# Some doctors lack empathy



## Ernest Nagel (Sep 24, 2008)

Yeah, yeah, I know, old news _duh_-partment. :doh: Except that this does provide a little scientific documentation for the phenomenon and addresses its' significance in treatment effectiveness. 

I've decided to quit bothering to ask if anyone has ever experienced something like this or even commenting much. Because of various projects and clients I have access to some excellent news aggregators and web crawlers. It just takes me a minute or two to post something here. I figure maybe it helps someone, maybe it doesn't; I can risk a minute. 

Anyone's opinion that "Geez, everyone has known that for years! DUH!!" probably won't dissuade from posting further of this ilk. Unless your intention is just to feel smug and condescending I thought I'd save you the time. I don't know "everyone" but I've found anecdotal evidence that a lot of obvious things are not as common knowledge as we may think.

Sorry for the rant but I'm dealing with a little lack of Dr empathy myself lately. 


http://www.washingtonpost.com/wp-dyn/content/article/2008/09/22/AR2008092201894.html

*For Some Doctors, Empathy Is in Short Supply*

By Amanda Gardner
HealthDay Reporter
Monday, September 22, 2008; 12:00 AM

MONDAY, Sept. 22 (HealthDay News) -- Doctors are missing their cues when it comes to opportunities to empathize with the plight of their cancer patients, a new study suggests.

While doctors are able to address such concerns as medication issues, missed appointments, or pain, they tended to skirt "existential" issues, such as questions dealing with life and death, which are of paramount importance to most patients, the study authors said.

"Physicians only responded to 10 percent of empathic opportunities and, when patients raised existential concerns, physicians tended to shift more to biomedical responses," said study author Dr. Diane Morse, an assistant professor of medicine and psychiatry at the University of Rochester Medical Center, in New York. "Physicians had trouble addressing the bulk of concerns, which were about patient fears, concerns about death or dying, or worsening conditions."

Yet this may be the most important point of intersection between a doctor and his or her patient.

"The relationship between a patient and a physician is more than just the delivery of a diagnosis or a treatment plan," said Dr. Arthur Frankel, a professor of medicine at the Texas A&M Health Science Center College of Medicine. "Basically, for cancer care, if you're not able to form a close tie with your patient and improve their quality of life, then there's a real question as to what you are doing.

"We can hopefully, at times, make suggestions or do things with patients that may buy some time and, in some cases, long-term remissions. But, by and large, the major job of an oncologist is to bond with the patient and the patient's family and help them with a crisis," added Frankel, who's also director of the Cancer Center, Cancer Research Institute and Division of Hematology/Oncology at Scott & White Hospital in Temple, Texas.

Empathy -- identifying with and understanding another person's situation and feelings -- has been linked with improved patient satisfaction, including less anxiety and better compliance with treatment. Physicians, residents and medical students also show evidence of more satisfaction and less burnout if they provide empathy, Morse said.

For the study, she and her colleagues analyzed 20 audio-recorded and transcribed interactions between male patients with lung cancer and their thoracic surgeons or oncologists.

The researchers identified 384 "empathic opportunities," but found that the physicians responded empathically to only 39 of them. Each encounter elicited an average of less than two empathic responses from the doctor.

Empathic opportunities included patient statements such as, "This is kind of overwhelming," and "Im fighting it."

When the doctors did show empathy, half the time it was in the last third of the encounter, even though patients had been raising concerns throughout the session.

"Physicians are more comfortable about things they know what to do about, like 'I ran out of my medicine,' 'I couldn't get appointment,' 'I'm having pain,'" Morse said. "But when the patient asks how much longer do I have to live, it's scary. It's hard to know what to say."

"It would be helpful for physicians to think about having a response ready," Morse added. "The bulk of patients' concerns are existential and physicians don't necessarily have to do something to fix it. Just acknowledging it, in and of itself, can be very helpful and it doesn't take a lot of time."

Added Frankel: "The most important job of a physician is also the most important job for a minister or for a lawyer or anyone else: To try and help people cope with the uncertainties of life."

The findings are published in the Sept. 22 issue ofArchives of Internal Medicine.

More information

For more on doctors and empathy, visit Kaiser Permanente.

SOURCES: Diane S. Morse, M.D., assistant professor, medicine and psychiatry, University of Rochester School of Medicine, N.Y.; Arthur Frankel, M.D., professor, medicine, Texas A&M Health Science Center College of Medicine, and director, Cancer Center, Cancer Research Institute and Division of Hematology/Oncology, Scott & White Hospital, Temple, Texas; Sept. 22, 2008,Archives of Internal Medicine


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## Ernest Nagel (Sep 24, 2008)

I recall a surgeon friend telling me a common axiom about his profession was "Sometimes mistaken; never uncertain!"

