A Model of Empathic Communication in the Medical Interview

Abstract

This empirically derived model of empathic communication has practical implications for clinicians and students who want to improve their communication and relationship skills. Based on our observations, the basic empathic skills seem to be recognizing when emotions may be present but not directly expressed, inviting exploration of these unexpressed feelings, and effectively acknowledging these feelings so the patient feels understood. The frequent lack of acknowledgment by physicians of both direct and indirect expressions of affect poses a threat to the patient-physician relationship and warrants further study.

“What concerns me is…” Expression of emotion by advanced cancer patients during outpatient visits

“…An analysis of the oncologists' behaviors in the recordings used in this study is reported elsewhere; in that analysis, oncologists responded empathically to patients' expressions of emotion less than one third of the time [42]. Research shows that when clinicians repeatedly miss patients' expressions of emotion, patients eventually cease to express emotion [56]. As the majority of the patients in our recorded conversations knew their oncologist, it may be that the patients "learned" not to express emotion by the time they were recorded.…”

“…Based on previous work [6,34,56], we defined negative emotional expression as any instance where a patient used words to describe a negative emotional state in the past, present, or future; for example, "I'm anxious about this test" or "I was feeling depressed." We identified all instances of verbal expression of negative emotion using a web-based coding software (ENCOUNTER) that allowed direct coding on the audio files.…”

“…Thus, the rates of patient cues per visit were higher compared with our study, where we solely included emotional statements. Second, because we were interested in the expression of distress, we coded only the expression of negative emotions, whereas other studies coded both positive and negative emotions [6,34,56]. Third, in our analysis, we only included "direct" expressions of emotion, when patients state a word that describes the emotion they are experiencing.…”

“…Third, in our analysis, we only included "direct" expressions of emotion, when patients state a word that describes the emotion they are experiencing. Other studies have also included "indirect" expressions of emotion, where patients allude to the presence of an emotion but do not name it directly [6,34,56]. We did not include these expressions in our analysis because we could not reliably code the type of emotion being expressed indirectly.…”

“…Unfortunately, multiple studies document that oncologists, like other medical providers, usually do not respond empathically when patients express emotion [6,34,56]. For example, a cancer patient may state, "I'm worried about these headaches."…”