Empathy and the physician patient relationship

Is anyone else tired of hearing about how important empathy is in the physician-patient relationship?  Every other day it seems a new study is talking about the therapeutic value of empathy.  Enough already!

It’s not that I don’t believe that empathy is important, I do.  I also believe the data that links physician empathy with improved patient outcomes, increased satisfaction, and better patient experiences.

A recent study released in Academic Medicine reported that “patients of physicians with high empathy scores were significantly more likely to have good control over their blood sugar as well as cholesterol, while the inverse was true for patients of physicians with low scores.”

Findings from this study are consistent with a 2009 study which found that among patients with the common cold those with physicians displaying high empathy had a significantly shorter duration of illness and trend toward lesser severity of illness and higher levels of immune response, compared to those patient whose physician displayed less empathy.

Going back further, in a 2001 review of 25 randomly controlled studies that looked at the influence of the practitioner-patient interac­tions outcomes concluded that,

one relatively consistent finding is that physicians who adopt a warm, friendly, and reassuring manner are more effective than those who keep consul­tations formal and do not offer reassurance.

The problem with empathy research is that no one, including doctors, seems to be any paying attention as attested to the fact that nothing has changed.  Research documenting the therapeutic value of empathy goes back at least 20 years.  Despite the evidence, it seems that physicians are no more empathetic today than when people first started researching empathy.

Today we are told the health care is supposed to be evidence–based.   I wish that was the case when it came to empathy and the physician-patient relationship.  If it were we would have a lot more empathetic physicians, healthier patients, and much more satisfying patient experiences.

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

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  • http://www.epmonthly.com/whitecoat WhiteCoat

    The issue isn’t that doctors eschew empathy.
    The issue is that patient satisfaction survey companies, administrators, and clipboard physicians who rarely if ever set hands on patients try to get the clinicians to believe that empathy is more important than medical decisionmaking and proper medical care.

    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.

    While all of these non-practicing entities micromanage patient care in an attempt to increase empathy, they end up increasing the disgust that many clinicians have with the medical system in general.

    Guess what that does to physician empathy and the physician-patient relationship.

  • http://cultureofempathy.com/ Edwin Rutsch

    My I suggest a further resources to learn more about empathy and compassion.
    The Center for Building a Culture of Empathy
    The Culture of Empathy website is the largest internet portal for resources and information about the values of empathy and compassion. It contains articles, conferences, definitions, experts, history, interviews,  videos, science and much more about empathy and compassion.
    http://CultureOfEmpathy.com

    Let’s Find 1 Million People Who Want to Build a Culture of Empathy and Compassion
    http://Causes.com/Empathy

    Also, we invite you to post a link to your article about empathy to our Empathy Center Facebook page.
    http://Facebook.com/EmpathyCenter

  • http://www.healthecommunications.wordpress.com Steve Wilkins

    White Coat,

    If the data in the empathy studies came just from patient satisfaction surveys I could agree with you. But much of the data comes from studies in which the medical interview was audio taped (sometime video taped as well) and the “utterances” from the interviews coded by multiple trained 3 rd parties with high inter coder reliability. What these studies show is that patients are giving doctors the “cues” for an empathetic response…but tit is not happening…based upon the actual audio transcripts of the visit. Visits in which physicians exhibit empathy are associated with patient sat scores.

    Personally, with one or two exceptions, I can’t recall any of my or my wife’s physicians ever exhibiting an empathetic response to a health problem…including my wife’s bout with Stage IV NSCLC and my very recent Vitrectomy. It doesn’t cost anything..it doesn’t take any more time and just might put a momentary smile on someone’s face.

  • http://www.epmonthly.com/whitecoat WhiteCoat

    Steve,
    You’re missing the point.
    I agree with you that empathy is a good thing. I also agree that there are some physicians who lack empathy.
    But who determines empathy and how are those determinations measured?
    That is where your research falls short. You make the statement that “it seems that physicians are no more empathetic today than when people first started researching empathy.” What is the basis for that assertion? Your insight from reading studies? Your family’s experience with a few physicians? The *only* real-world measurements of empathy come from patient satisfaction surveys. If those surveys are any indicator, overall, 85+% of physicians are rated as “excellent”.
    Overemphasizing empathy to the detriment of other metrics in the physician patient interaction is inappropriate and potentially dangerous.
    In the spectrum of medical care physicians have many qualities. Should medical schools, residency programs, and hospital medical staffs emphasize empathy to the point that it has negative effects upon appropriate medical care, cost effective medical care, timely medical care, or even available medical care?
    If you don’t believe that an overemphasis on empathy has these effects, then I posit that it is because you are reading about studies while others are working with patients and seeing the effects of an overemphasis on empathy first-hand.
    And as an aside, I sincerely wish you and your wife strength and fortitude in her battle with her cancer. I truly mean that. It is a horrible disease and I wouldn’t wish it upon anyone.

  • http://www.healthecommunications.wordpress.com Steve Wilkins

    White Coat,

    Thanks for your “empathetic response” concerning my and my wife’s current challenges. See…it is not so hard to identify empathy when one sees or hears it.