I'm sure it must take a staggering amount of self-confidence to be able to routinely take peoples lives into your hands. The article didn't mention it but I expect the Docs feel they could do with a little more empathy from patients sometimes?


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## thatgirl08 (Sep 24, 2008)

I've been dealing with anxiety/panic attack issues for the past few months and in that time I've seen quite a few doctors, hospital workers, nurses, etc. etc. and I can tell you that this is definitely a problem. I met with one of the RN's at my primary care doctor's office and after explaining the situation and expressing my concerns that I was having heart problems [which is a fairly common concern amongst people who are having panic attacks as they often mimic heart attacks in some ways] she actually laughed at me. She then told me that I was probably having panic attacks because I'm concerned over my "weight issues."  After telling her about all the shit that had been going on in my life, she kept insisting that those problems were NOTHING compared to my obvious weight problem, which was really the root of the anxiety problem. Needless to say, I requested to never see her again.

Her reaction, was sadly, not uncommon. Many of the doctors and other medicial people I met with reacted in a similar manner...even when I was in the hospital freaking out that I was having a heart attack. Looking back, and knowing more about panic attacks now than I did then, I realize that I really WASN'T and they obviously knew this too...but their reactions [laughter, ignoring me, etc.] actually made the problem a lot worse. I remember saying to my mom at one point "I'm sitting here, dying, I'm having a heart attack, and they don't even care. I'm going to just die right here, right now, and no one cares" after one of the nurses laughed at my plea to see a doctor quicker. 

Like I said, I realize the situation wasn't as dire as I thought it was...but imagine thinking you're on the brink of death and you're in a hospital and none of the doctors or nurses will even talk to you.


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## lypeaches (Sep 24, 2008)

Agreed about the 2 - way street thing. I think that a lot of doctors (and other personnel) who are dealing with a lot of people who are seriously ill and possibly dying , every single day...my guess is that in order to protect their own well being, that they shut down their own emotional side, thus making them come across as very clinical. I'm not saying it's right, just saying it's kinda a normal defense mechanism, I think. And I've seen a lot of people in emergency rooms be crazy rude. Everyone's frustrated all the way around, it seems.


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## bigpulve (Sep 24, 2008)

Just like everyday there are going to be people in all professions that lack Empathy.........


Doctors are no exception.


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## thatgirl08 (Sep 24, 2008)

I'm sure there are patients out there who should extend a little more empathy, but imo it's not exactly equal to the extent that a doctor or other medical professional should extend. Having a good bed side manner, imo, is a large part of a doctor's job. Yes, everyone has bad days, and doctors are no exception to this, but I do think there is a difference in being a little more "clinical" and being out right rude or cold. 

Feel free to take this with a grain of salt though, I've had some pretty awful doctor experiences lately so my perception is a little biased.


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## Ernest Nagel (Sep 24, 2008)

bigpulve said:


> Just like everyday there are going to be people in all professions that lack Empathy.........
> 
> 
> Doctors are no exception.



And even though empathy is a welcome attribute in nearly any field it's not quite as mission critical for plumbers, cabbies, lone assassins and so on as for health care professionals.


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## Shosh (Sep 24, 2008)

I think empathy and respect should go both ways. There are certainly doctors that are clueless when it comes to speaking in the correct manner to patients, but then there are patients that can be rude and verbally abusive also.

My cousin Rachel is an emergency medicine consultant and the head of an ER in a London hospital. Some of the stories that she tells me about regarding the abuse that some patients dish out is shocking.

She realizes that patients can be at their lowest point when the come into hospital in these kind of situations, she just does not see why she should have to be a target for their anger etc.

Doctors work long hours, under stressful conditions, and they are generally underpaid.

Having said that there are as I said doctors that could use training in how to interact positively and in the correct manner with their patients.


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## No-No-Badkitty (Sep 24, 2008)

I can totally sympathize about idiot Dr. who are emotional duds...

However....


