Tuesday, October 29, 2013

Medical treatment - should doctors build empathy?

It seems that the news is full of stories about how our medical system lacks empathy, how we need to increase it, and the benefits of doing so.

Things like this: Thomas Dahlborg "How a lack of Empathy Affects our Healthcare"

And this: Danielle Ofri "My Leap of Faith in Medicine"

And this too: Jessie Gruman "Adding Empathy to Medical School Requirements"

I see (from the patient's point of view) a big difference in how I'm treated by different doctors, and how it makes me feel.

In a typical doctor visit, I check in at the front desk. I wait in the waiting room. I wait in the examination room. The nurse examines me and asks some questions, then the doctor comes in to talk or examine or give results. I've been having doctor visits just like this for all of my life.

However I've noticed that some doctors interact with me quite differently than others. Case in point; the story of Dr C and Dr V.


Doctor C

Recently I've been having this twitch around my eye that won't go away. So I took the problem to a doctor, to see how he could help me.

When Dr C arrives, he asks me, "How are you doing?" He makes eye contact. He listens to me talk for a good few minutes, then examines me. He says, "Well, I think it's a muscle spasm, named (whatever)." I say, "Okay, what does that mean?"

He says, "Well, it could be an easy fix, but I'm not certain, so let's talk about your options." I told him about what I had read on the internet. He gave me more information about what I had read; how it could be something simple, but it could also mask a more serious problem. He suggested that I go to a specialist. He also asked me to "let him know" how things go with the specialist.

I thanked him and left.

My reaction coming out of this appointment? I felt listened to, and cared for. I felt like this doctor genuinely was interested in my well-being. I would want to share with this doctor how I was doing in the future. His comments were made in an empathetic way, and it made an impression on me. This was brought home even more when, a few weeks later, I got a call from Dr C's office asking if I had made an appointment with the specialist. I told them "Yes, I'm seeing Dr V next week". They reminded me again to please send the results of Dr V's visit to Dr C when I'm done. I asked, "Why do you need that?" and the nurse replied, "Dr C believes in holistic healthcare; knowing the whole picture about a patient."

This seriously could have been a scene from Little House on the Prairie, people. It felt that good, and I still had no idea what was wrong with my eye! :)

Dr V

After several appointments and tests with Dr V, today I had arrived to get (hopefully) some final results. After waiting in the waiting room and in the exam room, Dr V came in and sat down. He looked at his computer monitor and said, "So, you are here for the results of your test, hmmm?" I said yes. He said, "Hmm, well according to this report, (long string of completely unintelligible sci-babble)." I said, "Okay, what does that mean?" He looked up, and was about to reply when the phone rang in the next room. He said, "Oh, excuse me" and went next door to answer it. I know he was answering the phone because he left my exam door open. I know he was talking to an insurance agency, because of the things he said on the phone.

I was a little embarrassed, because I was sitting on the exam table with the door wide open. I was dressed, and all, but still it was a little odd. Then I got a little annoyed, because I did all of the waiting I'm supposed to, and here he is having a phone call. I mean, I realize that my time with him is limited but seriously? Taking calls?

So yeah, I'm feeling a little miffed but not too much, because I'm imagining reasons why he answered the call (his nurse is out today, he's expecting an important call, etc). I'm trying to keep calm and wait for the translation of the results.

Then he hangs up, and takes another call.

So I'm not feeling particularly respected or cared about at this point. I considered walking out, but I still needed to know what all the technobabble meant. So I waited for him to finish his second call.

Then he comes back in, says, "I'm sorry." He looks back at the computer screen and tells me my diagnosis. I've got a torn disc in my back and a pinched nerve in my neck. I look at him. "What does this mean?" I asked. He said, "Well, you are young. You don't need surgery. Just don't lift anything heavy and come back and see me in four months. Try to relax. Lose some weight."

