Is My Doctor Listening?

How do doctors respond to the emotional concerns of their patients? This question is at the heart of a study that I first read while training in palliative medicine. In the study, researchers recorded conversations between physicians and people with lung cancer. They wanted to know how physicians respond to patients’ expressions of emotion, referring to these moments as “empathic opportunities.” 

Here are the concerns that patients shared with their physicians:

• Fear of Dying

• Fear of Cancer Symptoms

• Worry that the disease was self-inflicted (by smoking)

• Difficulty in making decisions about treatment

• Mistrust of medical care

• Difficulty coping with a cancer diagnosis

• Frustration/confusion regarding logistics of cancer treatment

Sadly, the physicians responded empathically to only 10% of these sentiments! The researchers found: “In response, physicians expressed the difficulty of making prognostic predictions, focused on biomedical information, and did little to recognize or address patients' stated fears or to explore patients' clues hinting at potential fears, concerns, and uncertainties.” In most cases, physicians missed the underlying concern that the person was trying to convey, responding instead with technical information or changing the subject. 

This is disheartening and unfortunately, a lot of studies show the same thing 🙁. People share their values, their fears, and what matters most to them. But clinicians often miss the opportunity to respond therapeutically or to address their concerns in a meaningful way.

Though disappointing, I don't blame the clinicians. They are people too - afraid to hurt or scare their patients. And they are taught to treat illness, not tend to emotions. It’s good to have a clinician who is skilled in their practice and knowledgeable about disease, but we also want to be cared for. Care is an art as much as a science. So, if medicine is a healing art, then these are missed moments to practice that art. 

As a clinician myself, I see this study, not as a statement of failure, but as a call to action. I like this study, not because it demonstrates how physicians fail to respond to emotion, but because it proves that people want to have meaningful conversations with their clinicians. They want to talk about their fear of dying, what to expect in the future and how to make decisions. They want to talk about their fear of suffering and how to speak with their family about their illness. These are not extras - for most people, this is central to their care. 

I would argue that the majority of serious illness care is about responding to emotion. In fact, this study and others like it are excellent teaching tools. I teach my trainees how to notice emotional questions, or “empathic opportunities,” and respond in kind. It’s heartening to see impressive clinicians, expertly skilled in the technical aspects of medicine, come to realize that tending to emotion is the part of care that makes all the difference to our patients.