The Cheerful Oncologist

“I Feel Your Pain. Now, Getting Back to Your Co-Pays…”

Posted by Craig Hildreth on January 8, 2008
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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.

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Comments

  1. #1 Dave Briggs
    January 9, 2008

    We saw that a lot. The doctors don’t lack empathy,” he said. “They just have trouble expressing it.”

    I think the doctors should pursue bedside manner as a career goal, but I wonder if maybe sometimes they don’t empathize because it opens them up to their own emotions of vulnerability and mortality?
    Dave Briggs :~)

  2. #2 laura
    January 9, 2008

    “For instance, a patient would say, ‘I’m scared,’ and the doctor would go off on a ‘scientific riff’ about the disease.”
    They must have watched my doctor.

    Worse is when he dismisses my fears by saying things like: “you know, you’re probably cured.” Yes, I realize that the statistics are in my favor, but I’m still scared. Yes, I’m glad my 3cm tumors didn’t travel into my lymph nodes, but that doesn’t make me crazy for worrying. but you seem to think that I’m not only a whiner, I’m also a wimp. At least acknowledge that there’s a good reason that someone with stage II breast cancer, after six months of chemo and two surgeries, would be worried. Let me have my fear without guilt!

    BTW doc, I have a strong suspicion that you’d be on the winning end of this study. You write the most compassionate blogs about cancer on the internet. It would be bizarre if that didn’t come across just as strongly in person.

    Thanks for what you do. I feel more comforted by your presence and writings than I do from my own medical team. What does that say about the state of doctor/patient communication?

  3. #3 gsk
    January 9, 2008

    About a year ago, I was a chemo patient who expressed anxiety about my co-payments directly to my oncologist. (Looking back, I can’t believe I spoke up.)

    I was very fortunate to have a very compassionate doctor who immediately took action and eased my concerns before he continued to the exam. At the time, I felt like the weight of the world had been lifted by him.

    He said he had “super-powers” and could take care of the problem. And he did.

    Everyday for the last year I have silently been saying thank you to that doctor and my surgeon for being great doctors and getting me healthy.

    Next appointment, I will say it directly to you Dr Hildreth. Thank you!

  4. #4 Laura
    January 9, 2008

    My dad’s oncologist was not overly empathetic, but neither did I find him cold. I think to some extent he relied on his staff to provide emotional support to patients. He has a physician’s assistant who is herself a Hodgkins’ survivor. During the last month of my dad’s life, Dad burst into tears in the oncology office, which led my mom to start crying also. The PA cried along with them.

    Dad’s doc displayed what I consider a healthy level of empathy — for example, listening to what my dad’s goals were (like to attend a class reunion) and tailoring treatment to make those goals possible, as opposed to a single-minded pursuit of a cure. Hooray for the doc!

    Laura

  5. #5 Dr. H
    January 18, 2008

    I think some oncologists may be exhausted from so much empathy. If they get caught up with every patient they see, it may become harder and harder to get through the day.

    Also, if you become too attached to the patient it can be difficult to remain impartial and continue to make good sound medical decisions.

  6. #6 AnnR
    January 23, 2008

    I think it might also be one of those things where what’s sympathetic to one person isn’t to another.

    When our Onc came in and announced “only God knows what his plan for you is” he probably was trying to be sympathetic.

    Given the state of anxiety we were in it wasn’t all that reassuring. However he’s wonderful about answering questions and getting his staff onto things we need, and putting in the paperwork to make things happen. I’m sorry to say that’s an improvement over other Doctors I’ve had, so he’s a keeper in my book.