Primary Care Research

Physicians should empathize with patients who are worried that their symptoms may indicate something serious

Patients who visit their doctor for common symptoms sometimes express worry that the symptoms could indicate something serious. Patients are more satisfied with their care when doctors empathize with their concerns. Although doctors commonly reassure these patients, they less often express empathy, acknowledge uncertainty about a diagnosis, and explore emotions, reveals a new study.

Ronald M. Epstein, M.D., of the University of Rochester, and colleagues surveyed 50 current patients and covertly audiorecorded 2 standardized patient (SP) visits for each of 100 primary care doctors from a large managed care organization. The SPs are actors trained to pose as patients with particular symptoms.

The SPs in 613 SP prompts expressed worry about "something serious" in 2 scenarios: chest pain characteristic of gastroesophageal reflux disease (GERD) or poorly characterized chest pain with medically unexplained symptoms (MUS). In both scenarios, if physicians expressed empathy, it was most likely to occur at the beginning of the conversation, and tended to facilitate further questions about the patient's condition. In contrast, physician action, such as proceeding with the physical exam or prescribing a medication tended to close down the discussion, leading to a change of topic. Overall, physicians responded to the patient's worry that they may have "something serious" with acknowledgment of their concerns (40 percent), additional clinical questions (17 percent), medical explanation without reassurance (11 percent), reassurance with or without medical explanation (10 percent), and empathy (6 percent).

Empathy was significantly associated with higher patient ratings of interpersonal aspects of care, but only when the standardized patients portrayed the more complex MUS scenarios—situations that tend to be associated with uncertainty and higher patient anxiety. The study was supported by the Agency for healthcare Research and Quality (HS10610).

More details are in "'Could this be something serious?' Reassurance, uncertainty, and empathy in response to patients' expressions of worry," by Dr. Epstein, Taj Hadee, M.D., Jennifer Carroll, M.D., M.P.H., and others, in the December 2007 Journal of General Internal Medicine 22(12), pp. 1731-1739.

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