The Canadian Cancer Society says this year alone, more than 170,000 Canadians will be diagnosed with the dreaded disease. What those patients want from their doctors is a little kindness along with chemo. That's not something all doctors know how to provide. But a recent study has concluded doctors can learn some empathy skills. And the teacher may surprise you.
The doctors in this study, published last week in the Annals of Internal Medicine, learned empathy - from a computer. That's right, a computer. Researchers at Duke University in the US developed a computer program that teaches what cancer specialists learn when they take courses on empathy. Researchers audiotaped between four and eight encounters between the cancer doctors and their patients - people with advanced cancer. Those recorded sessions were submitted throughout the study period to monitor empathic responses and - in the case of the doctors who received special training in the empathic response - provide tips on how to improve.
All the doctors who entered the study attended a one-hour lecture on communication skills. Half received training via computer that reinforced communication skills - especially how to recognize and respond to emotional cues from patients; the other half received no other training.
Cancer specialists who received the one-hour lecture but did not take the computer course made no improvement in the way they responded to patients with emotional concerns or fears. Doctors in who received the training by computer responded empathetically twice as often.
The doctors who got empathy training by computer learned how to recognize and respond to opportunities in conversations when patients share unpleasant feelings. They also learned how to frame information about prognosis. Doctors in the training program got feedback how they could improve. The computer sent them messages to commit to making changes in their practice, and the computer reminded them to stick to their committments.
The doctors who got the training were able to respond empathetically to patients talking about feeling sad or depressed or anxious. Beyond the empathic response, they also got better at using techniques to encourage patients to talk about their feelings rather than shut these discussions down.
There were other benefits. Patients whose doctors were trained to be more empathetic perceived them as being more empathetic. These patients gained a greater sense of confidence that the oncologist understood them as a whole person. They had higher trust in their doctor. In other words, the doctor-patient relationship was strengthened.
If the fix is so simple, then why the problem with empathy in the first place? There are several reasons for this. While cancer doctors want to offer a sympathetic ear, they may sometimes miss emotional cues from patients. Often, when patients bring up their worries, doctors change the subject or focus on the medical treatment, rather than the emotional concern.
James A. Tulsky, M.D., director of the Duke Center for Palliative Care and lead author of the study, was quoted as saying. "Often, when patients bring up their worries, doctors change the subject or focus on the medical treatment, rather than the emotional concern. Unfortunately, this behavior sends the message, this is not what we're here to talk about."
Doctors may also worry that these exchanges will cause the appointment to spiral out of control - turning a fifteen minute checkup into a thirty or forty minute session. They may also fear that the demand among patients for empathy will escalate over time.
Some health professionals may be reluctant to be empathetic because they mistake empathy (acknowledging the patient's emotional state) for sympathy (feeling the emotion that the patient feels).
I think the biggest reason why doctors fail to respond empathically to patients is that they haven't been taught how. I think many of my colleagues believe that empathy is a personality trait; you either have it or you don't. In fact, the empathic response is a a skill - like putting in a chest tube or a central line. Most assuredly, it can be learned.
The lesson here is that brief training improves patient trust. Trust between doctor and patient has been shown to be associated with improved health as reported by the patient. It has also been shown in studies to benefit patients with diabetes.
The technology used in this study needs to be updated. For instance, if privacy and data security concerns can be allayed, they could use smart phones to record doctor-patient encounters for quick feedback and reinforcement.
We don't need more study on the merits of a teaching program like this. It's good for patients and also good for health professionals. Let's just do it.