“Let Me See If I Have This Right …”: Words That Help Build Empathy

Abstract

Medical Writings7 August 2001"Let Me See If I Have This Right …": Words That Help Build EmpathyJohn L. Coulehan, MD, Frederic W. Platt, MD, Barry Egener, MD, Richard Frankel, PhD, Chen-Tan Lin, MD, Beth Lown, MD, and William H. Salazar, MDJohn L. Coulehan, MDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902, Frederic W. Platt, MDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902, Barry Egener, MDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902, Richard Frankel, PhDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902, Chen-Tan Lin, MDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902, Beth Lown, MDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902, and William H. Salazar, MDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-3-200108070-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Consider these two physician–patient dialogues:1. Patient: You know, when you discover a lump in your breast, you kind of feel—well, kind of—(her speech tapers off; she looks down; tears form in her eyes).Dr. A: When did you actually discover the lump?Patient: (absently) I don't know. It's been a while.2. Patient: (same as above)Dr. B: That sounds frightening.Patient: Well, yeah, sort of.Dr. B: Sort of frightening?Patient: Yeah … and I guess I'm feeling like my life is over.Dr. B: I see. Worried and sad too.Patient: That's it, Doctor.Dr. A's patient ...References1. Konrad TR, Williams ES, Linzer M, McMurray J, Pathman DE, Gerrity M, et al . Measuring physician job satisfaction in a changing workplace and a challenging environment. SGIM Career Satisfaction Study Group. Society of General Internal Medicine. Med Care. 1999;37:1174-82. [PMID: 10549620] CrossrefMedlineGoogle Scholar2. Donelan K, Blendon RJ, Lundberg GD, Calkins DR, Newhouse JP, Leape LL, et al . The new medical marketplace: physicians' views. Health Aff Millwood. 1997;16:139-48. [PMID: 9314685] CrossrefMedlineGoogle Scholar3. Bates AS, Harris LE, Tierney WM, Wolinsky FD. Dimensions and correlates of physician work satisfaction in a midwestern city. Med Care. 1998;36:610-7. [PMID: 9544600] CrossrefMedlineGoogle Scholar4. McMurray JE, Williams E, Schwartz MD, Douglas J, Van Kirk J, Konrad TR, et al . Physician job satisfaction: developing a model using qualitative data. SGIM Career Satisfaction Study Group. J Gen Intern Med. 1997;12:711-4. [PMID: 9383141] CrossrefMedlineGoogle Scholar5. Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med. 1984;101:692-6. [PMID: 6486600] LinkGoogle Scholar6. Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient's agenda: have we improved? JAMA. 1999;281:283-7. [PMID: 9918487] CrossrefMedlineGoogle Scholar7. Roter DL, Stewart M, Putnam SM, Lipkin M, Stiles W, Inui TS. Communication patterns of primary care physicians. JAMA. 1997;277:350-6. [PMID: 9002500] CrossrefMedlineGoogle Scholar8. White J, Levinson W, Roter D. "Oh, by the way …": the closing moments of the medical visit. J Gen Intern Med. 1994;9:24-8. [PMID: 8133347] CrossrefMedlineGoogle Scholar9. Nightingale SD, Yarnold PR, Greenberg MS. Sympathy, empathy, and physician resource utilization. J Gen Intern Med. 1991;6:420-3. [PMID: 1744756] CrossrefMedlineGoogle Scholar10. Levinson W, Stiles WB, Inui TS, Engle R. Physician frustration in communicating with patients. Med Care. 1993;31:285-95. [PMID: 8464246] CrossrefMedlineGoogle Scholar11. Levinson W, Gorawara-Bhat R, Lamb J. A study of patient clues and physician responses in primary care and surgical settings. JAMA. 2000;284:1021-7. [PMID: 10944650] CrossrefMedlineGoogle Scholar12. Suchman AL, Roter D, Green M, Lipkin M. Physician satisfaction with primary care office visits. Collaborative Study Group of the American Academy on Physician and Patient. Med Care. 1993;31:1083-92. [PMID: 8246638] CrossrefMedlineGoogle Scholar13. Cohen-Cole SA. The Medical Interview: The Three-Function Approach. St. Louis: Mosby; 1991. Google Scholar14. Coulehan JL, Block MR. The Medical Interview. Mastering Skills for Clinical Practice. 