Empathy Is 'Powerful Tool' in Improving Patient Outcomes, Say Family Physicians

March 23, 2011 03:05 pm Barbara Bein

Family physicians often have to make a point of displaying empathy to each of their patients while also striving to meet the demands of everyday practice. But, according to a recent study by family physicians and others, when a physician is highly empathetic, his or her patients' clinical outcomes are likely to improve.

"Empathy is one of the most powerful tools that physicians have at their disposal," said Richard Wender, M.D., professor and chair of the department of family and community medicine at Jefferson Medical College in Philadelphia and president of the Association of Departments of Family Medicine.

This tool may be especially important for family physicians, he added, because they must get information from patients, counsel them about behavior change and medications, and see them regularly.

Wender and Fred Markham, M.D., professor in Jefferson Medical College's family medicine department, were among several co-authors of a study on physician empathy and clinical outcomes for patients with diabetes that was published in the March Academic Medicine.

According to the study(journals.lww.com), a direct, positive relationship between physicians' empathy -- as measured by the broadly accepted Jefferson Scale of Empathy, or JSE -- and patients' clinical outcomes was confirmed statistically. In short, physicians with high empathy scores had more patients with good control of hemoglobin A1c and LDL cholesterol levels. In fact, the odds of good control of these indicators increased by 80 percent in patients whose physicians had high empathy scores.

The study defined empathy as a physician's ability to understand a patient's experiences, to communicate this understanding and to convey the intention to help. Based on the JSE, physicians in the study were classified as high- , moderate- or low-scoring on empathy.

The study authors found that physicians' degree of empathy was a "unique and significant contributor" to the prediction of good control of hemoglobin A1c and of LDL among almost 900 patients with diabetes who participated in the study.

AAFP Has Tools to Help Boost Empathy

The Academy has produced a number of resources designed to help physicians and physicians-in-training develop positive, effective physician-patient interactions.

The Family Practice Management, or FPM, article, "Have You Really Addressed Your Patient's Concerns?" discusses strategies to ensure patients' expectations are met during each office visit. FPM also offers numerous other relevant articles in its "Patient-Centered Care" article collection.

And the AAFP's Virtual Family Medicine Interest Group website has developed a document that gives students -- and practicing physicians -- tips on building the doctor-patient relationship(2 page PDF).

The strong association between physicians' empathy and positive clinical outcomes suggests that empathy is an integral component of physician competence, said the authors. One possible explanation for the association is that greater empathy in the physician-patient relationship enhances mutual understanding and trust.

This understanding and trust, in turn, promotes "sharing without concealment, leading to better alignment between patients' needs and treatment plans and, therefore, more accurate diagnosis and greater adherence," they said.

Markham described a personal instance when a physician's empathy helped him recover from a fractured acetabulum. After the injury and subsequent surgery to repair it, Markham's orthopedic surgeon told him that he had only a 2 percent chance of developing avascular necrosis of the hip. The surgeon pledged that in a couple of years, when the risk of avascular necrosis had passed, they would celebrate Markham's recovery together.

The surgeon's empathetic style reassured Markham and helped him deal with the uncertainty. "The work of healing is easier to do when a patient feels cared for," Markham said.

He contrasted that experience with the reaction he got from another physician, who Markham said scared him when "he warned me to pray to the gods of hips that I didn't get avascular necrosis. The same information presented in a more negative way can have a very deleterious effect on a patient's emotional state," Markham said.

"Most physicians have the capacity for empathy, but demonstrating this empathy in every patient communication takes determination and commitment," Wender told AAFP News Now. "The business of practice and reliance on high-volume care definitely can render the communication of empathy more difficult."

The patient-centered medical home -- where the patient is at the center of all interactions for the entire team -- offers a natural opportunity for team members to practice empathy, according to Wender. Team-based care that incorporates culturally sensitive motivation and tools for change clearly expresses empathy, he said. In addition, a population management perspective allows practices to reach out to patients, show their concern and invite patients in for care.

"Individuals selecting careers in primary care value empathy and are rewarded by establishing long-lasting, trusting relationships with patients," Wender said. "But some physicians allow their empathy levels to fade with time and the stress associated with practice.

"Establishing and maintaining high levels of empathy helps to create more rewarding and satisfying careers, and now we have data to indicate that empathy impacts patient outcomes, as well."

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