If Evidence Really Mattered, Physicians Would Be More Empathetic With Patients

[tweetmeme source=”Healthmessaging” only_single=false]Is anyone else tired of hearing about how important empathy is in the physician-patient relationship?  Every other day it seems a new study is talking about the therapeutic value of empathy.  Enough already!

It’s not that I don’t believe that empathy is important, I do.  I also believe the data that links physician empathy with improved patient outcomes, increased satisfaction, and better patient experiences.

A recent study released in Academic Medicine reported that “patients of physicians with high empathy scores were significantly more likely to have good control over their blood sugar as well as cholesterol, while the inverse was true for patients of physicians with low scores.”

Finding findings from this study by Hojat et al are consistent with a 2009 study by Rakel et al which found that among patients with the common cold those with physicians displaying high empathy had a significantly shorter duration of illness and trend toward lesser severity of illness and higher levels of immune response, compared to those patient whose physician displayed less empathy.

Going back further, in a 2001 review of 25 randomly controlled studies that looked at the influence of the practitioner-patient interac­tions outcomes , Di Blasi et al concluded that:

One relatively consistent finding is that physicians who adopt a warm, friendly, and reassuring manner are more effective than those who keep consul­tations formal and do not offer reassurance.

The problem with empathy research is that no one, including doctors, seems to be any paying attention as attested to the fact that nothing has changed.  Research documenting the therapeutic value of empathy goes back at least 20 years.  Despite the evidence, it seems that physicians are no more empathetic today than when people first started researching empathy.

Today we are told the health care is supposed to be evidence –based.   I wish that was the case when it came to empathy and the physician-patient relationship.  If it were we would have a lot more empathetic physicians, healthier patients, and much more satisfying patient experiences.

What do you think?


Hojat, M. et al. Physicians’ Empathy and Clinical Outcomes for Diabetic Patients. Academic Medicine March 2011 – Volume 86 – Issue 3 – pp 359-364.

Rakel, D. et al. Practitioner Empathy and the Duration of the Common Cold.  Family Medicine, 2009;41(7):494-501.

Di Blasi, Z. et al. Influence of context effects on health outcomes: a systematic review. Lancet 2001;357(9258):757-62.


9 responses to “If Evidence Really Mattered, Physicians Would Be More Empathetic With Patients

  1. Carolyn Thomas

    Hello Stephen
    Excellent points here. This post reminds me of Canadian psychosocial research a few years back that showed (wait for it!): patients feel better when their doctors LISTEN to them.

    And yet some docs may have somehow stumbled upon this phenomenon as part of their medmal-prevention strategies. For example, in response to one of my recent posts on doctor/patient miscommunication republished on KevinMD.com – http://www.kevinmd.com/blog/2011/03/patients-blame-miscommunication-cardiac-stents.html – I received this comment from a physician:

    “The details and facts are long-since forgotten by both patient and physician, but the impression of whether the physician could be trusted to recommend the best course of action is usually long remembered. In my opinion, communicating competence, objectivity and trust can be more important than a summary of facts and statistics.”

    He made this statement in response to a very alarming study that found up to two thirds of cardiac stents are being implanted in patients who don’t need them.

    So all a doc has to do is try to COMMUNICATE COMPETENCE, OBJECTIVITY, AND TRUST – and evidence-based science can go out the window?

    I wonder if it’s too much for patients to expect BOTH empathy and medical know-how from their health care professionals?


  2. I always try to be empathetic, but how do you measure patient perceptions, especially at the point of contact? Moreover, how do we teach it to our young physicians or those for whom this isn’t their strong point?

    • Great questions.

      Most studies of physician-patient interactions involve recording the audio portion of the medical interview, including both patient and physician “utterances,” and then coding each utterance according to its’ type. An utterance for example may be coded as relationship-building, information giving, a question (open-ended, closed ended), supportive and so on. According to communication and social science, conversations between physicians and patients, like anyone else, are sequential and reciprocal. For example a question begets an answer. A statement of concern is followed by an acknowledgment such as “ok, uh huh,” etc.

      What audio analysis does is evaluate the physician-patient dialogue from a variety of different dimensions. It also allows physicians to identify their dominant communications style, (e.g.,biomedical, psychosocial, patient centered), as well as the stylistic communication preferences of individual patients (physician-directed vs patient centered. You can also see how much time is spent on a given “exchange” within a visit – say the amount of time associated with prescribing a new medication, including dosing instructions, side effects, etc. Today for example, physicians often spend < 60 seconds when prescribing a new medication to a patient. No wonder patients are non-adherent.

      Knowing this a physician can then tailor their communication style to the patient's preferred style which in turn is associated with improved outcomes, better safety/quality, improved satisfaction and so on.

  3. I think Carrie raises a good question – how do you teach empathy? Dr. Lawson points out in his article, Clinical Empathy as Emotional Labor in the Patient-Physician Relationship, that “medical students and residents can benefit from long-term regular training that includes conscious efforts to develop their empathic abilities.” However, I don’t think this is a main focus of most medical schools.

    • Darleen,

      Thanks for your thoughts! Question….what if you could be altered to “empathy cues,” like care gap alerts in EMRs based a prior knowledge captured say from the patient’s visit agenda and list of concerns (assuming you knew this)?

      Steve Wilkins

  4. I wonder if the question isn’t “Can you teach empathy?” but “Why does medical training still systematically squash empathy ?” Students are bombarded with messages that in order to be a “good” doctor, they must stay detached and not get emotional. How do you treat someone with chronic pain or paralyzed with fear at their diagnosis and NOT feel?

    Perhaps teaching doctors to objectify their patients in order to avoid to remain detached from their own emotions is at the core of a healthcare system built around what works for the providers, instead of what is best for the patients.

  5. In fact, empathy–one of the four tenets of Emotional Intelligence–can be taught. However, individuals can have high natural levels of empathy along with above average Emotional Intelligence. It would appear that training programs are not only not teaching but not selecting those individuals from the applicant pool. see http://www.talentsmart.com/test as a quick paradigm for establishing a baseline and determining the success of interventions to increase empathy and other EQ subsets.

  6. Great point Steve! And really empathy isn’t all that mysterious. A good starting point is ‘Reflective listening’ which is a technique used to get at the fundamental question ‘how does this person (speaker) see the situation?’ It has its roots in psychotherapy, but this kind of listening can applied by anyone. Interesting, reflective listening was a technique used by Carl Rogers in his therapeutic approach called ‘client-centered’ therapy. Sound familiar?

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