A study from Duke University reveals that oncologists who hear an expression of emotional concern from their patients respond with an empathic statement only 22% of the time. In other words, patients who share feelings of distress such as anger, discouragement or fear with their doctors are likely to receive no recognition of their suffering nor any emotional support in return. As a medical oncologist I find this embarrassing.
By identifying how seldom oncologists provide empathic support to patients, the study illuminates the potential benefit of teaching such skills to doctors. Previous research has shown that patients who receive empathic responses (called “continuer statements,” as opposed to “terminator statements”) experience less anxiety. In one study cancer survivors who watched videotapes of physician-patient encounters, with and without just 40 seconds of compassion expressed by the physician, rated the empathic doctors as “warmer and more caring, sensitive, and compassionate.” The study participants also reported less anxiety after watching the “enhanced compassion” tape. Listen to the introduction to the Duke study, published in the Journal of Clinical Oncology:
Cancer care involves addressing patient emotion. When patients express negative emotions, empathic opportunities emerge. When oncologists respond with a continuer statement, which is one that offers empathy and allows patients to continue expressing emotions, rather than with a terminator statement, which is one that discourages disclosure, patients have less anxiety and depression and report greater satisfaction and adherence to therapy.
The senior author of the study, Dr. James A. Tulsky, director of the Center for Palliative Care at Duke University Medical Center, summarizes the problem in a New York Times article about the project:
“It is absolutely the role of the oncologist to provide a bit of emotional support.”
“One doctor who was especially good with patients, and who often consulted on very serious cases, opened discussions with new patients by saying, ‘Tell me what you understand about your illness,’” Dr. Tulsky said. By contrast, with other doctors, Dr. Tulsky said, “There were a number of times when patients brought up emotional content and it went right by the doctors.”
“For instance, a patient would say, ‘I’m scared,’ and the doctor would go off on a ‘scientific riff’ about the disease. We saw that a lot. The doctors don’t lack empathy,” he said. “They just have trouble expressing it.”
As suggested in the article, patients should not feel ashamed to express feelings of distress, which can often be assuaged with a few words of kindness and encouragement. Sometimes oncologists need to be reminded that the body sitting before them is not a tumor host but a living being, filled with the same emotions that abound in all living beings, including doctors who one day will certainly find themselves sitting in a similar chair that their patients fill at this moment.