Physicians miss opportunities to empathize with emotionally vulnerable patients

An emotional connection between patients struggling with the emotional effects of a life-threatening disease and their physicians is often missing, according to a recent study of physician behavior.

An evaluation of audio recordings found that physicians missed about nine of 10 opportunities to show empathy during consultations with lung cancer patients. Mammographers say their patients receive far better treatment.

Studying transcriptions of recorded appointments, researchers at the University of Rochester in New York conducted a qualitative thematic analysis of 20 consultations between patients with lung cancer and their surgeons or oncologists (Archives of Internal Medicine 2008;168[17]:1853-1858).

They found 384 opportunities for an empathetic response. Physicians responded to only 39. If physicians responded empathetically, often it was only when the patient lamented a difficulty with the health system or in regards to making a decision about treatment, said Dr. Diane S. Morse, a clinical associate professor of internal medicine at the university and lead author of the study.

She cites being busy, not recognizing an empathetic opportunity, and consciously avoiding an empathetic response as reasons for the physicians' indifferent behavior.

Patients may bring up issues related to their morbidity and mortality, which can be difficult for physicians to address and thus physicians avoid responding altogether, Morse said.

"This difficulty may be related to limited cure potential that results in a sense of failure and/or identification with the patient that is difficult for the physician to acknowledge or express and may raise within the physician awareness of his or her own vulnerability to illness and mortality," Morse said.

While physicians dealing with lung cancer may have trouble responding empathetically to patients, Dr. Ellen Mendelson, a professor and director of breast imaging at Northwestern University, said interacting with patients is part of the attraction for radiology residents who decide to specialize in breast imaging.

"The positive responses validate the commitment to communicate directly with patients, and I encourage all of my fellows to become the imaging physicians for these patients so that patients will know them by name and realize that the recommended patient management plans, most often based on imaging findings, have been authored by radiologists," she said.

Dr. Stamatia Destounis, an attending radiologist at Elizabeth Wende Breast Care in Rochester, said the radiologists themselves communicate the results of a cancer diagnosis to each of their patients at EWBC.

She encourages questions from her patients and provides them with her cell phone number so they can reach her whenever they need to, Destounis said.

"Our center has made its reputation in talking to patients and communicating," she said.

In addition to explaining the case in detail with the patient, the radiologist performs breast ultrasound and needle biopsies herself.

"It builds loyalty with our patients and they keep coming back [here] for their checkups after their diagnosis," she said.

Destounis noted that whenever the center sends out surveys, they get positive comments as well as cards and letters that inspire the staff to do even better in the future.

When physicians respond empathetically, it facilitates patients' ability to listen to brief biomedical explanations, reduces physician stress and burnout, and can make medical practice more rewarding, Morse said in the study.

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