Some people mistake emotion for "empathy". A doctor may very well be empathetic with an individual but just will not get emotional. If you think about it, they can't afford to get emotional.
I've been accused of being un-empathetic in some instances in my line of work...but the truth is I can't afford to break down and cry and bawl over every sad moment. If I did I would be an an institution under emotional duress. Sometimes a professional has to be able to detach themselves so that they can act as a professional.
It doesn't mean they don't feel your pain it just means they have learned to contain their personal response to your pain.
People are usually Dr. s because they want to make people better (generally)....so their personality is based in the need to help...and that as a whole takes empathy.
I realize there are bad seeds...but sometimes too the patient fails to recognize the difference....and the Dr. for the sake of everyone that needs them can't exhaust themselves mentally/emotionally...


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## Shosh (Sep 24, 2008)

No-No-Badkitty said:


> I can totally sympathize about idiot Dr. who are emotional duds...
> 
> However....
> 
> ...




I think you are right. 

l try to be very positive, but the truth is that I have a chronic progressive neurological condition.

Last week I sat in the neurologists office and I just cried and cried. I try to be stoic but sometimes I cannot help myself.

The neuro sat very quietly during all of this and I know that she does care, even though she may not always know how to respond to these kind of situations.
She sees people all day that have these conditions. Maybe she would not be able to manage if she got emotional every time one of her patients got emotional.

Anyway open communication and respect between doctor and patient goes a long way.


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## bigpulve (Sep 24, 2008)

Ernest Nagel said:


> And even though empathy is a welcome attribute in nearly any field it's not quite as mission critical for plumbers, cabbies, lone assassins and so on as for health care professionals.


some people are unable to feel empathy. Why is it that all doctors and health professionals have to be amazing people persons.....not all are. 

I know...Im in the heath care field.....sorta.


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## thatgirl08 (Sep 24, 2008)

bigpulve said:


> some people are unable to feel empathy. Why is it that all doctors and health professionals have to be amazing people persons.....not all are.
> 
> I know...Im in the heath care field.....sorta.



Although not a stated component of a doctor's job, it's often expected from them because of the nature of their work. Personally, I just feel better going to see a doctor who is empathetic and caring toward my concerns.


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## bigpulve (Sep 25, 2008)

thatgirl08 said:


> Although not a stated component of a doctor's job, it's often expected from them because of the nature of their work. Personally, I just feel better going to see a doctor who is empathetic and caring toward my concerns.


That I understand but thats why there are thousands of doctors in this country. Personally I would rather have a doctor that just got down to business....I dont want to be set up with empathy or emotion.....


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## Ernest Nagel (Sep 25, 2008)

bigpulve said:


> some people are unable to feel empathy. Why is it that all doctors and health professionals have to be amazing people persons.....not all are.
> 
> I know...Im in the heath care field.....sorta.



I'm not a "people person". In fact I have a condition called borderline Asperger's syndrome. Basically means I have the emotional intelligence of yogurt. I can still recognize that most people need to feel a social connectedness when being supported by someone. I don't particularly need people to like me. I _could_ just do my job (not health care, btw) leave a silver bullet and move on. Unfortunately lacking empathy does not excuse being inconsiderate. Getting related may seem like a waste of time to me but it isn't for them. I do it because although I am largely lacking in compassion I like things to work as well as possible. Even emulated empathy makes things better for the people I support. They need to feel their issues are more than just a job or a puzzle for me. Sometimes just pretending even makes that a little bit true.


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## thatgirl08 (Sep 25, 2008)

bigpulve said:


> That I understand but thats why there are thousands of doctors in this country. Personally I would rather have a doctor that just got down to business....I dont want to be set up with empathy or emotion.....



I look at empathy and emotion as completely different. One can be empathetic toward another persons situation without being emotional about it. I don't think it'd be really professional or appropriate for a doctor to get too emotionally invested in someone..but they really should have empathy for the situation their patient is in. I wouldn't want a doctor to get overly emotional..but it'd be nice if they could show a little empathy, otherwise it seems too cold.


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## bigpulve (Sep 25, 2008)

Ernest Nagel said:


> I'm not a "people person". In fact I have a condition called borderline Asperger's syndrome. Basically means I have the emotional intelligence of yogurt. I can still recognize that most people need to feel a social connectedness when being supported by someone. I don't particularly need people to like me. I _could_ just do my job (not health care, btw) leave a silver bullet and move on. Unfortunately lacking empathy does not excuse being inconsiderate. Getting related may seem like a waste of time to me but it isn't for them. I do it because although I am largely lacking in compassion I like things to work as well as possible. Even emulated empathy makes things better for the people I support. They need to feel their issues are more than just a job or a puzzle for me. Sometimes just pretending even makes that a little bit true.


I work in a house with 5 autistic kids, my mother has a special ed degree and I have been tested for Aspergers....I do lack a lot of empathy and suck at reading people....

