EMPATHY -- A CRUCIAL PIECE TO PATIENT/PHYSICIAN COMMUNICATION

There was a study published last week in the Archives of Internal Medicine that indicated many doctors don’t demonstrate empathy even when their patients seem to ask for it. This particular study examined a number of encounters where patients were being treated for lung cancer, and the physicians were either oncologists or surgeons. The researchers concluded that doctors were able to express empathy only about 10 percent of the time. Physicians appeared more comfortable discussing medical concerns and shifted the conversation away from emotional issues, including fears and anxieties about death and dying.

It would seem that discussing things like death and dying would be difficult for anyone, but studies have indicated that patients who are shown empathy are more likely to be satisfied with their care and have better knowledge about their condition. Still, empathy is not something one can learn – as they say, you either have it or you don’t. Some people, including doctors, are just better at it than others.

This whole discussion led us to thinking – what about the physicians who need to disclose and apologize following an adverse event? How difficult, in those cases, must it be to empathize with the patient and/or family member? Would an ordinarily compassionate and empathetic clinician be less so because of other complicating factors? We have identified a number of barriers to honest and compassionate communication with patients following an adverse, and possibly preventable, event. These would include the clinician’s shame, humiliation, and feelings of incompetence as well as the culture of fear surrounding the medical-legal issues. Quite simply, these discussions can be extremely uncomfortable to have.

A full disclosure and empathetic apology can be charged with extraordinary emotion, for both the patient and the physician. We would favor a “team” approach – oftentimes the expertise of someone from Social Work, Patient/Family Services, or Chaplaincy is needed. Also, the clinician directly involved may not possess the requisite communication skills. In any case, institutions need to adopt communication policies that encompass these difficult situations. They need to have clear processes and procedures in place that are understood by all providers throughout the organization. Most importantly, hospitals need to train staff, develop tools that can be accessed by anyone at anytime, and have a system of support in place for patients and families as well as clinicians.

SCRUBS IN PUBLIC -- A HEALTH HAZARD?

Given Linda's experience over the past year with MRSA (which has been chronicled in this blog) in addition to the fact that my 3 year old niece was just diagnosed, I wondered whether or not I was beginning to get "germ phobic."

There was an interesting piece in the NY Times Well Blog yesterday that deals with the issue of wearing scrubs in public places. This is something which I had never given a thought to before -- I've seen medical people wearing scrubs at the supermarket, at the dry cleaners, in the dentist's office, and all those other places that we "regular" people frequent in our daily lives. (I was probably even a little impressed up until now -- especially if they had a stethoscope hung around their neck.) Now, I'm thinking "Typhoid Mary" and looking for the quickest exit!

Seriously, though, this brings up an important point. As a clinician, do you have occasion to wear your scrubs in public? Are you alarmed when you see someone else wearing their scrubs out and about? If you're not, should you be? Is this much ado about nothing, or might there be some legitimate concern here?

Winnie Tobin

THE PATIENT IS DOING WELL!

Linda Kenney's surgery went smoothly yesterday afternoon, and she is resting comfortably this morning in her hospital room. Thank you to everyone for their best wishes and prayers!

OH MY, NOT AGAIN!!!

As many of you know, Linda Kenney, MITSS Executive Director, has a very long history of surgeries on her ankles. Well, she is headed to the hospital today for yet another unexpected surgery. If all goes according to plan, she will be in the hospital for about 3 days with two weeks on crutches after that. She is, of course, very optimistic about her recuperation period and determined not to let this take too much time out of her busy schedule.

Join us in wishing Linda a safe and uneventful surgery as well as a speedy recovery!

TOOLS FOR CONSUMERS AND PRESCRIBERS TO CURB DRUG NAME MIX-UPS

As the Quaid family tragedy illustrates (see post below), prescription drug mix-ups can have devastating consequences. Some drug names in particular are quite similar to others and can lead to confusion for both patients and prescribers. Bad handwriting, smudged ink, or a data entry mistake can change the name of one drug to something altogether different. The results can be dangerous and sometimes lethal. At least 1.5 million Americans are estimated to be harmed each year from medication errors, with name mix-ups accounting for a quarter of them.

The Boston Globe reported in a story on Tuesday that a web-based tool (http://www.usp.org/) is now available to consumers and doctors to check whether they are using or prescribing error-prone drugs and the names they might be confused with. Coming some time this fall from the Institute for Safe Medication Pratices and iGuard (an online health service) is a more patient-oriented website that will send users e-mail alerts about drug-name confusion.

The Food and Drug Administration is also piloting a program that would hold the drug manufacturers more responsible to guard against name confusion. The hope is to avoid confusing drug names before the product gets to market.