Physicians seldom responded empathetically to the concerns of patients with lung cancer in a small study released on September 22, 2008 in Archives of Internal Medicine, one of the JAMA/Archives journals.

The authors of the study initially highlight the importance of empathy in the bedside interaction. "Empathy is an important element of effective communication between patients and physicians and is associated with improved patient satisfaction and compliance with recommended treatment." They continue, commenting on the relative effectiveness of fulfilling communication for patients: "Patients who are more satisfied with the communication in their medical encounters have improved understanding of their condition, with less anxiety and improved mental functioning."

Many physicians have difficulty responding to the emotional needs of their patients thanks to a level of detachment that is usually attained during medical school. The authors postulate that this may be in order to cope with the extreme time constraints or sadness.

To investigate the levels of empathy in consultations with lung cancer patients, Diane S. Morse, M.D., of the University of Rochester Medical Center, Rochester, N.Y, and colleagues examined 20 recorded and transcribed consultations between lung cancer patients and their physicians. The patients were all males with an average age of 65, and the physicians were composed of three oncologists and six thoracic surgeons.

An average of 326 statements were identified in each visit, and the comments made by physicians were classified as statements about the impact of lunch cancer, statements about diagnosis or treatment, and statements about health systems issue that might affect the care received.

A total 384 statements were identified in the 20 visits that were made by patients which provided opportunities for empathy from physicians. Some examples include: "This is kind of overwhelming" and "I'm fighting it." Most of these opportunities related to the impact of lung cancer. The authors expand on this: "Patients' morbidity [illness] and mortality [death] expectations and concerns were the most commonly coded empathic opportunity, which hinted at fears, worries and existential concerns and comprised 32 percent of overall empathic opportunities."

An empathetic response was elicited from the physicians in 10% (39) of the opportunities. The authors note that ""Otherwise, physicians provided little emotional support, often shifting to biomedical questions and statements," the authors write. "With a mean of less than two empathic physician responses per encounter, empathy was an infrequent occurrence." This low ratio of empathetic responses to encounters indicates that it was an "infrequent occurrence." In the last one-third of the period of the enounter, half of the empathetic responses occurred. This was true despite patient concerns being raised throughout the visit.

The authors point out several reasons that physicians may not show empathy in a significant set of the interactions. For instance, they may think that time in the interaction is too limited for empathetic discussion. Also, they may be too consumed with additional tasks to recognize the opportunities for empathy. Finally, they may consciously avoid empathetic responses in favor of biomedical information that they find reassuring.

The authors finally recommend action for physicians: "We suggest the use of interval empathy to respond to empathic opportunities offered by patients periodically throughout the encounter, particularly in encounters with patients with life-threatening conditions who may be most likely to raise multiple empathic opportunities," they write. "Use of this communication skill may allow increased understanding and progressive rapport and trust with patients. Fortunately, studies indicate that expressing empathy can be taught and that these statements can be brief and powerful, not prolonging the encounter or necessarily changing a physician's style."

Missed Opportunities for Interval Empathy in Lung Cancer Communication
Diane S. Morse, MD; Elizabeth A. Edwardsen, MD; Howard S. Gordon, MD
Arch Intern Med. 2008;168(17):1853-1858.
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Anna Sophia McKenney