So here I am, sitting there a little shell-shocked by the diagnosis. I still am trying to process this, and I asked him about ways to treat it and things I can do. I took out my notepad to make some notes. He said, "Don't bother writing this down, I'll print out this report for you with the names of the issues," (which he didn't.) We moved on to the second part of our visit, which was a follow-up test, and that was it. He walked me out. End of visit.


I can't help but feel the different types of treatment from the different doctors acutely, because of all this thinking about empathy. It's clear to me that Dr C wants to show that he cares about the feelings of his patients. It's also clear to me that Dr V, regardless of how much he cares about his patients, doesn't find it important to show that to us. I feel disrespected coming out of Dr V's appointment, and as a result I feel like I want to take my money and my business elsewhere. As good as he may be at 'doctoring' he hasn't made me feel good.

Dr C and Dr V could be anyone's doctors. I can't help but feel bad for the people who only have Dr V's in their life, and grateful that we have some Dr C's around. 

More empathy in healthcare? Yes, I agree. We definitely need it.


Himself said...

Interesting stuff. As a hypochondriac who sees a lot of doctor's I can completely relate to both situations. The funny thing is, the first doctor we like because of their bedside manner, even though they may not be a good clinician. The second may be a great clinician, but you don't want to work with him/her because of their mannerisms.

I've personally opted for having a PCP with a good bedside manner and will cut my specialists some slack if they have a bad bedside manner. Fortunately, I have generally been pleased with my doctors - Even my neurosurgeon, who is in high demand in the Philadelphia area, has a great manner about him and I'd imagine it must be appreciated by people who have serious/life-threatening issues going on.

SP said...

Should doctors have empathy for their patients or treat them as customers.
Your definition and use of "empathy" isn't what I know it means.
To empathize: to put oneself in the position or place of another.

Janet said...

Thanks Himself and SP!

Himself, I agree that we do and should cut our doctors slack (after all, they save our lives, they give us health.) I just also think that a little customer service goes a long way to making something work better.

One of the arguments for bringing empathy into the medical profession is that by building up trust with your patients, the doctor gives them the freedom to more easily share issues. If I'm scared of my doctor, I won't talk to my doctor about what's bothering me. If I like my doctor, I'll share my issues with them.

SP, In one case, I believe that the doctor was putting himself in my shoes. He was listening to me and reacting to me, showing that he was feeling my feelings.

In the other case, not so much.

SP said...

In that case one had empathy, in the other you were his customer.
Shouldn't matter in his evaluation or treatment recommendations.
One of them was dreaming about his golf game.

Janet said...


You are right. It shouldn't matter in his treatment or evaluations, but I think that it does. If I don't trust him, I don't want to work with him.

If I don't trust him, I won't tell him what's wrong. If do tell him and he's not listening to me, I don't think he's doing his job.

SL said...

doctor no. 2 is just that.

Janet said...

SL - I wouldn't have put it quite that way. :)

In the end, I'd like Dr V to have more empathy for his patients (like me) but I'd also like to find a way to build empathy for him. That's the hard part.

susan thom said...

i have had my share of doctor's appointments. just last week, i had to wait 20 minutes, which wasn't long considering! for my appointment, 20 minutes for the doctor to come in, and although i didn't feel well, i was told the doctor would increase one of my medications, and take blood, and we'd see what the results were. i still haven't heard. i like this doctor, but sometimes, i think doctors don't know anymore than we do!

SP said...

You are right about wanting to trust, but don't confuse his ability to diagnose with his social skills.
If doctors are all the same, blah blah, but this guy touches you- that makes a difference.

Janet said...

SP - agreed!

Susan - I hope you hear back from the doctor soon. I agree that the doctor doesn't always know the best way to move forward. That's one of the reasons I appreciate a doctor who is willing to work with his patients to come to the right answer. I appreciate when a doctor and I can come up with an answer together rather than just doing what I'm told to do.

In the end, I trust that they are the experts at their profession, and I am the expert at my own body.

I wonder how they feel about it.

SL said...

you are paying him. it is his job to be empathetic, not yours.

Janet said...

Thanks SL!

I definitely agree that's his job; that's my point of my story.