Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

So You Feel My Pain?

Empathy may not need a prescription, but you won’t find it over the counter.

Medicine prides itself on its objectives: normalizing a high blood pressure, lowering a high blood sugar. Doctors take victory in achieving these objectives.

Unfortunately, there has not been the same emphasis on individual patient desires, what victories the patient wants from those visits to the doctor. However, lately the medical literature has begun to reflect an emphasis on satisfying the patient’s sense of quality of care—the feeling the patient has as a result of being cared for.

For several years there has been active research undertaken in the field of empathy. Currently, researchers are studying the relationship between empathy and the approach to patient care, particularly the holistic approach to patient care. A study published last year in the “International Journal of Medical Education” examined the effects of reflective writing among health care providers, and this showed the power of narrative and reflective writing to increase individual empathy. The conclusion is that medical schools need to encourage reflection and empathic behavior as means to improve the delivery of health care.

Empathy facilitates patient trust and disclosure. Physicians express empathy not only by grasping the personal meanings of patients' words, but also by (automatically, hopefully) matching patients' nonverbal style; for example, their vocal tones. When doctors attune to patients nonverbally, patients feel more comfortable and give fuller histories. It is as if an additional, reinforcing level of communication is occurring. This can only aid the doctor-patient relationship, and add to the positive medical outcomes of the care provided.

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There is a growing body of evidence suggesting that empathy directly enhances therapeutic efficacy. Engaged communication has been linked to decreasing patient anxiety, and, for a variety of illnesses, decreasing anxiety has been linked to physiologic effects and improved outcomes. This is particularly true with the chronic pain patient. An expert panel on how physicians deliver bad news concluded that patients cope better in the long term if their doctors are empathic.

But it is better to have a little emotion with all that empathy.

The skeptic might ask why it matters whether physicians respond emotionally if they just behave empathically. There are many answers to that rumination:

1) Observational studies show that patients sense whether physicians are emotionally attuned.

2) Patients trust physicians who respond to their anxiety with their own responsive worry. Trust has been associated with better treatment adherence.

3) It matters when and how physicians ask patients about their feelings, and empathic attunement guides physicians about when to ask questions, when to stay silent, and when to repeat important words. Emotion can often be the guide during that short empathic journey in the examination room.

Empathy may not need a prescription, but you won’t find it over the counter. If you are lucky, you’ll see it in the eyes, or hear it in the voice.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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