    I am not fixated on the need for empathy so much as the need for physicians to do a better job across the board of communicating with patients. So you could just as easily substitute the communication tasks associated with agenda setting, medication reviews, patient self care instruction, etc. for empathy. They are all important elements pf the medical interview, in which physician skills are often found wanting.

    Take a look sometime at the work by Debra Roter at Johns Hopkins. Her work focuses on using conversational analysis techniques to assess what doctors and patients say during medical encounters. Lots of interesting insights in how physicians and patient communicate. I can provide some references if you are interested.

    Like I said before, I agree with your thoughts about the shortcoming of patient survey research. Conversational analysis is a different animal.

    Great conversation! Thanks.

  • http://www.littlepatientbigdoctor.com Haleh Rabizadeh Resnick

    The bottom line is that at the heart of being a doctor is a relationship with a patient. The better the relationship the better the result. At a minimum a doctor has to be adept at being able to connect to another person simply to have that person accurately share what their problem is.

    If you ask me, you can’t do enough empathy training. It should be a part of continuing education.

  • http://myheartsisters.org Carolyn Thomas

    Want to develop empathy? Get sick. Become a patient yourself. As Jerome Groopman described his own back injury in his ‘DocTalk’ interview with the Ontario College of Physicians and Surgeons last year:

    “I remember as an intern and resident, patients would come into Emergency with severe back pain, and half the time we would shrug and say they were a bunch of slackers and malingerers who wanted to get out of work. We had no idea. Until I injured myself, I had no concept of what it was like to struggle with debility.”

    Better yet, as part of basic medical training, put all medical students on a gurney in a busy hospital E.R. for 24 hours and ignore them. Use foreign jargon you know they won’t understand. It’s best if they can suffer unrelenting symptoms during this exercise, so you might have to pinch their trapezius muscles or put their hands into ice baths or some other form of devious but non-life-threatening torture. Subject them to frightening medical tests without explaining any procedures in advance.

    This might just help inform physicians about what it’s like to walk in their patients’ shoes. Or, as WhiteCoat maintains, might this merely “increase the disgust that many clinicians have with the medical system in general?” Really? Empathy = disgust?

    Jerome Groopman sums up his empathy advice for doctors: “… you shouldn’t have to have every disease in the world in order to develop that empathy.”

    More on this at “When Doctors Become Patients”:
    http://myheartsisters.org/2011/02/14/doctors-as-patients/

  • VikkiA

    There’s nothing wrong with the old school “good bedside manner,” but apparently, it’s not enough and physicians have be empathetic, too.

    As a non-medical professional, I didn’t realize physicians are under so much pressure to be empathic with their patients. Why is it no longer sufficient to be a compassionate physician? It doesn’t seem practical to raise the physician-benevolence quotient to one of empathy.

    Empathy is a strong, profound emotion. It goes beyond the kindly, caring benevolent healer that people hope for in a physician. With empathy, the individual physically and/or emotionally experiences the pain of the afflicted. It’s almost a fusing of one person with the other.

    Let’s leave empathy to the psychiatrists and religious, and show compassion while they struggle with burn-out that feeling empathy for others engenders.

  • http://myheartsisters.org Carolyn Thomas

    Hi VikkiA – “….with empathy, the individual physically and/or emotionally experiences the pain of the afflicted. It’s almost a fusing of one person with the other…..”

    Not necessarily. That would make empathy absolutely exhausting! I believe it’s more like the individual is able to IMAGINE what it must be like to be in the other’s position – not to be enmeshed IN the pain, but merely to “get it” about the pain, to understand the meaning of another’s experience.

  • Mishael

    It seems that most people, who do not deal with sickness or a disability first hand, can say that others don’t need an empathetic physician to give a patient comfort while being in pain or scared. I have had 14 surgeries because of kidney stones in the last TWO years. I am 33 years old and I have many disabilities that cause me to go to the doctor often.

    If a doctor cannot empathize with my situation and cannot be nice and reassuring, why would I want them as a doctor in the first place!

    I end up going to the ER and they want to label me as a drug seeker and a certain butt head “so-called” ER physician put lies in my papers that he treated me and I was supposed to have told him that I do ecstasy! He wouldn’t even do an ultra sound like I had asked. He actually ignored me when I called on him to ask some questions.

    Then states that he discharged me when I walked out of the ER and ended up at another because of the pain. Then I find out that I have Diverticulitis which was on the same CT Scan he was supposed to have read when I was there in the first place!

    Anyways, if anyone should have empathy it should be Primary Physicians, ER doctors, and all the above!
    I feel sorry for those who think that caring about a patient is a waste of time! What if it is your child, mother, father, brother or sister?

  • Kevin N.

    Empathy is an internal process. You can *feel* empathy, but fail to communicate it. Likewise, you can NOT feel empathy, yet communicate understanding of what the patient is likely going through. Regardless of what a physician feels or doesn’t feel during a patient encounter, he or she should treat patients with courtesy and respect. I could care less if my doctor “feels my pain,” but I certainly would like to be treated competently and kindly.

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