Doctors are routinely missing or ignoring moments that beg for empathy and need more training in responding to human emotions, an article in Canada's leading medical journal says.
Researchers from the University of Toronto and Duke University in Durham, N.C., say studies suggest doctors fail up to 90% of the time to respond to emotional cues from their patients.
"Empathy is the ability to understand another's experience, to communicate and confirm that understanding with the other person and to then act in a helpful manner," the authors write in the Canadian Medical Association Journal.
But, in real practice, doctors "infrequently articulate" empathetic responses, they say.
The team points to a recent study, published in the Archives of Internal Medicine, in which researchers analyzed 20 transcripts from recordings of 137 consultations between doctors at a U.S. Veterans Affairs hospital and patients with lung cancer.
In all, 384 moments or "empathetic opportunities" when patients expressed fears, worries or concerns were identified. Physicians responded empathetically to only 39 of them, or 10%.
In one exchange, a doctor tells a patient with biopsy-confirmed lung cancer that most likely the entire lung will need to come out.
"All right?" the surgeon asks.
Patient: "OK. That's the darkest picture."
Physician: "Yeah. That's the darkest and the most likely."
Another study, this one involving nearly 400 videotaped conversations between 51 oncologists and 270 patients with advanced cancer, found doctors responded only 22% of the time during moments when patients expressed emotions such as "I've got nothing to look forward to."
"For about 80% of the time, doctors don't know how to acknowledge emotions," says Dr. Robert Buckman, lead author of the article.
Dr. Buckman, an oncologist at Princess Margaret Hospital and the University of Toronto's faculty of medicine who lectures regularly on doctor-patient communication, says that when doctors respond with empathy, patients have less anxiety and depression. They're more likely to comply with treatment and less likely to lodge malpractice complaints.
But training around communication and empathy has lagged behind education in other areas.
"We come into medical school and we're probably quite normal human beings," says Dr. Buckman.
"Unfortunately there is so much to learn that, in some respects, maintaining the human being stuff gets beaten out of you, because you've got to learn the nine different kinds of associations with parathyroid hormone over secretion, or the 20 different causes of hypercalcemia.
"It's really important that you do know that, but it's also important that you learn how to acknowledge human feelings."
Doctors fear that empathy "is something you're born with — either you are empathetic, or not," Dr. Buckman says. "That is rubbish. Empathetic communication is something you can learn," in as little as a half-day workshop, he says.
He teaches medical students and doctors how to identify the emotion and its source. "Then you make a response that shows you've made the connection — 'What I've just told you is obviously very upsetting,' or, 'That comes as a bad shock, doesn't it?' "
There's no ideal script, he says. "There's probably 80 different ways you can phrase the words. All you have to do is see what the emotion is, see where it started and show the other person that you've made the connection."
Lisa Machado, a 38-year-old mother of two, was diagnosed with chronic myeloid leukemia just over two years ago. "A cancer diagnosis can be pretty devastating," she says.
"Even though … it's highly treatable, and I've got medication and it's working, it has been so critical for me to have a doctor where I can just go in and sort of go down those dark roads."
Doctors miss "a whole piece of the patient by not dealing with the scary things that go through your mind," she said. "Whether your fears are rational or not, they're still very real."
