Does empathy mean giving patients what they want?

Recently, KevinMD.com picked up my post on empathy or should I say the lack of it.  I received some engaging comments.

One comment in particular caught my attention.

The contributor for some reason equated “being empathetic” with “giving in” to patient requests presumably during routine office visits.  Here’s a direct quote:

Give the patients what they want! Antibiotics are OK for colds. The patients want them. So what if narcotic-addicted patients get more pain medication. That’s what they want. Why make a big deal about a patient’s weight or a patient’s smoking habits? It will upset them.

It then struck me that I hear variations on this theme quite often from physicians.   I interpret this to mean that some physicians are afraid that saying no to a patient request may negatively impact their patient satisfaction scores.   I can see why one would be concerned about this issue so I did a little research to see where the truth lay.

First of all, patient requests are not uncommon.  For example, a sample of 200 patients (closed panel HMO) generated 256 requests for service, like medications, tests, and specialty referrals.  Treating physicians complied with most frequently with patient requests for medications (75.6%) and tests (71.4%) more frequently than expectations for referrals (40.8%).  So what was the impact of these physicians “saying no” figuratively and literally on patient satisfaction and patient trust?  Nothing. Patient satisfaction and trust in their physician remained high regardless of whether patient expectations were met or not.

When patients make requests, I really wonder what they are asking for.   Do they really want or need that antidepressant which they ask for by name, or do they just want their physician to listen to them; yes even empathize with them?

After all, the number one complaint of patients is that their doctors don’t listen to them.  Do patients make requests because they worry that their doctor is too busy to notice a problem like anxiety or depression?  I suspect that negotiating patient requests is not a big concern in physician practices characterized by strong patient-physician relationships and high quality physician-patient communications.

I could be wrong … what do you think?

Steve Wilkins is a former hospital executive and consumer health behavior researcher who blogs at Mind The Gap.

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  • Jeniffer

    Most doctors DON’T HAVE ENOUGH TIME to listen to patients for too long, even if they’d want to. I think that’s the system’s fault. Having to schedule a pt. every 15min to meet department quotas doesn’t seem like it leaves much time to listen to the patient. Right?

    • Brennan

      Yeah it seems like with the current set up we have forces doctors to say yes to every request to save them the time from having to explain why a particular treatment (like antibiotics for a viral infection) isn’t appropriate.

      I think it is well established that both doctors and patients would like more face time. The current set up gives me the impression that evidence based decisions are getting sidelined because docs don’t get adequate time with their patients. This hurts patients in the short and long run.

  • http://Hokiemd.blogspot.com Christopher Bayne

    Burnout is the term that reader was looking for. Empathy has nothing to do with ‘giving into patient requests.’

  • horseshrink

    I think WhiteCoat’s response was one of jaundiced sarcasm.

    Understanding another’s feelings is fundamentally different from agreeing with their requests. Effective parents learn this quickly.

    Also, it’s been my experience that a patient who feels heard/understood by me is more amenable to recommendations that don’t agree with their initial requests.

    Hard to listen faster, though, as appointment duration drops. That narrows clinicians to indulgent responses in order to win favor, akin to a divorced “Disney Dad.”

    Are we willing to keep running faster & faster on the CPT/allowable-reimbursement, $$/minute hamster wheel? Have we now reached a point of diminishing returns?

  • http://www.nomidzolam.blogspot.com J-M

    I hate to say this because I like the article, but since when is “giving patients what they want” a bad thing? Not everybody is drug seeking! Most of us now realize that anti biotics don’t work for some things and can actually be bad for us. I think most patients are better educated than Dr.s think.
    Why should we be afraid to ask for something that we know works for us, or that we think MAY work for us? We are bombarded daily by drug companies extolling the virtues of drugs for this and that. These invariably end with “ask your Dr. if _______ is right for you! If we ask our Dr. about this drug are we demanding that you give us what we want? Does this threaten the Dr.? Does this devolve into a “peeing contest” between the Dr. and patient?
    What about those of us who demand that you NOT use a drug that the Dr. wants? Is giving in to the patients desire NOT to have a popular drug because of disagreeable side effects a bad thing? Do we have to get into a match between Dr. and patient over this? If the Dr. follows the patient’s instructions is this a bad thing?
    We patients know our own bodies better than the Dr. We have lived with the same body for years. If the patient feels that something is wrong and wants a certain test… What’s the problem? Conversely, those of us who wish NOT to have intrusive tests regarded fondly by the Dr. are vilified.
    I get an uneasy feeling reading this kind of article. My encounter with the health care field was fraught with peril from medical personnel who wanted what they wanted, and my wishes had no bearing whatsoever upon what they did or did not do. (hospital outpatient, minor elective surgery) I guess they didn’t want to “give the patient what they want” for fear of seeming weak? Or maybe to show me who was boss? Empathy is the very last word I would use in defining the attitude from medical people that I personally experienced…

  • http://bit.ly/9TaS5c Dyck Dewid

    Neither parents nor doctors are imbued automatically with the wisdom or even good judgment needed to navigate themselves on life’s journey, let alone children or patients. So, could that be the question too?

    As time passes, the few may realize that the subject-in-need is the instrument of teaching… and the few are the one’s learning… and changes occur.

    But, my most valued learning is not the result of plugging in an answer to a question like a piece to fits into a puzzle. In fact seeking the answer may take me in the opposite direction of truth. I must begin with a worthy question (to have energy), allow it to develop into the ‘right’ question, and then allow it to remain open in my consciousness.

    Keeping the question alive allows the question to bring me ‘up’ to it… rather than me bringing the question ‘down’ to fit my terms. In this way it changes me as I live.