Empathy an Especially Important Skill for Oncologists

Can be learned, like table manners

Nick Mulcahy

January 28, 2011

January 28, 2011 — Clinical empathy is an "essential medical skill" that can be learned and improved, "thereby producing changes in physician behavior and patient outcomes," according to an essay published online January 24 in CMAJ.

The skill is especially important for oncologists, the lead author of the essay, Robert Buckman, MD, PhD, told Medscape Medical News.

"Oncologists need to be better trained than most physicians — largely due to the misconceptions surrounding the word 'cancer'," said Dr. Buckman, who is a medical oncologist at Princess Margaret Hospital and a professor at the University of Toronto, in Ontario, Canada.

"Everyone thinks cancer means that you will be dead by Friday," he explained. Because of the great collective fear of cancer, patients are especially in need of empathic responses from their oncologists, he suggested.

Empathy is distinct from sympathy, which can involve an entangling of experience between the observer and sufferer, say Dr. Buckman; Gary Rodin, MD, also from the University of Toronto; and James A. Tulsky, MD, from Duke University in Durham, North Carolina.

Empathy is more of a mirroring of another person's experience, explained Dr. Buckman. He and his coauthors define it as "an accurate understanding of the experience of the sufferer leading to an attuned response from the observer."

Dr. Buckman provided an example of clinical empathy. Patients informed of cancer can respond with great fear, he said; a physician who is empathic might say, "I realize that it's a great shock."

To be empathic, explained Dr. Buckman, "you identify the emotion, the source of the emotion, and respond in a way that shows that you made this connection."

Oncologists can be poor empathists, according to 2 studies cited in the essay. In one, oncologists were videoed speaking with patients and responded to only 22% of moments thought to be an empathic opportunity. In another, oncologists responded to a mere 11% of empathic opportunities with lung cancer patients.

Empathy has multiple rewards, say the essayists. It is associated with "improved patient satisfaction, . . . as well as fewer malpractice complaints," they write, citing other research (JAMA. 1997;277:553-539).

"Good empathic responses change the perception of everything — on the patient's side but also on the doctor's side," said Dr. Buckman. He told the story of a patient of his who had advanced breast cancer and was approaching death. Dr. Buckman felt that he had "failed her." Nevertheless, he maintained empathy. "Over her last several weeks, I kept making empathic responses with her. Finally, one day, she told me, 'You did your best'." Empathy can have unexpected emotional rewards for doctors, summarized Dr. Buckman.

Empathy needs to be taught in medical school and in continuing medical education (CME), the essayists emphasize. Why has this education lagged? Perhaps because the development of empathy is considered a "mysterious and osmotic process (i.e., an intuition)" rather than an educational process, say the authors.

Learning Empathy

Empathy can be learned, and easily, said Dr. Buckman. "It is as simple as learning good table manners, which are not God-given," he said. "Someone had to teach you to eat with your mouth closed."

However, as the authors point out, medical school training gives empathy short shrift. "There is little information concerning the specific teaching of clinical empathy as a distinct technique; when it is taught, it is usually included in the curriculum covering communication skills," they write.

Until medical education, including CME, provides empathy-specific programs, clinicians keen to hone their empathy skills might turn to a recently published book.

Dr. Buckman's Practical Plans for Difficult Conversations in Medicine (Johns Hopkins University Press) comes with an accompanying DVD that provides recordings of unscripted and unrehearsed conversations with standardized patients. The clinical scenarios include demonstrations of the skills of empathy, he said.

Other potential sources of education, say the essayists, might one day include a Web-based quiz for the recertification of clinicians in practice in which different responses and their consequences are illustrated on video, as in the award-winning Crossroads section of the I*CARE Web site.

The hit film The King's Speech offers some instruction in empathy, said Dr. Buckman. "The speech therapist character, played by Geoffrey Rush, spoke to the King as if he was an ordinary human being." The same challenge applies to physicians with all their patients — to be aware that patients have a condition but respond to them as if they are ordinary individuals, he summarized.

Dr. Buckman reports receiving an honorarium for his lectures of physician communications skills from a variety of organizations, such as Cancer Care Ontario.

CMAJ. Published online January 24, 2011. Abstract

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