4th ed. Philadelphia: FA Davis; 2001. Google Scholar15. More ES. "Empathy" enters the profession of medicine.. In: More ES, Milligan MA, eds. The Empathic Practitioner. Empathy, Gender, and Medicine. New Brunswick, NJ: Rutgers Univ Pr; 1994:19-39. Google Scholar16. Basch MF. Empathic understanding: a review of the concept and some theoretical considerations. J Am Psychoanal Assoc. 1983;31:101-26. [PMID: 6681414] CrossrefMedlineGoogle Scholar17. Wispe L. History of the concept of empathy.. In: Eisenberg N, Strayer J, eds. Empathy and Its Development. Cambridge, UK: Cambridge Univ Pr; 1987:17-37. Google Scholar18. Book HE. Empathy: misconceptions and misuses in psychotherapy. Am J Psychiatry. 1988;145:420-4. [PMID: 3348445] CrossrefMedlineGoogle Scholar19. Buie DH. Empathy: its nature and limitations. J Am Psychoanal Assoc. 1981;29:281-307. [PMID: 7264177] CrossrefMedlineGoogle Scholar20. Wilmer HA. The doctor-patient relationship and the issues of pity, sympathy and empathy. Br J Med Psychol. 1968;41:243-8. [PMID: 5728595] CrossrefMedlineGoogle Scholar21. Strayer J. Affective and cognitive perspectives on empathy.. In: Eisenberg N, Strayer J, eds. Empathy and Its Development. Cambridge, UK: Cambridge Univ Pr; 1987:218-44. Google Scholar22. Brothers LA, Finch DM. Physiological evidence for an excitatory pathway from entorhinal cortex to amygdala in the rat. Brain Res. 1985;359:10-20. [PMID: 4075137] CrossrefMedlineGoogle Scholar23. Grattan LM, Eslinger PJ. Empirical study of empathy [Letter]. Am J Psychiatry. 1989;146:1521-2. [PMID: 2619825] CrossrefMedlineGoogle Scholar24. Katz RL. Empathy: Its Nature and Uses. New York: Free Press; 1963:26. Google Scholar25. Lief HI, Fox RC. Training for "detached concern" in medical students.. In: Lief HI, eds. The Psychological Basis of Medical Practice. New York: Harper & Row; 1963:12-35. Google Scholar26. Halpern J. Empathy: Using resonance emotions in the service of curiosity.. In: Spiro H, McCrea Curnen MG, Peschel E, St James D, eds. Empathy and the Practice of Medicine. New Haven, CT: Yale Univ Pr; 1993:160-73. Google Scholar27. Wispe L. The distinction between sympathy and empathy: to call forth a concept, a word is needed. Journal of Personality and Social Psychology. 1986;50:314-21. CrossrefGoogle Scholar28. Wilmer HA. The doctor-patient relationship and the issues of pity, sympathy and empathy. Br J Med Psychol. 1968;41:243-8. [PMID: 5728595] CrossrefMedlineGoogle Scholar29. Bertakis KD, Roter D, Putnam SM. The relationship of physician medical interview style to patient satisfaction. J Fam Pract. 1991;32:175-81. [PMID: 1990046] MedlineGoogle Scholar30. Roter D, Lipkin M, Korsgaard A. Sex differences in patients' and physicians' communication during primary care medical visits. Med Care. 1991;29:1083-93. [PMID: 1943269] CrossrefMedlineGoogle Scholar31. Levinson W, Roter D. Physicians' psychosocial beliefs correlate with their patient communication skills. J Gen Intern Med. 1995;10:375-9. [PMID: 7472685] CrossrefMedlineGoogle Scholar32. Spiro H. What is empathy and can it be taught? Ann Intern Med. 1992;116:843-6. [PMID: 1482433] LinkGoogle Scholar33. Brock CD, Salinsky JV. Empathy: an essential skill for understanding the physician–patient relationship in clinical practice. Fam Med. 1993;25:245-8. [PMID: 8319851] MedlineGoogle Scholar34. Platt FW, Keller VF. Empathic communication: a teachable and learnable skill. J Gen Intern Med. 1994;9:222-6. [PMID: 8014729] CrossrefMedlineGoogle Scholar35. Platt FW, Platt CM. Empathy: a miracle or nothing at all? Journal of Clinical Outcomes Management. 