A review of 28 trials published in the Journal of the Royal Society of Medicine last week quantifies what many doctors already knew: empathic, positive communication benefits patients.
Two true stories motivated me to do the review. Archie Cochrane reports the first. He was the only doctor in a prisoner of war camp during World War II. One night the Germans dumped a young Soviet prisoner in his ward. The soldier had pleurisy (holes in his lungs) and was screaming. Cochrane didn’t want to wake up the other prisoners, so took him to his private room. He had no morphine, just aspirin, which wasn’t working. He felt desperate. He knew very little Russian and there was no one in the ward who did. He finally instinctively sat down on the bed and took the soldier in his arms. The screaming stopped and the prisoner died peacefully in Cochrane’s arms a few hours later. It was not the pleurisy that caused the screaming but loneliness. He was ashamed of his misdiagnosis and kept the story secret.
A doctor friend called Anne (real name withheld) told me the a more recent story about her experience. Anne was teaching three smart medical students who were told to diagnose a woman complaining of severe pain in her left shoulder. After 20 minutes of questions, the students wrote seven pages of notes and
recommended two drugs: an anti-inflammatory and a painkiller. Anne looked at what the students did and agreed that it was evidence-based. But something told her there was more to the story. She sat beside the patient, asked general question
s, and listened carefully. After a few minutes, the woman broke down in tears and told her about a personal tragedy involving one of her children. After some comforting, the tears and shoulder pain both vanished. Anne’s empathy and understanding prevented the woman from unnecessary painkilling drugs. This is significant because Jane Ballantyne from the University of Washington School of Medicine worries that even milder painkilling drugs may contribute to the current opioid crisis, as patients may subsequently seek stronger and stronger treatments.
Our review suggests Cochrane and Anne’s empathy aren’t just the stuff of stories. Empathic and positive communication seems to improve conditions ranging from lung function and length of hospital stay, to pain, patient satisfaction, and quality of life. From related research, we also understand more and more about how positive empathic communication works. First, you need empathy to make the right diagnosis. Without it patients may not share symptoms, especially embarrassing ones. Next, an empathic practitioner will help put a patient at ease and reduce their stress. Dozens of trials suggest that relaxation reduces pain, depression and anxiety, and even lowers the risk of heart disease. Also, by being positive (which is part of empathy), activates the patient’s brain in such a way that the patient makes his or her own painkilling endorphins.
Our review had some limitations. For example the studies in the review were small and blinding is hard to achieve, since doctors know if they have been trained to provide additional empathy. Another limitation is that the effect was small: for example empathic and positive communication reduced pain by an average of half a point on a 10-point scale. However this small effect is important, especially if we take harms and drug options into account. Many commonly used over the counter drugs, on the other hand, barely outperform placebos for back pain, cancer pain, and many chronic conditions, yet can have serious side effects. By contrast, a key finding of the study was that positive empathic communication does not seem to harm patients.
Whether or not doctors prescribe drugs for pain, adding a dose of empathy will probably boost the drug’s effect without risking any harm to the patient. And for some patients a dose of empathy is all they need.
Postscript
Since publishing the paper some people have asked: how can I use empathy to help me? The answer to that goes beyond the evidence in the trial. However there is one way I think we can extrapolate the evidence in a scientific way. Few people would deny that they sometimes (even often) have negative, unconstructive thought patterns. Evidence suggests that these are bad for our mental health. Empathy involves understanding, then acting on the understanding. So being empathic with ourselves—at a high level—means understanding that we’re human and make mistakes, then moving on to deal with whatever needs to be dealt with in a constructive way.
A version of this newsletter was published on the Huffington Post on 24 April 2018