When Musculoskeletal Clinicians Respond to Empathetic Opportunities, do Patients Perceive Greater Empathy?

Abstract

Background Patient use of verbal and nonverbal communication to signal what is most important to them can be considered empathetic opportunities. Orthopaedic surgeons may have mixed feelings toward empathetic opportunities, on one hand wanting the patient to know that they care, and on the other hand fearing offense, prolonged visit duration, or discussions for which they feel ill prepared. Evidence that action about empathetic opportunities does not harm the patient's experience or appreciably prolong the visit could increase the use of these communication tactics with potential for improved experience and outcomes of care. Questions/purposes Using transcripts from musculoskeletal specialty care visits in prior studies, we asked: (1) Are there factors, including clinician attentiveness to empathetic opportunities, associated with patient perception of clinician empathy? (2) Are there factors associated with the number of patient-initiated empathetic opportunities? (3) Are there factors associated with clinician acknowledgment of empathetic opportunities? (4) Are there factors associated with the frequency with which clinicians elicited empathetic opportunities? Methods This study was a retrospective, secondary analysis of transcripts from prior studies of audio and video recordings of patient visits with musculoskeletal specialists. Three trained observers identified empathetic opportunities in 80% (209 of 261) of transcripts of adult patient musculoskeletal specialty care visits, with any uncertainties or disagreements resolved by discussion and a final decision by the senior author. Patient statements considered consistent with empathetic opportunities included relation of emotion, expression of worries or concerns, description of loss of valued activities or loss of important roles or identities, relation of a troubling psychologic or social event, and elaboration on daily life. Clinician-initiated empathetic opportunities were considered clinician inquiries about these factors. Clinician acknowledgment of empathetic opportunities included encouragement, affirmation or reassurance, or supportive statements. Participants completed post-visit surveys of perceived clinician empathy, symptoms of depression, and health anxiety. Factors associated with perceived clinician empathy, number of empathetic opportunities, clinician responses to these opportunities, and the frequency with which clinicians elicited empathetic opportunities were sought in bivariate and multivariable analyses. Results After controlling for potentially confounding variables such as working status and pain self-efficacy scores in the multivariable analysis, no factors were associated with patient perception of clinician empathy, including attentiveness to empathetic opportunities. Patient-initiated empathetic opportunities were modestly associated with longer visit duration (correlation coefficient 0.037 [95% confidence interval 0.023 to 0.050]; p < 0.001). Clinician acknowledgment of empathetic opportunities was modestly associated with longer visit duration (correlation coefficient 0.06 [95% CI 0.03 to 0.09]; p < 0.001). Clinician-initiated empathetic opportunities were modestly associated with younger patient age (correlation coefficient -0.025 [95% CI -0.037 to -0.014]; p < 0.001) and strongly associated with one specific interviewing clinician as well as other clinicians (correlation coefficient -1.3 [95% CI -2.2 to -0.42]; p = 0.004 and -0.53 [95% CI -0.95 to -0.12]; p = 0.01). Conclusion Musculoskeletal specialists can respond to empathic opportunities without harming efficiency, throughput, or patient experience. Clinical Relevance Given the evidence that patients prioritize feeling heard and understood, and evidence that a trusting patient-clinician relationship is protective and healthful, the results of this study can motivate specialists to train and practice effective communication tactics.

CORR Insights®: When Musculoskeletal Clinicians Respond to Empathetic Opportunities, do Patients Perceive Greater Empathy?

“…In this month’s Clinical Orthopaedics and Related Research ® , Pierson et al [2] reviewed transcripts of musculoskeletal consultations and found that when physicians responded to opportunities to show empathy during office visits—supporting patients who shared concerns about their conditions or described how their lives were affected by those conditions—those office visits were not substantially longer. Efforts like these are important; clinicians, including orthopaedic surgeons, need to consider how psychosocial factors might affect how patients experience and recover from trauma and other musculoskeletal conditions.…”

“…Based on findings like those, amplified by the discoveries by Pierson et al [2] in this month’s CORR ® , surgeons might consider challenging themselves to look out for empathetic opportunities in their consultations. They can be reassured that it won’t take long and has the potential to help their patients.…”

“…The team that wrote this paper [2] showed that in most consultations, patients offered empathetic opportunities, so clinicians can now look out for these in their own practice and seek to engage with them. For clinicians still concerned that acknowledging empathetic opportunities results in a longer consultation time, I hope they are reassured that the average duration reported in this study was just 13 minutes!…”

“…Julia Blackburn MD 1 Where Are We Now? I n this month's Clinical Orthopaedics and Related Research ® , Pierson et al [2] reviewed transcripts of musculoskeletal consultations and found that when physicians responded to opportunities to show empathy during office visits-supporting patients who shared concerns about their conditions or described how their lives were affected by those conditions-those office visits were not substantially longer.…”