Appendix 53b - Pretend

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

I Can't Hear You While I'm Listening

From the Annals of Internal Medicine, "It happened the other morning on rounds, as it often does, that while I was carefully auscaltating* a patients chest, he began to ask me a question. 'Quiet,' I said, 'I can't hear you while I'm listening.'"[614]

* Auscultation means listening with a stethoscope.

One study on empathy showed that following clinical experience there was a slight but statistically significant negative change in the average measured empathy among medical students. More medical school meant less empathy.[615]

From an article entitled "The Empathic Physician":

"How painful and draining it must seem to feel deeply the experience of every patient by looking into oneself.... The wary physician may be concerned about being drowned in a sea of emotional purulence [pus].... On the other hand, empathy can be very time effective...."[616]

A study of physician empathy was published in Lancet a few months ago.[617] Twenty-nine doctors were videotaped and not one of the physicians checked for the patients' understanding of the instructions; not one attempted to identify potential barriers to patient compliance; not one explained to a patient in any way why a follow-up visit was necessary. With proper training, however, one can show, "Statistically significant improvements in empathic behaviors such as asking for patients understanding and... offering reassurance...."

Quoting the method at length:

Patients rarely verbalize their emotional distress, but instead offer verbal 'clues' (potential empathic opportunity). Physicians can pursue this opportunity by prompting the patient to express their emotion (potential empathic opportunity continuer) or ignore the opportunity (potential empathic opportunity terminator). Most physicians did not usually respond to the initial emotional clue. For those that did, once the patient responded by expressing the emotion (empathic opportunity), the physician could then acknowledge the emotion (empathic response), leading to the patient feeling understood. Patients who were blocked at either the potential empathic opportunity or the empathic opportunity stage often persisted by 'escalating' the intensity of the emotional clues. This practical paradigm can be easily incorporated into one's own clinical practice....



[614] Baron, RJ. "An Introduction to Medical Phenomenology." Annals of Internal Medicine 103(1985):606-610.

[615] Diseker, RA and R Michielutte. "An Analysis of Empathy in Medical Students Before and After Clinical Experience." Journal of Medical Education 56(1981):1004-1010.

[616] Zinn, W. "The Empathic Physician." Archives of Internal Medicine 153(1993):306-312.

[617]Neuworth, ZE. "Physician Empathy - Should We Care? " The Lancet 350(1997):606.



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