psychologist and science journalist with the New York Times popularised the concept with his 1995 best seller “Emotional Intelligence: why it can matter more than IQ”³.

‘Emotional intelligence’ refers to the capacity for recognising our own feelings and those of others, for motivating ourselves, and for managing emotions well in ourselves and our relationships. Dan Goleman, 1995

The following five emotional competencies are considered to be key components of emotional intelligence:

1. self awareness
2. self regulation
3. motivation
4. empathy
5. social skills.

People with these skills tend to have integrity and resilience, be honest, have high levels of commitment, can influence without positional authority and show positive emotional energy. Goleman talks of these individuals having a large “trust radius”.

Sound like important skills for clinicians, don’t they? If self-regulation is the hallmark of professionalism, EI should be as important to us as professionals as technical competence; this is being increasingly recognised by our professional colleges, employers and regulators.

Marketing and business were first to show great interest in EI, because it has long been recognised that EI is important to business success. In those industries, the evidence is irrefutable that this is no ‘soft skill’ – successful businesses and leaders in industry operate with high levels of EI. Leaving aside the fact that healthcare is unmistakably a big business, what can an understanding of EI offer to clinicians in the care of their patients and themselves?

Why emotional intelligence matters at work

First and foremost there is great potential for our patients to benefit from interacting with more emotionally intelligent clinicians. It has been demonstrated in a large number of research studies that patients’ adherence to (or compliance with) medical recommendations is strongly influenced by their relationship with and trust in the clinician², which in turn hinges on the clinician’s emotional intelligence.

A meta-analysis³ of 102 articles on the topic of adherence published between 1970 and 2005 confirmed that compliance with long-term medication therapies sits at a (much lower than you would hope) 40-50%, and when we recommend lifestyle changes to improve health, patients’ ability to comply is even poorer, at 20-30%.

We strive to provide the best evidence-based care, but if our patients fail to follow our recommendations⁴, reliable care and health outcomes will be poor. Underlining the need for us to become more emotionally intelligent is the uncomfortable fact that we cannot place all blame on our patients for failure to adhere to the treatment we have so carefully recommended. Our attitudes, communication skills (or lack thereof) and emotional intelligence undoubtedly contribute.

Jin and colleagues³ claim that much of the research into compliance/adherence to date has focussed on ‘hard’ factors like disease characteristics, therapy-related facts including route of administration and duration, and economic factors. The authors identified that efforts to improve adherence will fail if we ignore so-called ‘soft’ factors – the patient-provider relationship and patients’ beliefs about the therapy in question. In particular, an idea raised in this paper resonated with me. Patients with chronic diseases do their own cost-benefit analysis when deciding whether to accept the treatment offered. Their decisions are informed by this, perhaps consciously, or more usually subconsciously.

Our failure to communicate the nature of the illness and the importance of the therapy, and the patient’s relationship with us, particularly lack of trust, can seriously undermine the success of any treatment plan. If we ignore the impact of EI, we are in effect undermining our commitment to evidence-based care.

The modern version of the Hippocratic Oath was written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University and includes this line:
‘I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.’⁵

Emotional intelligence is critical for effective team functioning

Interactions with a colleague who is angry, frustrated or upset, because of events at work or outside of work, fatigue or other factors, can be distressing and have an impact on professional relationships and patient safety. These problems can be resolved if we learn to listen empathically, maintain our self-awareness and ability to self-regulate, and utilise our social skills; in other words, by being emotionally intelligent.

Andy Habermacher, a Swiss business coach, calls emotional intelligence ‘leading 100 billion neurons’⁶. If paying attention to our emotional intelligence means bringing a better brain to work, wouldn’t that be a great thing for our patients and our workplaces?

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