Something bothered me last week while blogging about teaching medical students to deliver bad news to patients.
Although training and practice can help develop and reinforce effective, empathetic communication skills in medical students as well as doctors, I kept having the nagging thought that this wasn’t the whole story. Is delivering bad news merely about following the six steps of the SPIKES protocol? Would I want a conversation involving bad news to be packaged as a carefully learned formula? Don’t patients sense the difference between rote platitudes and genuine caring?
Then… eureka! an article appearing in the New York Times the same day captured it exactly.
Dr. Timothy Gilligan, co-director of the Center for Excellence in Healthcare Communication at the Cleveland Clinic, and Dr. Mikkael Severes, director of the leukemia program at the Cleveland Clinic, nailed it: Doctor-patient communication isn’t something you can readily force or script or reduce to “10 Easy Techniques For Demonstrating Empathy.” Although good communication is an essential skill for any health care practitioner, it should be real, not faked.
From their article:
No communications course will magically transform lifelong introverts to hand-holders and huggers. At the same time, we must ensure that we are not converting people who genuinely care about their patients into people who only sound as if they care. Having physicians sound like customer service representatives is not the goal.
For those doctors who are emotionally challenged, communications courses can provide the basics of relating to other human beings in ways that, at the very least, won’t be offensive. But for the rest of us, we should take care to ensure the techniques and words we learn in such courses don’t end up creating a barrier to authentic human contact that, like the white coats we wear, make it even harder to truly touch another person.
As one of those “lifelong introverts”, I take exception to the implication that introverted clinicians need fixing so they can give more hugs. Introversion and good communication are not mutually exclusive, and introverted doctors may in fact be better than many extroverts at listening to their patients.
But Drs. Gilligan and Severes raise important questions about the degree to which empathy can be taught and the unintended consequences of trying to program clinicians into better communicators.
Reactions to their article were almost as fascinating as the article itself. A sample:
– “Patients usually come to us because they hurt. They’re suffering, and most of their suffering isn’t from tumors or low platelet counts; it’s from their own normal emotions in response to being sick: depression, anger, confusion, loneliness, anxiety, and so on. We might be able to fix their lesions, but we can address their emotions only by listening to them, and that’s a more sublime skill than repeating, ‘Go on’ or ‘How does that make you feel?'”
– “Providing education and skill sets to improve communication will only go so far. Addressing issues around emotional intelligence is the core of the problem.”
– “As a physician, I find It amazing that anybody could write about problematic interactions between doctors and patients without noting the 2,000 pound gorilla in the room: what our healthcare system pays doctors for. The less time doctors spend with each patient, the more patients they are able to see and the more money they can make. If you pay doctors the same whether they talk to patients for five minutes or 45 minutes, guess which they are most likely to do.”
– “Most of these technically brilliant but interpersonally stunted doctors are either married, have friends, and successful careers, meaning that they must have some social skills. I’m not sure the issue has anything to do with being introverted or geeky. I think it might have a lot to do with arrogance and not seeing the patient as a person.”
I’ve heard some health care workers say scripts help them stay focused, especially in difficult situations. Others find scripts restrictive, even a bit silly, and would rather allow the conversation to flow naturally.
What do you suppose patients and families prefer – empathy that’s clumsily expressed but sincere, or all the right words with no feeling behind them?