Patients wonder, 'Could this be something serious?'

December 4, 2007

Nearly 4,800 patient surveys and 100 covertly recorded visits by actors posing as patients revealed that empathy is lacking in many exam rooms around the Rochester, N.Y., area – however, doctors who do convey empathy are viewed as more trustworthy.

The study, led by Ronald Epstein, M.D., professor of Family Medicine at the University of Rochester Medical Center, is published in the December Journal of General Internal Medicine. www.springerlink.com/content/fw64033k08136500/?p=dd9c18c8853a44da84328bfeaaf3e5b7&pi=14>

Epstein and colleagues observed how doctors responded when patients asked loaded questions indicating worry about symptoms involving chest pain. The study builds on previous work by Epstein’s group, in which they have described how good communication between doctors and patients, and a willingness to explore concerns, results in improved health care and lower costs.

An analysis of the doctor-patient interactions showed that doctors voiced empathy in only 15 percent of the office visits, even after repeated prompting by the patients.

“I think this study supports the notion that ‘mindfulness’ is an essential clinical skill,” said Epstein, who also directs Rochester’s Center to Improve Communications in Health Care. “Mindfulness helps the doctor understand the patient’s world to a sufficient degree, so that no matter what the doctor’s personal style is, he or she can express empathy.”

The research began with 100 consenting doctors (47 family physicians and 53 general internists) in the greater Rochester area in 2001-2002. The doctors agreed to receive two unannounced visits over a one-year period by actors trained to portray patients in a realistic and uniform way. The actors would record the visits without the doctors’ knowledge. Meanwhile, the research team also collected 10-minute surveys from real adult patients in a variety of doctors’ waiting rooms. About 96 percent of the all patients approached agreed to take the survey, yielding 4,746 completed questionnaires.

The actors portrayed two roles. They all claimed to be new patients, 48 years old, with chest pain. Some described their pain as characteristic of gastroesophageal reflux disease (GERD), while others presented more ambiguous chest pain, poorly characterized. They all took part in standard, 15-to-20-minute acute visits.

Researchers trained the actors to deliver prompts that might elicit empathy, such as “Do you think this could be something serious?” Or to say something like, “You hear a lot about cancer and heart disease, and I was worried about that.”

They used the patient surveys from the waiting rooms and transcripts of the audio-recorded exams to evaluate the doctors’ responses. Researchers characterized the responses by type, frequency, pattern, and communication style, and correlated them with patient satisfaction ratings. They also looked for signs that doctors doled out empty reassurances, were dismissive, or made statements that served as conversation-stoppers.

The most common physician response was a simple acknowledgement of the symptoms, followed by biomedical questions or medical explanations. Later, some physicians reassured the patients and suggested diagnostic tests, medications, or other treatments. Surprisingly, reassurance from the doctor sometimes increased patient anxiety, the study said.

Patients reported the most satisfaction when doctors empathized with them in challenging situations, such as when the medical answer was not clear-cut, the study said.

Few studies have noted that empathy makes a difference in health care, Epstein said. The research also spotlighted nuances about communication and behavior, such as whether the timing of empathetic statements is important, and how long it takes to voice empathy in the context of a typical office visit.

Source: University of Rochester Medical Center

Explore further: Inpatient satisfaction improved by five-minute intervention, study finds

Related Stories

Inpatient satisfaction improved by five-minute intervention, study finds

October 16, 2017
As hospitals seek to improve inpatient satisfaction, one effective way takes only a few minutes and no expensive equipment. A study at the University of Virginia School of Medicine recently found that a daily five-minute ...

Doctors gain a greater understanding of skin cancer using tattoos

September 26, 2017
Cancer is on the rise and the need to be empathetic when giving a patient their diagnosis and throughout treatment is imperative. Now, a collaborative study, with a Huddersfield professor, has enabled future doctors to experience ...

Most alternative therapies for treating autism show inconclusive benefits

September 27, 2017
Dr. Shafali Jeste knows well the desperation of a parent seeking a cure for their child with autism spectrum disorder. As a clinician who both researches the causes of the disorder and treats children with autism, Jeste, ...

Female doctors show more empathy than male doctors

September 6, 2017
Our latest research found that female doctors are better at empathy than male doctors, and this probably makes them better doctors.

Study challenges perception that empathy erodes during medical school

September 11, 2017
The relationship between a doctor and patient relies heavily on the physician's capacity to empathize with or be sensitive to a patient's emotional state. Empathy has been associated with patients' increased adherence to ...

Art courses could help medical students become better clinical observers

September 6, 2017
Observation skills are an essential component of any medical education, aiding doctors during patient exams and in making medical diagnoses, yet several studies have indicated inadequacies in this area among medical trainees ...

Recommended for you

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

Team eradicates hepatitis C in 10 patients following lifesaving transplants from infected donors

April 30, 2017
Ten patients at Penn Medicine have been cured of the Hepatitis C virus (HCV) following lifesaving kidney transplants from deceased donors who were infected with the disease. The findings point to new strategies for increasing ...

'bench to bedside to bench': Scientists call for closer basic-clinical collaborations

March 24, 2017
In the era of genome sequencing, it's time to update the old "bench-to-bedside" shorthand for how basic research discoveries inform clinical practice, researchers from The Jackson Laboratory (JAX), National Human Genome Research ...

The ethics of tracking athletes' biometric data

January 18, 2017
(Medical Xpress)—Whether it is a FitBit or a heart rate monitor, biometric technologies have become household devices. Professional sports leagues use some of the most technologically advanced biodata tracking systems to ...

Financial ties between researchers and drug industry linked to positive trial results

January 18, 2017
Financial ties between researchers and companies that make the drugs they are studying are independently associated with positive trial results, suggesting bias in the evidence base, concludes a study published by The BMJ ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.