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.