And just as important, Ronald Epstein and Anthony Back write in JAMA, being engaged like this also helps physicians reconnect with a deeper purpose in their work.
In their highly reflective essay, Epstein and Back note that doctors are trained to diagnose and treat. They tend to want to fix things, and if they can’t — which is often the case with individuals with chronic disease — many withdraw emotionally. They may even blame the patient.
Instead of turning away, the authors write, a better approach is for doctors to turn toward patients and recognize their suffering. Treat them as whole persons, not just diseases.
Doctors need to be “authentic, emotionally available and engaged,” urge Epstein, a professor of medicine, psychiatry and oncology at the University of Rochester, and Back, a professor of medicine at the University of Washington. Sometimes asking patients a simple question is what's needed: “What’s the worst part of this for you?”
Much of this seems to be common sense, but the pair acknowledges the challenge. “For physicians to address suffering explicitly and routinely use these approaches would be a radical departure from the way medicine is practiced now,” they write.
The suffering — and subsequent healing — of one of Epstein’s patients prompted their essay. The woman was beset by joint pain and disability but went years without a diagnosis. She had knee, hip, wrist and elbow surgeries. She only began to improve after team of doctors started to truly engage with her — asking what was important about the care she received — and her improving medical condition prompted her to make changes in her personal life, according to the authors.
In an interview, Epstein said that what he and Back are advocating goes beyond empathy.
“You can be empathetic without being engaged,” he said. “When a doctor says, ‘I can see how this is making you feel sad,’ that’s not implying a personal connection.” But if a doctor says, "I can only begin to imagine….,” there is a conscious change in perception.
One difficulty is the limited time most clinicians have to spend in face-to-face conversations with patients. “I see patients every 20 minutes, and these are very complex patients,” Epstein said. Being emotionally available “is not an easy job.”
But when his patients feel he is better understanding them, it's better for their care. “They don’t need to keep reiterating their concerns, and we can move more quickly towards solutions,” he said.
Sometimes, doctors also can help patients connect with what is important and meaningful in their lives because of their illness experience, Epstein and Back believe. In the case of the woman patient, they write, doctors supported her efforts "to be the person she wanted to be — and not to be constrained by dependence on medications or by the expectations of family and medical personnel."