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Doctor and Patient Relationships: Empathy & Litigation

Doctor and Patient Relationships: Empathy & Litigation
Author Information (click to view)

Dustin D. Smith, MD

Emergency Medicine Physician

Loma Linda University Medical Center & Children’s Hospital

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Dustin D. Smith, MD (click to view)

Dustin D. Smith, MD

Emergency Medicine Physician

Loma Linda University Medical Center & Children’s Hospital

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Research has shown that emergency physicians (EPs) with better interpersonal skills and who spend more time with patients appear to have fewer malpractice claims filed against them. Studies have also shown that empathy from EPs can influence how healthcare providers are viewed and may have a role in patients’ decisions on whether or not they wish to pursue litigation.

To investigate this issue further, Dustin D. Smith, MD, Jesse Z. Kellar, MD, and colleagues had a study published in the Emergency Medicine Journal that sought to determine whether the presence or absence of empathetic statements from EPs would alter patient thoughts regarding litigation.

For the study, researchers randomized adults in an ED waiting room to watch videos of simulated discharge conversations between physicians and patient actors. Half of the videos differed only by the inclusion of two brief empathetic statements. “These statements included verbalizations that EPs recognized that the patient is concerned about their symptoms and the patient knew their typical state of health better than a physician seeing them for the first time and did the right thing by seeking evaluation,” explains Dr. Smith.

After watching the video, participants were asked to rate their thoughts regarding suing this physician in the event of a missed outcome leading to lost work. Questions were also asked about measures of satisfaction with the physician encounter.

Demonstrating Empathy Matters

According to the results, the addition of brief empathetic statements to ED discharge scenarios appeared to lead to significant reductions in thoughts of litigation. “Adding brief empathetic statements also led patients to have more positive impressions of the physician and a better understanding of discharge instructions,” Dr. Smith says. Patients who saw videos with empathetic statements were more likely to regard the physician as being an “expert,” to believe that the doctor cared about the patient, and to want this physician as their doctor.

Dr. Kellar says that demonstrating empathy is important for EPs. “By taking time to communicate more with patients and showing empathy, EPs can make a significant impact on the patient experience,” he says. In turn, this may improve patient satisfaction and may increase compliance, decrease anxiety, and improve clinical outcomes.

The physicians participating in the videos used in the study did not receive any additional training on how to demonstrate empathy more effectively. “Simply put,” says Dr. Smith, “EPs demonstrate empathy well when they accurately understand the patient’s feelings and then convey this understanding to patients.”

Looking Ahead

Despite the increased understanding and importance of empathy, recent studies suggest that there is a trend towards decreased empathy that tends to start in medical school and continues into residency. “It’s also important to recognize that empathy is different from sympathy,” Dr. Smith says. “To show empathy, it requires taking the time to understand patients’ perspectives.”

The study group noted that future investigations aim to replicate these findings and investigate other variations of such physician behaviors. Once best practices are clearly identified and defined, additional training in how to demonstrate empathy effectively could be used to counter this trend toward decreased empathy in the future.

Dustin D. Smith, MD, and Jesse Z. Kellar, MD, have indicated to Physician’s Weekly that they have no financial disclosures to report.

Readings & Resources (click to view)

Smith DD, Kellar J, Walters EL, Reibling ET, Phan T, Green SM. Does emergency physician empathy reduce thoughts of litigation? A randomized trial. Emerg Med J. 2016;33:548-552. Available at: http://emj.bmj.com/content/33/8/548.abstract.

Neumann M, Edelhäuser F, Tauschel D, et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med. 2011;86:996-1009.

Pollak KI, Alexander SC, Tulsky JA, et al. Physician empathy and listening: associations with patient satisfaction and autonomy. J Am Board Fam Med. 2011;24:665-672.

Suchman AL, Markakis K, Beckman HB, et al. A model of empathic communication in the medical interview. JAMA. 1997;277:678-682.

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