Yeah, but have you ever timed 23 seconds?

In response to my earlier post lamenting prescribing privileges for naturopaths, long-time commenter Snarky McSnarksnark remarked:

Good health outcomes–and, even more, patient satisfaction–track very closely with “feeling listened to.” And modern physicians largely don’t listen, for both cultural and economic reasons. I have a friend who is a GP (yes, there’s still a few of those), and she tells me that insurance reimbursement rates are built on a model of 4-and-a-half minutes spent per patient. What’s more, she says, in actual practice, more than half that four and a half minutes is spent on paperwork and supporting documentation for reimbursement. Moreover, as medical specialization increases, doctors take a more and more mechanistic approach to healing. (One of my favorite medical statistics is that physicians let their patients speak for only 23 seconds, on average, before interrupting them and redirecting the conversation).

Please.  Have you ever listened to a patient drone on and on about “numb” this and “crushing chest pain” that?  It’s a miracle we can even stand it for 23 seconds.

I kid.

All joking aside, I think he and other commenters are onto something when they attribute the success of naturopaths and other “non-traditional” practitioners to the empathy that these providers seem to express.  While that’s hardly an excuse for the faux remedies and ersatz diagnostics they peddle, it does leave people feeling better and more looked-after.  (Quick caveat — insofar as complementary or alternative medical providers are legitimately investigating the efficacy of their treatments using real science, my skepticism and scorn does not apply to them.  NB: another comment by a respected friend.)  When physicians and other medical providers fail to listen to our patients and take their concerns seriously, we fail in our duties.

Which prompts me to comment on this article I saw a few days ago and then forgot about:

Empathy has always been considered an essential component of compassionate care, and recent research has shown that its benefits go far beyond the exam room. Greater physician empathy has been associated with fewer medical errors, better patient outcomes and more satisfied patients. It also results in fewer malpractice claims and happier doctors.

A growing number of professional accrediting and licensing agencies have taken these findings to heart, developing requirements that make empathy a core value and an absolute “learning objective” for all doctors. But even for the most enthusiastic supporters of such initiatives, the vexing question remains: Can people learn to be empathetic?

A new study reveals that they can.

Building on research over the last decade that has shown that empathetic observers have brain activity, heart rate and skin electrical conductance that mirror those of the person undergoing the emotional experience — observing a friend’s hand getting slammed in a car door, for example, causes us to flinch because an image of the accident gets mapped onto the pain and threat sensors in our own brain — Dr. Helen Riess, director of the Empathy and Relational Science Program in the department of psychiatry at the Massachusetts General Hospital in Boston, created a series of empathy “training modules” for doctors. The tools are designed to teach methods for recognizing key nonverbal cues and facial expressions in patients as well as strategies for dealing with one’s own physiologic responses to highly emotional encounters.

[snip]

To test the effectiveness of the lessons, Dr. Riess and several of her colleagues enrolled about 100 doctors-in-training and asked their patients to evaluate their empathy, based on the doctor’s ability to make them feel at ease, show care and compassion and fully understand patient concerns. Half of the doctors then took part in three one-hour empathy training sessions.

[snip]

Compared with their peers, doctors who went through the empathy course interrupted their patients less, maintained better eye contact and were better able to maintain their equanimity if patients became angry, frustrated or upset. They also appeared to develop resistance to the notorious “dehumanizing effects” of medical training. After the empathy classes, one physician who had complained about being burned out said, “I feel as though like I like my job again.”

So, can empathy be taught?  Or, perhaps more precisely, can it be learned?  I absolutely believe that it can.

I know I’ve alluded to this at some point in the past, but for my own part it’s been something I’ve had to work on.  Taking call from home means I’ll often get paged in the middle of the night, in the car on my way somewhere, or in some other situation where the Better Half is around to hear my end of the conversation.  (This is probably not 100% HIPAA-compliant, but short of hurtling from a moving motor vehicle it can’t really be helped.  And I generally don’t loudly identify my patients by name and date of birth, so it all works out OK.)  Over the years, he’s given me Notes on my performance.  Early on in full-fledged medical practice, it seems I would sound rather more annoyed to have been bothered than was helpful for good patient care.  After various phone calls, the Better Half would very gently tell me that maybe I should try to sound less annoyed the next time.  Occasionally I was told that I had overcompensated, and had veered into saccharine territory.

I found it very exasperating to be told these things, mainly because I knew perfectly well that he was right.  But I also knew it was really important to improve.  No matter how irritating it is to be woken at 2 AM with a minor complaint that really could have waited another five hours, I was failing in an important aspect of my job if I didn’t find a way to get over it and help the person on the other end of the line.

At the risk of tooting my own horn, I believe I’ve gotten much better at it.  (It’s helped that I’ve also become a parent myself, which increased my understanding of what my patients’ parents were going through exponentially.)  I’ve worked really hard at communicating better and with more empathy, and I think it’s paid off not only in how I handle phone calls, but also in how I interact with patients and parents in the office.  Lord knows I’m not perfect, and there are probably more days than I’d be keen to admit when I come off as brusque or harried.  But it’s something I take very seriously, and strive to do well.

Which brings me, at last, to my point — I definitely think empathy can be learned if medical providers truly want to learn it.  It’s not clear to my reading whether the residents who took the empathy training were assigned it, or if they signed up for it.  If it was the latter, then it self-selects for physicians who thought it was an important issue in the first place.  Furthermore, residents aren’t a great sample from which to draw larger conclusions.  Residents are still getting evaluated on their performance, and have an added incentive to please the people administering the training.  I’m a bit skeptical that simply forcing unwilling doctors to sit through empathy training modules will do anything except make them more irritable.

Physicians must understand that it’s not enough to be competent, though obviously competence is essential.  (And no physician is so amazingly competent as to be able to get away with what the fellow in the picture above gets away with.  In real life, dude would have been fired and stripped of his license midway through the first season.)  We must do a better job of listening to our patients.  We must learn that doing so is actually important.  When we don’t, they will indeed try to find someone who does listen, and will find the open arms of the charlatans and the hucksters waiting for them.  And that failure won’t be theirs, it will be ours.