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http://newsblogs.chicagotribune.com/triage/2008/09/doctors-score-l.html

Originally posted: September 23, 2008
Doctors score low on empathy: too little, too late

It’s no secret that many doctors appear detached and unwilling to relate to patients emotionally.

Experts who specialize in medical communication understand this can interfere with the doctor-patient relationship and impair the quality of care.

Now, a small study shines new light on the subject by examining the degree to which physicians express empathy for people with lung cancer, the No. 1 cancer killer in the U.S.

The report finds that surgeons and oncologists responded to cues that lung cancer patients were sad, frightened, anxious, or otherwise emotionally agitated only 10 percent of the time. It was published today in the Archives of Internal Medicine.

"We found that patients provided multiple opportunities for physicians to express empathy, which were missed, and that where physicians did provide empathy it was too little too late," said Dr. Howard Gordon, an author and staff physician at Chicago’s Jesse Brown Veterans Affairs Medical Center.

Researchers examined transcripts of 20 doctor-patient interactions at a VA medical center in the south for the study. Coders identified every time patients expressed emotions about their illness and every acknowledgment of the emotions by physicians.

Altogether, patients articulated 384 so-called "empathetic cues" and the surgeons and oncologists responded 10 percent of the time.

"There was a clear mismatch between what patients think is important and what physicians respond to," said Dr. Diane Morse, lead author of the report and assistant professor of medicine and psychiatry at the University of Rochester School of Medicine.

That’s an even worse performance than documented in other research, which has found that primary care doctors express empathy 21 percent of the time, oncologists, 22 percent, and surgeons, 38 percent.

Notably, in the new lung cancer study physicians were least likely to address the concerns most often articulated by patients, which surrounded fear and anxiety over death and dying. Instead of openly acknowledging those feelings, doctors talked about patients’ prognosis or treatment.

There are several reasons why physicians may miss indications that patients are seeking emotional understanding, either consciously or unconsciously. Doctors may be too busy. They may believe their primary job is to diagnose and treat illness. They may assume patients are reassured by their biomedical expertise. Or they may be burned out, stressed and not recognize patients’ emotional concerns, the report suggests.

In actuality, it doesn’t take much time for a doctor to say, "I understand that must be hard," or "It sounds like you’re worried" or other brief statements that make it clear a patient is being heard, Morse says.

There are important benefits to be had from making the effort. Previous research has demonstrated empathetic responses improve patient’s satisfaction and understanding of their condition as well as their willingness to comply with recommended treatments.

For their part, people with lung cancer can try telling their doctors, "I know there isn’t anything you can do to cure me, but I just want you to know that this is something I’m worried about," Morse suggests. "Express your concerns. Ask questions. Be assertive," Gordon adds.

Have you had experienced a failure of empathy in a medical encounter? If so, what happened and how did it make you feel?