You see I dont see not being empathatic as being inconsiderate......House is inconsiderate......but still has empathy.....



thatgirl08 said:


> I look at empathy and emotion as completely different. One can be empathetic toward another persons situation without being emotional about it. I don't think it'd be really professional or appropriate for a doctor to get too emotionally invested in someone..but they really should have empathy for the situation their patient is in. I wouldn't want a doctor to get overly emotional..but it'd be nice if they could show a little empathy, otherwise it seems too cold.


since I dont really know what empathy is I see them as similar.....see above post.....

So I want a doctor that will be blunt with me.....I hate sugar coatings.


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## thatgirl08 (Sep 25, 2008)

bigpulve said:


> since I dont really know what empathy is I see them as similar.....see above post.....
> 
> So I want a doctor that will be blunt with me.....I hate sugar coatings.



Empathy isn't really sugar coating, it's understanding.


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## JoyJoy (Sep 25, 2008)

Having empathy involves trying to imagine how you would feel in another person's situation and using that to color how you deal with that person and/or their problem. I personally think it's something that can be learned and should be taught in medical school (it likely is, to some extent). 

For some people it comes naturally, but I think if one wants to badly enough, they can be empathetic toward another person. If you're in a service industry, such as medicine, that skill is an extremely important part of your job. 

Being empathic doesn't mean you have to get inside a person's head or sit down and cry with them. It involves showing some understanding of what the person is going through and treating them the way you would want to be treated if you were in their situation. If a patient does indeed just want the facts and nothing but, there's nothing wrong with that, but not everyone is like that. A doctor should spend enough time talking to his patients to learn what method each patient seeks, and act accordingly.


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## mossystate (Sep 25, 2008)

When my Mom was diagnosed with end-stage cancer, she went to talk to a doctor to learn how they were going to manage her pain.

I was not at this particular appointment, but, I was told that after the doctor had gone through all the nuts and bolts of the situation ( and being quite clinical ), he asked my Mom if there was anything he could do for her. 


My Mom said, " I am an 86 year old woman with cancer ". The doc's eyes filled with tears and he gave her a big, lingering, hug.


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## bigpulve (Sep 25, 2008)

thatgirl08 said:


> Empathy isn't really sugar coating, it's understanding.


never said it was.....I was just saying.


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## MissStacie (Sep 26, 2008)

Ok..so the drama continues with the results of my ultrasound having found the dastardly stones in my gall bladder, they IMMEDIATELY set me up with a consult with a surgeon for yesterday...yeah, YESTERDAY, not even a week between the u/s! Made me nervous because they were not delaying this at all...so, THEY schedule me with a surgeon..and I go...

I get into the office, sign all the paperwork and am in right away. I get into the exam room, and notice one of those great little steppie things with a nice handle...GREAT! I'm liking this place already. I hope up on the table and wait. Now, I've never met this doctor, never even HEARD of him, but I'm going with it. I asked the receptionist about him, she LOVES him, and he's done a surgery for her, and I asked the nurse when she brought me in, and SHE had her gall bladder out in August by him and RAVED about him. So, I'm at ease now.

He walked in. Says "Hey you"....He's about 55, balding, goatee and a total cutie. He's completely laid back and matter of fact. We go through all the "have you ever had this...that, etc"...I'm answering "no, no no no"...I said "I'm fat, I'm not unhealthy"...he grins and raises his eyebrow...and I immediately said "don't look at me that way, I know that look!"...I'm laughing and he says "I'd say you were maybe stretching a little'...I agreed, but DID defend myself and said that I didn't have the "typical" ailments of an obese person. He agreed...so we go on and he says 'so, when do you want to do this"...I said "when is good for you, in the next couple weeks is good for me". He says "ok..I can do that". I was like "What? Do your kids need books for school or something? Is it a slow month?"...and he laughed and said that all the kids had left, but his fully self sufficient daughter just moved back home and while she can take care of her own bills,. etc, she always wants to go to dinner with him. I'm like "duh, Daddy's paying!"...we laughed and I knew then that I really liked him.

So, he said that he doesn't anticipate any problems doing it lap, but DID say that there are 4% of people that can't have it done for various reasons, and due to my size, I COULD be one of them, not WILL be one of them, but could happen, but he didn't think it would be a problem. I said cool..lets do this!

So, I go in on Tuesday and have the little sucker removed....good riddance, I say!

I'll be at the same hospital that I had my panni done so I'm comfortable with them, too.




Hugs,


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