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How to treat the scourge of modern medicine—bad bedside manner

Illustration by Florian Bayer

When I was pregnant and working as a foreign correspondent in Beijing, my obstetrician suggested an amniocentesis test for Down’s syndrome. Afterwards, I was told to call in three weeks for the results, by which time I could already feel the baby’s first kicks. “There’s a problem,” the nurse said when I phoned, adding that the doctor was out. She advised me to call back in an hour. I hung up the phone and burst into tears. Worst-case scenarios overwhelmed me. Did “a problem” mean I’d have to terminate the pregnancy? Did it mean this, my first pregnancy, would be my last?

One hour later, I dried my eyes and phoned back. “Everything’s fine,” my doctor said. I was too relieved to complain about the nurse. Eventually it dawned on me that all she had meant by “problem” was that the doctor was out.

I recalled that experience in the wake of several new studies about miscommunication, patient outcomes and the widespread lack of empathy among health professionals. One study, published this year in the Canadian Medical Association Journal, found that oncologists fail up to 90 per cent of the time to respond to emotional cues from their patients.

That’s not news to the legions of us who have encountered a brusque nurse or an arrogant physician. But I was surprised to discover that nicer doctors have healthier patients. At Thomas Jefferson University in Philadelphia, researchers monitored 891 diabetic patients between 2006 and 2009 and found that those whose doctors scored highest on empathy tests were better at controlling their blood sugar and cholesterol levels and had fewer hospitalizations. Two more studies, not yet published, involving 242 primary care physicians and more than 284,000 patients in Parma, Italy, are currently in the works. Preliminary results suggest that there, too, the more empathic doctors have better patient outcomes.

While we often conflate empathy and sympathy in everyday conversation, the two are not the same. Empathy is a cognitive skill. It’s the intellectual ability to understand another’s emotion without actually experiencing the feelings of the other. Once upon a time, we called this good bedside manner, and some doctors come by it naturally. By contrast, sympathy is affective. It’s the quality of being emotionally moved by the state of another’s feelings. Sympathy in doctors is bad because it reduces objectivity and can lead to compassion fatigue, vicarious trauma and burnout. Empathy, which includes the ability to respond appropriately, sometimes with humour, is good. It elicits better information, leading to more accurate diagnoses and better patient cooperation. For doctors, this can also mean fewer errors, complaints and malpractice suits.