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For Some Doctors, Empathy Is in Short Supply
Date:9/22/2008

Study finds they miss patients' cues about fears of well-being, even death

MONDAY, Sept. 22 (HealthDay News) -- Doctors are missing their cues when it comes to opportunities to empathize with the plight of their cancer patients, a new study suggests.

While doctors are able to address such concerns as medication issues, missed appointments, or pain, they tended to skirt "existential" issues, such as questions dealing with life and death, which are of paramount importance to most patients, the study authors said.

"Physicians only responded to 10 percent of empathic opportunities and, when patients raised existential concerns, physicians tended to shift more to biomedical responses," said study author Dr. Diane Morse, an assistant professor of medicine and psychiatry at the University of Rochester Medical Center, in New York. "Physicians had trouble addressing the bulk of concerns, which were about patient fears, concerns about death or dying, or worsening conditions."

Yet this may be the most important point of intersection between a doctor and his or her patient.

"The relationship between a patient and a physician is more than just the delivery of a diagnosis or a treatment plan," said Dr. Arthur Frankel, a professor of medicine at the Texas A&M Health Science Center College of Medicine. "Basically, for cancer care, if you're not able to form a close tie with your patient and improve their quality of life, then there's a real question as to what you are doing.

"We can hopefully, at times, make suggestions or do things with patients that may buy some time and, in some cases, long-term remissions. But, by and large, the major job of an oncologist is to bond with the patient and the patient's family and help them with a crisis," added Frankel, who's also director of the Cancer Center, Cancer Research Institute and Division of Hematology/Oncology at Scott & White Hospital in Temple, Texas.

Empathy -- identifying with and understanding another person's situation and feelings -- has been linked with improved patient satisfaction, including less anxiety and better compliance with treatment. Physicians, residents and medical students also show evidence of more satisfaction and less burnout if they provide empathy, Morse said.

For the study, she and her colleagues analyzed 20 audio-recorded and transcribed interactions between male patients with lung cancer and their thoracic surgeons or oncologists.

The researchers identified 384 "empathic opportunities," but found that the physicians responded empathically to only 39 of them. Each encounter elicited an average of less than two empathic responses from the doctor.

Empathic opportunities included patient statements such as, "This is kind of overwhelming," and "Im fighting it."

When the doctors did show empathy, half the time it was in the last third of the encounter, even though patients had been raising concerns throughout the session.

"Physicians are more comfortable about things they know what to do about, like 'I ran out of my medicine,' 'I couldn't get appointment,' 'I'm having pain,'" Morse said. "But when the patient asks how much longer do I have to live, it's scary. It's hard to know what to say."

"It would be helpful for physicians to think about having a response ready," Morse added. "The bulk of patients' concerns are existential and physicians don't necessarily have to do something to fix it. Just acknowledging it, in and of itself, can be very helpful and it doesn't take a lot of time."

Added Frankel: "The most important job of a physician is also the most important job for a minister or for a lawyer or anyone else: To try and help people cope with the uncertainties of life."

The findings are published in the Sept. 22 issue of Archives of Internal Medicine.

More information

For more on doctors and empathy, visit Kaiser Permanente.



SOURCES: Diane S. Morse, M.D., assistant professor, medicine and psychiatry, University of Rochester School of Medicine, N.Y.; Arthur Frankel, M.D., professor, medicine, Texas A&M Health Science Center College of Medicine, and director, Cancer Center, Cancer Research Institute and Division of Hematology/Oncology, Scott & White Hospital, Temple, Texas; Sept. 22, 2008, Archives of Internal Medicine


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