“Could this Be Something Serious?”

Abstract

BACKGROUND: Previous work suggests that exploration and validation of patients' concerns is associated with greater patient trust, lower health care costs, improved counseling, and more guideline-concordant care. OBJECTIVE:To describe physicians' responses to patients' worries, how their responses varied according to clinical context (straightforward versus medically unexplained symptoms [MUS]) and associations between their responses and patients' ratings of interpersonal aspects of care.DESIGN: Multimethod study. For each physician, we surveyed 50 current patients and covertly audiorecorded 2 unannounced standardized patient (SP) visits. SPs expressed worry about "something serious" in 2 scenarios: straightforward gastroesophageal reflux or poorly characterized chest pain with MUS. PARTICIPANTS:One hundred primary care physicians and 4,746 patients. MEASUREMENTS:Patient surveys measuring interpersonal aspects of care (trust, physician knowledge of the patient, satisfaction, and patient activation). Qualitative coding of 189 transcripts followed by descriptive, multivariate, and lag-sequential analyses. RESULTS:Physicians offered a mean of 3.1 responses to each of 613 SP prompts. Biomedical inquiry and explanations, action, nonspecific acknowledgment, and reassurance were common, whereas empathy, expressions of uncertainty, and exploration of psychosocial factors and emotions were uncommon. Empathy expressed during SP visits was associated with higher patient ratings of interpersonal aspects of care. After adjusting for demographics and comorbidities, the association was only statistically significant for the MUS role. Empathy was most likely to occur if expressed at the beginning of the conversational sequence.CONCLUSIONS: Empathy is associated with higher patient ratings of interpersonal care, especially when expressed in situations involving ambiguity. Empathy should be expressed early after patient expressions of worry.

Communication skills training enhances nurses' ability to respond with empathy to parents' emotions in a neonatal intensive care unit

“…This result is consistent with previous studies on cancer patients, which demonstrated that physicians and nurses rarely respond to patients' emotions with empathy 6, 7, 8, 9, 10. After the course, the nurses responded to 54% of the patients' emotions with empathy, meaning that the use of empathic responses more than tripled.…”

“…In another study, oncology physician assistants, nurse practitioners and nurse clinicians responded to patients' emotions with empathic language 30% of the time 8. Similarly, physicians responded to empathic opportunities during routine primary care and surgery office visits in 15–21% of primary care cases and in 38% of surgical cases 9, 10.…”

“Speaking-for” and “speaking-as”: Pseudo-surrogacy in physician–patient–companion medical encounters about advanced cancer

“…This can be done by interrupting the visit momentarily to seek the patient’s perspective on a companion’s statement, perhaps by asking the patient, “Have you had a chance to talk together about this?,” “Tell me what you’ve been thinking,” or saying, “It’s only natural for people to have different perspectives about these kinds of things, especially as things change.” Open communication will hopefully result in shared attentional focus, voicing of multiple perspectives, greater patient participation in deliberations and decisions, determination of the degree to which there is agreement among the parties, and avoidance of implicit assumptions about the patient’s values and preferences. (10, 12, 30) Executing this simple action, like any new communication behavior, requires awareness and training: physicians must recognize in-the-moment when a companion is speaking on behalf of a patient; decide whether this particular instance will influence decision-making; and ultimately create a “multipartial alliance” between all parties, while still prioritizing the interests of the patient.…”

The Listening Practices of Exemplary Physicians

“…When physicians offer empathy, encouragement, and active help, patients are more likely to feel that their physicians are trustworthy and supportive. Feeling responded to with empathy was found to be distinct from being given reassurance, which may paradoxically raise the patient's anxiety (Epstein et al, 2007).…”