Patients (and Insurers) to Doctors: More Empathy, Please!

Neil Chesanow

Disclosures

November 11, 2015

In This Article

Wanted: More Empathic Doctors

If you work in a hospital, an outpatient practice owned by a hospital, or an independent practice, or if you are a member of an accountable care organization (ACO), training in how to empathically communicate with patients may be in your future.

That's because the traditional paradigm for good bedside manner—detached concern—is now being viewed by insurers, health plans, and hospital systems as being too detached, when surveys show that patients want more interpersonal connectedness with and trust in their physicians.

However, this is not to suggest that physicians lack compassion for their patients.

"I believe that doctors, as well as other clinicians, are deeply empathic," insists oncologist James A. Tulsky, MD, chairman of the Department of Psychosocial Oncology and Palliative Care at the Dana-Farber Cancer Institute and chief of the Division of Palliative Medicine at Brigham and Women's Hospital in Boston. "I think that's the reason they go into medicine. They care about other people."

"The question," Dr Tulsky says, "is whether patients know that their doctors are feeling that empathy, and whether doctors are able to express that to a patient in such a way that the patient feels supported. That's the issue. The question is not about whether doctors lose empathy or whether one needs to unlock empathy."

A patient-centered approach to bedside manner has many benefits, studies show. It can sharpen your diagnostic skills,[1] improve compliance and therefore outcomes,[2] increase your job satisfaction,[3] reduce your risk for burnout,[3] and make it less likely that you'll be sued for malpractice.[4]

What is a patient-centered approach? And what if you aren't given to displays of feeling? Can you learn to express your empathy in ways that will resonate with patients? If you do manage to improve your skills, given the brevity of patient visits, will you actually have time to put them into practice? Let's take a look.

A Widespread Problem

Research shows that even doctors who perceive that their bedside manner is in no need of tweaking tend to see a marked uptick in patient satisfaction after just a couple of hours of empathy training.[5,6]

In one study that included 48 oncologists and 264 patients with advanced cancer, one half the doctors were randomly assigned to receive an interactive CD-ROM on responding to patients' negative emotions, including tailored feedback on the oncologists' own recorded conversations.[5] Control doctors received no training.

The results show that those who were trained used more empathic statements and were more likely to respond to negative emotions empathically than the control doctors.[5] Patients of the oncologists who received empathy training also reported greater trust in their doctors than did patients of the control oncologists.

"The big word in medicine right now is 'value,'" observes Dr Tulsky, the study's lead author. "Quality comprises two things: One is outcomes; the other is the patient experience. Health systems, particularly as there is more competition among them, are beginning to recognize that patient experience drives quality. That is what is expected by people. A key piece of the patient experience is what the encounter is like with their provider. The thing that will affect their sense of having a good experience is their sense of a clinician whom they believe understands what they're going through. That's the definition of empathy."

This focus on empathy isn't happening in a vacuum. It's part of a strategy by health systems nationwide to improve value in health care across the board. It includes investing in better information systems; introducing or expanding telemedicine services; improving customer service at every level, from admission to discharge in the case of hospitals; reducing hospital readmissions; and improving outcomes for patients with chronic conditions in outpatient settings.

Insurers are exerting economic pressure to get these results. The Centers for Medicare & Medicaid Services, for example, randomly surveys patients after hospital discharge, including how well nurses and doctors communicated with them during their stay, how responsive staffers were to their needs, how well the staff communicated with them about their medications, and how well they understood their post-hospital care needs.[7] Scores are part of a hospital's value-based purchasing program, through which payment is linked to performance.

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