1998;5:30-3. Google Scholar36. Suchman AL, Markakis K, Beckman HB, Frankel R. A model of empathic communication in the medical interview. JAMA. 1997;277:678-82. [PMID: 9039890] CrossrefMedlineGoogle Scholar37. Charon R. The narrative road to empathy.. In: Spiro H, McCrea Curnen MG, Peschel E, St James D, eds. Empathy and the Practice of Medicine. New Haven, CT: Yale Univ Pr; 1993:147-59. Google Scholar38. Carson RA. Beyond respect to recognition and due regard.. In: Toombs SK, Barnard D, Carson RA, eds. Chronic Illness from Experience to Policy. Bloomington, IN: Indiana Univ Pr; 1995:105-28. Google Scholar39. Hunter KM, Charon R, Coulehan JL. The study of literature in medical education. Acad Med. 1995;70:787-94. [PMID: 7669155] MedlineGoogle Scholar40. Novack DH, Suchman AL, Clark W, Epstein RM, Najberg E, Kaplan C. Calibrating the physician. Personal awareness and effective patient care. Working Group on Promoting Physician Personal Awareness, American Academy on Physician and Patient. JAMA. 1997;278:502-9. [PMID: 9256226] CrossrefMedlineGoogle Scholar41. Coulehan JL. Tenderness and steadiness: emotions in medical practice. Lit Med. 1995;14:222-36. [PMID: 8558910] CrossrefMedlineGoogle Scholar42. Connelly J. Being in the present moment: developing the capacity for mindfulness in medicine. Acad Med. 1999;74:420-4. [PMID: 10219225] CrossrefMedlineGoogle Scholar43. Epstein RM. Mindful practice. JAMA. 1999;282:833-9. [PMID: 10478689] CrossrefMedlineGoogle Scholar44. Miller SZ, Schmidt HJ. The habit of humanism: a framework for making humanistic care a reflexive clinical skill. Acad Med. 1999;74:800-3. [PMID: 10429589] CrossrefMedlineGoogle Scholar45. Barrett-Lennard GT. The phases and focus of empathy. Br J Med Psychol. 1993;66 Pt 1 3-14. [PMID: 8485075] CrossrefMedlineGoogle Scholar46. Gallop R, Lancee WJ, Garfinkel PE. The empathic process and its mediators. A heuristic model. J Nerv Ment Dis. 1990;178:649-54. [PMID: 2230750] CrossrefMedlineGoogle Scholar47. Hall JA, Roter DL, Rand CS. Communication of affect between patient and physician. J Health Soc Behav. 1981;22:18-30. [PMID: 7240703] CrossrefMedlineGoogle Scholar48. Larsen KM, Smith CK. Assessment of nonverbal communication in the patient–physician interview. J Fam Pract. 1981;12:481-8. [PMID: 7462949] MedlineGoogle Scholar49. Suchman AL, Matthews DA. What makes the patient-doctor relationship therapeutic? Exploring the connexional dimension of medical care. Ann Intern Med. 1988;108:125-30. [PMID: 3276262] LinkGoogle Scholar50. Suchman AL. Control and Relation: Two Foundational Values and Their Consequences.. In: Suchman AL, Botelho RJ, Hinton-Walker P, eds. Partnerships in Healthcare: Transforming Relational Process. Rochester, NY: Univ of Rochester Pr; 1998. Google Scholar51. Branch WT, Malik TK. Using "windows of opportunities" in brief interviews to understand patients' concerns. JAMA. 1993;269:1667-8. [PMID: 8455300] CrossrefMedlineGoogle Scholar52. Pinderhughes EB. Teaching empathy: ethnicity, race and power at the cross-cultural treatment interface. American Journal of Social Psychology. 1984;4:5-12. Google Scholar53. Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978;88:251-8. [PMID: 626456] LinkGoogle Scholar54. Platt FW, Gaspar DL, Coulehan JL, Fox L, Adler AJ, Weston WW, et al . "Tell me about yourself": the patient-centered interview. Ann Intern Med. 2001;134:1079-85. LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Dr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902Corresponding Author: John L. Coulehan, MD, Department of Preventive Medicine, HSC L3-086, State University of New York at Stony Brook, Stony Brook, NY 11794-8036; e-mail, [email protected]sunysb.edu.Current Author Addresses: Dr. Coulehan: Department of Preventive Medicine, HSC L3-086, State University of New York at Stony Brook, Stony Brook, NY 11794-8036.Drs. Platt and Lin: University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Denver, CO 80222.Dr. Egener: American Academy on Physician and Patient, Legacy Clinic Northwest, 1130 NW 22nd Avenue, Suite 220, Portland, OR 97210.Dr. Frankel: Highland Hospital, 1000 South Avenue, Rochester, NY 14620.Dr. Lown: Mount Auburn Hospital, 300 Mt. Auburn Street, Cambridge, MA 02238.Dr. Salazar: Medical College of Georgia, 1120 15th Street, HS2010, Augusta, GA 30902. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByHow does narrative medicine impact medical trainees' learning of professionalism? 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