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Don't look to a doctor for understanding

September 22, 2008 |  6:00 pm

Doctors provide little in the way of empathy, even when their patients seem to ask for it, according to a study in the Sept. 22 Archives of Internal Medicine. Researchers looked at real doctor/patient encounters between 137 patients and their oncologists or thoracic surgeons from a Veterans Affairs hospital.

Doctor1 Doctors could respond to concrete concerns, such as that a patient was feeling physical pain, or was having trouble getting an appointment. But they largely ignored patients' emotional concerns -- even when that concern was an outcome of surgery, or how long they had left to live.

Here's a sample of an encounter reported in the study when the patient received the diagnosis:

"Patient: But this is kind of overwhelming, you know...I've had anxiety problems before. I go to the [mental health clinic]...

Doctor: Okay."

And if that doesn't warm your heart, here's what a physician said when a patient revealed his life story in relationship to lung carcinogens:

"Patient: ...I worked very hard when I was a young man, young boy. I was doing a man's labor and was always told I had a good strong heart and lungs. But the lungs couldn't withstand all that cigarettes...

Physician: Yeah.

Patient: ...asbestos and pollution and second-hand smoke and all that other stuff, I guess."

Physician: Do you have glaucoma?"

And when it came to delivering the worst news a patient can hear, the news that he or she will die soon, one doctor in the study had this to offer:

"Patient: I don't know what the average person does in just two years, three years, a year?

Physician: I think that you certainly could live two or three years. I think it would be very unlikely ... But I would say that an average figure would be several months to a year to a little bit more."

On average, the physicians in the study responded with empathy only 10% of the time. The oncologists were a little more caring than the surgeons, responding empathically about 14% of the time, compared with about 6% for surgeons.

The authors suggested that doctors may not respond with empathy because they're busy, and fear it would take too much time. But the study suggested that brief comments such as, "I can imagine how difficult this is," turned out not to increase the time spent with the patient. In fact, those rare doctors who acknowledged the patients' concerns and responded as though they could relate actually had shorter visits with the patients.

But, the authors wrote, talking about life and death is difficult for everyone, including doctors.

"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."

But there's hope. Studies, like one in a 2002 issue of the journal Lancet, show that physicians can learn better communication skills, including empathy.

-- Susan Brink

Photo credit: Myung J. Chun / Los Angeles Times

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