A new study this week found that doctors often miss opportunities to express empathy to their patients. Does this mean doctors don’t care? Or could it be they just don’t have the time?
In her latest “Doctor and Patient” column, surgeon Dr. Pauline W. Chen writes about the new research and her own experiences talking — and empathizing — with patients.
Read the full column here, “Taking Time for Empathy,” and please share your thoughts with Dr. Chen below.
For more from Dr. Chen, listen to the Best of Well podcast below to hear our conversation about the new “Doctor and Patient” column and her reaction to the hundreds of reader comments she has received so far.
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I read this article before noticing who the author was. Of course, it was no surprise to me that this piece was written by Dr. Chen who I have respected and admired since I received a copy of “Final Exam” at my white coat ceremony.
She is, once again, right on point. I’m lucky enough to have had some amazing physician mentors who have demonstrated by their interactions with patients the many benefits of opening the door to the exam room with empathy.
When a patient feels that they are not being heard, they continue to voice their concerns. A patient who is heard and has his concerns addressed doesn’t need to focus on issues that have already been covered. An effective physician can understand what those concerns are and address them so that the encounter with the patient is both satisfying, successful, and efficient.
Patients don’t want to be in the office any longer than they have to be. But they don’t want to leave feeling as if they wasted the time they did spend with the doctor.
— LizI fully believe that doctors can take the time for empathy. Truthfully, that could mean that some people may be waiting two or three more minutes in the waiting room. But you know what, when they get in, if the doctors is empathetic with them as well, I bet they would believe they received better care than had they gotten in on time and simply been rushed out.
— Emily“We had finished our visit in time, and it was, I believe, worth every minute.”
Putting first the fact that the visit finished in time completely undercuts the rest of the the sentence. If you had run overtime, it would have been worth the extra time. Finishing on time, there was no extra cost to you.
— Lisa H.I think empathy is absolutely essential and personally it has also made the differnece between trusting a doctor completely vs. being ambivalent about their advice.
A small incident, nowhere as devastating as canccer. We had a miscarriage in our first pregnancy and while my gynaecologist in New York was completely honest and also told me that there was no guarantee of a successful pregnancy the next time, I still felt much calmer and reassured as he had taken a few minutes to listen to us. So when I was told by the same doctor 20 weeks into my successful pregnancy that the ultrasound scan had shown the presence of a choroid plexus cyst on the baby and detailed outcomes - the worst being Trisomy 18 we were still fairly calm and able to deal with it. All ended well but needless to say I miss my doctor now that we have moved to London.
The same applies to our paediatrician in New York. We looked upon her as not only as a doctor but our guide and counsellor in our parenting journey. A few minutes - but they make a crucial difference to the patient.
— SJThank you, Dr. Chen, for sharing what for many health care providers is the meat that feeds their souls. The value of the therapeutic relationship cannot be underestimated. In nursing this is a core value taught by design from many different perspectives. In medicine the skill of developing the therapeutic relationship should also be taught by design rather than left to chance and warm caring personalities.
— Kathy Matthews, DNP, FNPDr. Chen’s book, “Final Exam,” should be re-quired reading for everyone in medical school and nursing school and social work school. It might be sub-titled: “Do unto others….”
— Cynthia BurkeDoctors and other health care providers certainly have time for empathy - it can easily be incorporated into the normal medical dialogue that takes place during an appointment. A ten-second statement like “these symptoms must be very difficult for you to deal with” can dramatically improve the outcome of a doctor-patient encounter.
That being said, the primary point of a medical appointment in most instances is to treat and prevent illness. Emotional support can come from many non-medical sources, and health care providers cannot fulfill every single need of a given patient in a ten-minute appointment.
— Tom McDonaldSeveral years ago I was seen for a second opinion at Sloan-Kettering. I was fortunate enough to be seen by not only a competent , and dedicated physician Dr. Elisa Port, but a kind one as well. She wasn’t only professionally nice, she was naturally nice and despite being incredibly busy , she made me feel that I was an important patient and she gave me the time I needed to understand and ask questions. Later in the waiting room I overheard other patients praising her skills and her empathic understanding as well. There are a lot of great doctors out there who embody both great medical skills and kindness. When patients are confused and scared a kind gesture or some extra time really does make all the difference.
