Empathy in Patient/Doctor Relationships

*Names have been changed to protect privacy.*

Carl Patterson was with his elderly stepfather when he died from acute lymphatic leukemia. Tom had been a laid-back, easy going man who made friends easily and preferred to have a glass of wine than worry about small details. Carl, on the other hand, was detail-oriented and had been looking after his stepfather’s affairs for years.

Tom wanted to donate his body to a local university for medical research. In most cases, if a body is not received promptly after death, research organizations will refuse the donation. Carl knew this. So he grew impatient when hours passed after his stepfather died and the doctor, who needed to process the paperwork to release Tom’s body, didn’t appear. Carl repeatedly questioned the nurses. The nurses repeatedly paged the doctor. When she arrived, the doctor told Carl, “I have more important things to do with the living than with the dead.” Carl was stunned. “He had just died,” he said. “Her bedside manner didn’t exist.”

Numerous studies have found that empathy is often missing in doctor-patient communication. Expressing empathy can be even more difficult in situations involving conflict, anger, sadness or fear. These feelings are common on a cancer journey.  When medical professionals show empathy, patients feel more satisfied with the relationship. They also have more trust in their doctor, are less anxious about their condition, and are more likely to follow the doctor’s recommendations. Doctors feel better about their work too. Empathy is a learnable skill being taught more frequently in medical schools to help improve patient-doctor communication.

Although many clinicians remain detached, others become emotionally connected with their patients. Katrine Bellamy learned this after her nine-year-old son was diagnosed with a brain tumor. Katrine, who calls herself a “control freak” talks fondly about her son’s nurses. For the most part, they were patient. Some even gave her their cell phone number. They listened. They were empathic.

She shared an example that occurred after her son Steven’s first round of chemotherapy and a stem cell transplant. As she watched him vomit repeatedly, Katrine tried to squelch her growing panic, but she lost it when a nurse handed her a bag of oral medications to give to Steven. Why would the nurse give her oral meds when her son couldn’t keep anything down? She started crying, and the nurse tried to reassure her. Another nurse gently led her to a private room where they talked for two hours. Then Katrine was given the medicine in IV form.  To this day, Katrine is amazed the second nurse spent so much time with her.

Caitlyn Green, who had a double mastectomy following a breast cancer diagnosis when she was pregnant, calls the nurse at her doctor’s office a “sweetheart.” She said her doctor was also friendly and remembered personal details about her. “You start chatting with them about life and get to know them beyond medical information.” Patience, reflective listening, and acknowledging the person’s feelings are ways clinicians can demonstrate empathy.

Empathy in Personal Relationships

Conflict often occurs on a cancer journey when individuals think differently about a situation. They may disagree or disapprove of the other person’s choices, or they find fault with the way another person is reacting. Empathy can reduce conflict.

Jeannette Patterson became angry with several family members as she helped care for her brother-in-law who was terminally-ill with liver cancer. She was frustrated with her niece who sat in the living room, let her kids play loudly, and didn’t help care for her dad. Jeannette was even angrier when her sister said she wished her husband would die. Jeannette snapped back, “What a horrible thing to say. That’s going to happen soon enough.”

At the time, Jeannette could not fully empathize with her sister’s position. She thought her sister just wanted to “get on with her life.”  She didn’t consider that her sister might have made the comment because she wanted her husband’s intense pain to end. Years later, Jeannette has a different perspective. “When you’re under that stress and you have to make life or death decisions, it takes a toll.”

Seeing a situation through someone else’s eyes can improve emotional intimacy, encourage individuals to talk about their feelings, and ease conflict. Respect and listening are critical skills to help individuals be more empathic.

In Diane Martin’s case, her sister and brother-in-law refused to recognize that her husband’s Multiple Myeloma diagnosis was very serious. They rarely visited, and when Martin tried to talk to them about the situation, they would say, “Why are you telling us this? He’ll be fine.” While their reaction to her husband’s diagnosis caused conflict at the time, Martin explains that the problem was a lack of empathy. “They don’t mean to be mean or hateful. They just don’t understand.”

Words are not always necessary to convey empathy. Sometimes people show they care by gathering information, making meals, or helping with household chores. One of Caitlyn’s friends mailed her a card with a joke every week. The colleagues and friends of Tim Hayes, who was diagnosed with testicular cancer, took him to doctor’s appointments and ran errands for him. “It was a good support system.”

Martin calls the support she received a “lifesaver.” Extended family watched their children as Diane and Nate spent long hours at doctor’s appointments. Friends left meals in ice chests on her front porch. They helped her kids with their homework and shuttled them to and from school.

Showing empathy in face-to-face conversations can be more difficult, however. It’s not just what we say and how we say it, empathy is also communicated through body language. In a conversation, you can show empathy by squarely facing the other person, making good eye contact, keeping your body relaxed, and reflecting the person’s facial expressions. These are ways to let someone know you are listening and are interested. It’s important to keep in mind that what comforts one person may not comfort another.

Arturo Hernandez wanted to appear strong to his family and friends after he was diagnosed with prostate cancer. He didn’t want pity but wanted to be seen as a “normal person working with energy” even when he was weak and struggling with hormone injections and radiation treatment. He was raised to fight for what he wanted, to be the best, and never give up. His wife knew this. “I saw my wife crying just once or twice. She never said any soft words or comfort. She always challenged me, because she knows the man I am, and that helped me out,” he explained.

So how do you know how to approach a conversation about cancer? By listening and following the other person’s lead. Watch the other person’s body language, reserve judgment, and try to imagine the situation from his or her perspective to better understand how to talk about cancer. Being empathic can help everyone manage strong feelings, reduce tension, and lessen anxiety.

This research project was funded by a grant from the National Cancer Institute (CA144235; Dr. Wayne Beach, San Diego State University, Principal Investigator). Co-investigators included Dr. David Dozier from San Diego State University, and Mary Buller, Dr. Valerie Myers, and Dr. David Buller from Klein Buendel, Inc.