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Adventures in Empathy: “Nope, I Don’t Feel Your Pain”

Posted Sep 28 2008 11:15am

Patient: This is terrible.  I am overwhelmed.  I don’t know if I have one year to live, two years or what.

Doctor: Okay.  Do you have glaucoma?

I remember working as a tech at St. Whatever Memorial Hospital a bunch of years ago where I often felt the callousness and lack of empathy shown toward patients by jaded staff members was epidemic.  Patients were referred to by their diagnosis and bed numbers, not by their names. Mrs. Johnson became the “lung cancer in room 4″ and Mr. Preston was the “congestive heart failure in room 6.”  Now, there is actually some documentation of this attitude among medical physicians toward cancer patients.

People struggling with lung cancer reach out for some compassion from their doctors – these are called “empathic opportunities.”  What the researchers in one study discovered was that doctors generally ignored these moments. Questions about morbidity (being sick), and mortality (dying) were addressed less than 10% of the time. Listening to transcripts and recordings of 20 conversations between men with lung cancer and their doctors, Researchers at the University of Rochester School of Medicine identified moments when a doctor might respond with a few words to address patient concerns ranging from fear of illness and death, to mistrust about care and the health care system, to confusion about treatment. When doctors did not respond to initial opportunities to be empathetic, patients would try repeatedly, throughout the rest of the visit, to elicit that support in some way.  Physicians missed nearly every opportunity to respond with compassion.

Lack of time, failure to recognize empathic opportunities because they are attending to other tasks such as making a diagnosis, a sense of failure when there is limited potential for a cure, or a physicians own vulnerability to illness and dying were all listed as possibilities for the physician’s actions.

Sadly, the authors state that physicians often start medical school with empathy for their patients, and only later learn to detach.  Sure, being empathic all the time could be exhausting — remember that empath on Star Trek: TNG?  She was always tired and rather annoying from sensing everyone’s feelings.  But studies actually suggest that rather than draining a physician’s emotions, providing empathy is actually a way to prevent burnout and lessen stress. Furthermore, expressing empathy can be taught and these statements can be brief and powerful, not prolong the encounter or necessarily changing a physician’s style.

Some physicians argue that they don’t lack empathy, they just have difficulty expressing it.  Well, patients don’t require extensive counseling or endless dialogue from non-mental healthcare providers.  A few, well-placed phrases of interest and concern go a long way.  Substitute a “That must be really hard for you” for some of the usual statistical references.  Slipping in a “tell me a bit of what you’re going through” in place of a discussion of blood lab values might go a long way.

Do you sense lack of empathy in your own physician or are you a doctor who finds yourself cutting off emotional conversations with patients? How would you advise others that feel a lack of empathy from their own doctors?

Source:  Morse et al. Missed Opportunities for Interval Empathy in Lung Cancer Communication. Archives of Internal Medicine, 2008; 168 (17): 1853 DOI: 10.1001/archinte.168.17.1853

Rochesterchiro - The Skeptical Chiropractor - is written by Dr. Brett Kinsler.

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