— edAn interesting question.
While I tend to agree that if you simply connect with the patient on a human basis, the need to go out of your way to express empathy disappears, I would say that if you do the “decent” thing in these cases, you are certain to run a bit behind. If, on the other hand, you act like a piece of cardboard, you are likely to stay on schedule.
Two other points - the doctor must always remain on his guard for “time vampires,” who will suck him dry, and take an entire afternoon, if they are allowed to. These people require a practiced indifference, which keeps the doctor from getting “hooked” and held against his will.
Also, I believe that there are a large number of docs out there who are, quite simply, incapable of empathy, and who, therefore, will never express it.
I, myself, have been more or less drained of empathy (used to be a “bleeding heart”) by years of EMS and medicine (can’t even really feel it for my own family), but I can fake it well, so my patients tend to like me, and feel that I have heard and absorbed their concerns.
— EricI don’t think it’s just a matter of time, but emotional energy. Imagine dealing every day with multiple patients’ sense of loss, anger, etc. Doctors are not trained psychiatrists, though maybe they should be. I don’t think doctors have an obligation to be more empathetic but I think they do have an obligation to have someone present who has the skills to help the patient and their families through bad news. Let the doctor do what they do best — diagnose the patient — and then let the counselors do what they do best.
— JillEmpathy would be great. But that would seem such a luxury given that, at least judging from my own experience, not being condescended upon is not something that can be taken for granted. On my last visit to a doctor, he interrupted every sentence I tried to say, insinuated I was naive, exhibited impatience when I didn’t answer a question within a couple of seconds, my legitimate concerns and skepticism were flippantly dismissed (rather than addressed, that is) and generally left the impression that he could not stand to have the meeting last a nanosecond longer than it absolutely had to be. We are all conditioned to lower our expectations
— zippymaI know it wasn’t the intent of the author, but reading this piece made me laugh. How like an enlilghtened despot is this doctor. Or a junior executive with a difficult client. Here is a guy who is dying of liver cancer and the doctors is trying to deliver a modicum of ‘empathy’ along with the bad news without ‘opening the floodgates’ (taking too much time). What is the most cost effective way to do this? The fact that it is actually more efficient to deliver small, time effiicient doses of human concern throughout the visit just works so well within the whole time management, cost efficiency, business paradigm that is the world of modern medicine. It actually pays to care. Who knew?
— pat krierI just spent the past year taking care of my father who was in and out of “privatized” city hospitals and the Veterans Hospital. My father suffered from a degenerative disease; hospital visits consisted mostly of pain management and attempts at improving quality of life. From my observation the doctors at the privatized hospitals showed a lackluster attention to a patient’s emotional well being and displayed “zero” empathy, instead deferring to social workers who essentially tote the hospital’s party line in selling more services or are more concerned with extracting more money out patients. On the other hand when my father was in the care of the Veteran’s Hospital the quality of care (including the level of doctor empathy) was dramatically different. They were genuinely concerned with all levels of patient care and understood how the emotional well being of patients are just as important as physical well being. I place the blame squarely on the nickel and dimming of privatized hospitals and insurance companies. Doctors act more like used car salesmen instead of professional medical personnel. In the VA the doctors first concern is treating the patient; they don’t have to worry about a “money first corporate admin” coming down on them if the patient can’t pay for treatment. This allows Doctors to be “Doctors” and allows them to have some level of “empathy”. Its emotionally difficult to ask someone to display empathy with a patient when in the same breath they have to be a used car salesmen.
— DonI, personally, empathize with my doctors when I finally have face-to-face encounter with them. It is clear that with my program that my doctors have too many patients to actually recognize them.
If I were richer then perhaps I would be afford to have entrance into a less burdened practice.
When I fill out the stupidly repeative forms required whenever I go into still another office, I smile when I see the line saying “Family physician”. Who in the US now has a “family phsician” who actually is aware of the persons in your family unit and the structure of the family? What an out-of-date term!
