The Power of a Physician's Kind Word

Alicia Ault

Disclosures

April 10, 2019

In This Article

How to Show Compassion in the Clinical Setting

Physicians may struggle with the balance of keeping a professional distance and the desire to connect with patients on a personal level. The weight of administrative tasks, such as the EHR, is also a factor; some physicians feel that they don't have time for compassion. Others simply don't know how to convey kindness.

"I was taught in medical school to maintain a distant objectivity," said Ronald M. Epstein, MD, director of the Center for Communication and Disparities Research at the University of Rochester Medical Center, Rochester, New York. "I very quickly found that when I entered practice, that didn't lead to the kind of healing relationships that I think patients need and want," he told Medscape.

Patients want to feel seen, to feel known.

"Patients want to feel seen, to feel known," said Epstein. "If you have no capacity to enter into the patient's emotional world, they really won't feel heard," he said. It's important to hear them to help them, he said. "If suffering goes unrecognized, obviously you can't do a very good job of relieving it," Epstein said. Epstein and his colleagues teach mindfulness to physicians in an effort to improve emotional regulation and, in turn, compassion skills.

In a Manner of Speaking

The way a clinician talks to a patient helps convey compassion—or lack of it, said Epstein. Epstein and colleagues documented and defined real instances of compassion by recording conversations between oncologists and patients.[3]

The recordings were reviewed by a team that included clinicians and medical personnel with a communications or linguistics background. It became apparent "that compassion is not a quality of a single utterance but rather is made up of presence and engagement that suffuses an entire conversation," said the authors.

Clinicians expressed compassion through direct or indirect verbal statements that offered emotional resonance, softening of tone, or added emphasis, for instance.

They addressed suffering by making action statements such as "I'm going to help you through this," and they demonstrated compassion through personalization (treating someone as a unique individual), affirmation, reassurance, action, supplementary humor, non‐abandonment, and presence.

The conversations reflected a range of responses, from total absence of compassion to thoughtfulness. The authors concluded that it "confirmed others' extensive observations that physicians often respond inadequately to patients' suffering and re‐direct the topic of conversation away from the exploration of emotions."

Lack of compassion is particularly troubling for patients with advanced cancer "when medicine has relatively little to offer in terms of reversal of disease, but a lot to offer in terms of relief of suffering," Epstein said. "The research illustrated the paucity of compassion in a profession that espouses to value it."

Epstein said many physicians—oncologists in particular—may avoid getting close to a patient because they fear that it will compound a sense of hopelessness or burnout.

"But for me, at least, and for many clinicians, trying to distance yourself and denying that you have feelings and thoughts, and that it affects you in some way, sometimes takes more effort and is more elusive than just merely recognizing it and allowing yourself to experience that stress," he said.

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