Is Doctor Empathy the Best Rx?

Jan. 24, 2011— -- Erin Mitchell has met her share of doctors. Diagnosed with Type 1 diabetes at age 8, Mitchell, now 40, visits at least three times a year to stay on top of her condition.

"There are some doctors who act like patients exist only to be fixed," said Mitchell, who has "fired" more than one doctor for treating her like a case instead of a person.

Mitchell works in public relations in St. Petersburg, Fla., which keeps her on her toes and leaves her little time to think about blood glucose and insulin more than she needs to. So when one doctor suggested changing her treatment schedule from twice daily to every two hours, he just didn't get it, she said.

"I can't drop everything every two hours to test my blood and inject insulin," Mitchell said. "Not all patients are the same, and not all treatments are going to be feasible for a particular person because of other things in their life."

The ability to empathize with a patient not only makes doctors more likeable but improves the quality of care they provide, according to a report published in the Canadian Medical Association Journal. And as with knowing what test to run or what treatment to prescribe, empathy is a skill doctors have to learn, some doctors say.

"Currently, there is insufficient emphasis and time apportioned to teaching the empathic response in medical school, postgraduate training and continuing medical education," wrote Dr. Robert Buckman of the University of Toronto, and colleagues.

Medical training has historically emphasized understanding diseases rather than patients. But some medical schools in the United States are changing their game to produce more empathetic doctors.

"I think all of us as doctors should understand that our main role is to not just help people, but to really understand them and to have every encounter with a patient be something they leave feeling better," said Dr. Steven Abramson, senior vice president and vice dean for education, faculty and academic affairs at New York University's Langone Medical Center.

"In the sufferer, let me see only the human being," said Abramson, quoting the prayer of Maimonides; a pledge similar to the Hippocratic oath.

Teaching Empathy

In 2010, Abramson introduced the NYU School of Medicine's new, patient-centric Curriculum for the 21st Century -- "C21." A key feature of C21 is "Patient-Based Longitudinal Ambulatory Clinical Experience," a program that has students shadow patients rather than doctors.

"You need to know about their life, their home, their social network," said Matthew Mercuri, a first-year medical student at Langone who will be shadowing a melanoma patient this semester. "You need to get the whole picture so you can understand how the disease plays into it."

Mercuri said the C21 program was a key factor in his decision to go to NYU for medical school.

"A patient is far less likely to adhere to a treatment plan if they don't have trust in their doctor," Mercuri said. "If they don't trust their doctor, they won't trust the treatment."

But learning to balance empathy with doing what needs to be done is harder than it looks.

"It's not instinctive," Mercuri said. "But in the second month of med school, they made me very aware that I needed to learn this and that I needed to be proactive in learning this."

NYU's Abramson said, "It's very nice to have a doctor that you love and who puts an arm around you, but not if that doctor makes bad medical decisions.

"Compassion is important but compassion without competence is not a virtue."

A doctor may see up to 30 patients a day. But every visit -- no matter how short -- is an opportunity to show empathy, Abramson said.

"Smile, put your hand on somebody, look in their eyes -- don't stare into your computer as you take notes," Abramson said. "You're in the life of someone that comes in for 20 minutes. Ask about their home life, their support structures."

Mitchell said she appreciates when a doctor asks about her job and health insurance situation, too, both of which play into the decisions she makes.

And at the end of an appointment, a doctor should make sure things are clear, said Mitchell, speaking from decades of diabetes treatments.

"They should take just a minute to ask: Does that make sense to you?" she said. "Not just write a script with one foot out the door."