Perhaps a little bit less high-tech and need to pay for expensive medical machines and a little more emphasis on the whole person and their family situation might have a much better overall result.
How about at least a computer card with all of this boilerplate information for the individual patient so that you are not handed still another clipboard and asked the same, same information each time you see another doctor?
— Mary in MiamiIt is heartening to see Dr. Chen blogging. One need only read her book, Final Exam, to acquire a sense of how remarkably well she communicates important ideas.
One hopes that physicians who have the ability to empathize with their patients would find doing so a satisfying part of therapeutic practice. That said, I see no reason to expect physicians priori to be more skilled in expressing empathy than any other segment of the population–unless doing so become an integral part of their training.
Empathy, as perceived by a patient, may be a simple as having the physician sit down for a few minutes, listen, and simply acknowledge a patient’s feelings of vulnerability.
— AlanMany physicians are simply not empathic — or as some would have it, empathetic.
Empathy as well as other important traits, characteristics, strengths and weaknesses are not routinely assessed or even much taken into consideration in choosing medical students. Neither, more concretely, is hand-eye coordination, taken into consideration. And that is a big and sometimes costly mistake. For patients, as well as physicians.
In any case, it’s true, expressing empathy needn’t take forever; it can be expressed in an instant — if one is an empathic individual to begin with.
— Lee KarrIt seems to me that it was the note from the daughter that informed Dr Chen’s memory and her narrative of ‘empathy.’ The daughter is beloved throughout the essay because she is the one who successfully expressed empathy for Dr Chen when she wrote the doctor a thank you note. In other words, this essay is about the empathy of the daughter, not the empathy of the doctor. The best prose is also written by the daughter, not the doctor. The prose of the daughter comes from love. The prose of the doctor reflects the mind of a scientist –for her, expressions of empathy are valuable they are efficient. For the daughter love enables her to take care of the doctor as well as her father. The doctor could not take care of the tumor, but the daughter loved her anyway.
— LauraDr Chen
When you saw the patient, he not only had his scans available to you for you to see but also had a known diagnosis of liver cancer. How else could his daughter have researched his condition? All he came to you for was a simple ‘yes’ or ‘no’ to answer the question as to whether the tumour was operable.
I fully agree with you that empathy is extremely important and I do my best every day to listen to my patients and answer their questions - but answer me this: what else did you have to discuss apart from that operation question? Of course you had time to be empathetic! Were you addressing any of his co-morbid illnesses, reviewing his medications, organising home health or other services for him, making phone calls to other consultants, any of that? Or did you say hello, look at the scan, agree the answer was no and dictate your note? What does that take, ten minutes?
I realise I am presuming he had at least a primary care doctor or an oncologist to continue his care and you were acting in a consulting role, and I apologise if I have that wrong and you were dealing with more than you have described. I’m glad you brought up this topic but it would have been far more valuable if you had described the more typical scenario - rushing to gather all the evidence, sifting through a long and complicated history, dealing with uncertainty in your differential diagnosis, calling various other consults/services/insurance companies, and still hearing the concern and worry in a relative’s voice and most important, running over time by however how it takes even at the expense of the next patient so you can address it.
From Pauline Chen: Yes, I described only one clinical scenario, but I still think Dr. Morse’s work probably has implications for other situations.
What I found particularly compelling was that for doctors in the study, acknowledging a patient’s concern and worry throughout a visit (rather than, for example, acknowledging only at the end of the visit or changing the subject altogether) did not necessarily require more time.
— Sarah Mooney MDThere should be no “time” allotted for empathy. Empathy is a process, and if a doctor has to deliver horrendous news, the empathetic process begins as the doctor walks in the door and faces the patient. If the patient is given a chair and the doctor faces the patient eye-to-eye instead of standing above the patient looking down, their common humanity helps the patient bear the weight of the news.
My doctor had the closed chart in his hand, in case I had detailed questions, but he spoke to me as a fellow human (who cleverly understood that I would not grasp much after he said the word, “cancer”). I was saying to myself, “So this is what it’s like when you hear about real cancer”. He told me where I could learn more, assured me he would do his very best to cure me, waited for questions, and gave me a few minutes alone to be composed when the nurse came back into the room.
The nurse knew that I had heard bad news, and just barely touched my hand for a moment - another human gesture which was very kind. No words were necessary, and anything more might have been embarrassing. Perky would have been surreal. Then she quietly began the business tasks of scheduling tests, surgery, lab work, etc. She repeatedly said “we”, as did my doctor, meaning that I was part of the team beginning the process to try to heal me.
I left the office knowing that both the doctor and the nurse were distressed about the news as one would feel badly when a friend has terrible trouble. I also knew that they are concerned for my well-being and that they would use all the resources at their disposal to try to help me.
Throughout the course of my treatment, I have known that they were available for questions, but I have had surprisingly few questions because they anticipated my concerns at each step.
From Pauline Chen: Your doctor and nurse are inspiring.
— EdgarEarly on a Sunday morning I went to the frony door to pick up my TIMES — went back to my bedroon with toast and coffee and. the paper; selecting from the many sections. I was 38…
Feeling pressure on my chest, not pain –never pain, I noted the time. It went away in 10″; then returned in 10″. It continued… Being alone and having many relatives who suffered from cardiovascular conditions…
I figured that I should get to an emergency room ASAP. I took a cab… I went as a precaution — but, when I got to the street, I was soooo tired. Probability of having an M. I. went from 10% to 50%
It was a myocardial infarction!!! Assigned a young cardiologist by lottery — i.e., whoever was available. Out of ICU on two dayss; home in two weeks — i had indeed survived.
But, the cardiologist was young, cold and seemed to treat me as an object.
That was over teo decades ago — but, I saw him as an out-patient only once; a friend referred me to another physician
whom I have seen since. My knowledge and intuition tell me that he knows what he is doing; and is cutting edge [OUCH--cutting!].
Not patronizing at all we seem to share similar interests — the opera, politics, fine restuarants…. We relate as peers — though he obniosly knows much more than I will ever know about his speciality. He is a mensch and I suspect that I am.
Competence, not patronizing, and giving you the illusion that you have as much time as you wish. And, he seems to care.
I have been asymptomatic for over 25 years.
I actually look forward to seeing him in his office about three times ever two years; and, at the Metroplitan Opera… This is a good sign.
I think I am giving good advise which must be modified given each individual’s needs — I suspect that my comments are especially useful in the area of selecting a mental health professional.
— David Chowes, New York CityHate to be cynical but of course doctors do not have time for full empathy. Neither do parents?
The existential reality is that we all have empathy needs that are limitless. In the end we are indeed alone. That is why God was invented.
But as humans and hopefully especially as doctors and as parents we do our best to give what we can.
— Dr. Rick LippinDoctors must see that there are other ways to be empathetic. After a breast biopsy ( it turned out I had cancer) I was asked to wait in a small room to hear the verdict. The room was entirely bare except for some shelves, two chairs and a table. On the table was a breast prothesis. It was agony to sit there, staring at the prothesis, awaiting the results of my biopsy.
— JaneYou cannot teach empathy, just like you cannot teach love. Either you have it and feel it, or you don’t. Many people have unrealistic expectations from their physicians. They are professionals, not priests. (BTW, imagine how your priests will treat you if there is a 5-minute limit on confession time and a $20 co-pay). I think it’s pretty good if the doctor can address your concern, appear to listen, and be able to explain the facts to you without talking down on you. Everything else is an icing on a cake that only can be found in boutique practices in the UES.
— NYCRealistI sorely miss the empathy of my now retired doctor who had been our care giver for 25 years. This past Spring I spent 27 days in the hospital, had five operations and was diagnosed with ovarian cancer. My primary care doctor, who was apprised of all of this has offices across the street from the hospital. Not once did he or his office so much as call me to show any interest or sympathy. I have
been going through chemo etc for months and have yet to
hear a word from him. I sure don’t feel good about putting
his name down as my Primary care doctor even on forms.
There will need to be a line for “no care” doctor.
— TinaWhat a great selling point for doctors — empathy won’t cost you time/money in the long run! Makes it pretty clear what their priorities are.
— SKV