The Power of a Physician's Kind Word

Alicia Ault

The Effect of Kind Behavior

Physicians sometimes wonder how much patients pay attention to what they say and what kind of impact they have made.

The answer appears to be that a kind word and expression of concern from a physician can have a far more powerful effect on patients than was previously thought. A growing body of evidence suggests that offering kindness, empathy, or words of encouragement leads to better patient engagement, a more trusting relationship, better health outcomes, and a less stressful practice for clinicians.

Physicians often feel compassion and warmth toward patients but don't realize that they're not always expressing it in a way that comes through, say experts. A few well-placed words and actions from a physician can make a huge difference in how a patient responds, both physically and emotionally.

What Does a Physician Convey to Patients?

While empathy and compassion are often used interchangeably, they're not the same, and both are important, said Stephen Trzeciak, MD, MPH, professor and chair of medicine at Cooper Medical School of Rowan University, Camden, New Jersey. Empathy is the ability to mirror someone's emotions—feeling their pain—while compassion indicates a desire to take action, Trzeciak told Medscape.

Trzeciak says that spending an extra 40 seconds showing compassion to a patient can make a large difference in the patient's outcome and in reducing physician burnout. Trzeciak and colleague Anthony Mazzarelli, MD, JD, MBE, recently published Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference (Perfect Paperback), which explores the impact of compassion in medicine. Most of the 440 references cited in the book point to a strong correlation between kindness and better health, said Trzeciak.

"What we found through this systematic review is a very clear signal in the data that compassion matters," he said, "and that it matters in ways that are not just meaningful, emotional, sentimental, and ethical, but also in scientific ways."

Trzeciak and colleagues identified 50 potential mechanisms of action for compassion—ranging from effects on physiology, pain, psychology, and neurobiology, to health quality, experience, and patient and physician satisfaction—and 45 potential outcome measures.

They found evidence that compassion can reduce systemic inflammatory pathophysiology, leading to enhanced wound healing and better immune function. Compassion can also stimulate better patient adherence, leading to better control of disease progression and a shorter recovery time, they suggested.

Admittedly, it is an evolving science because so much of the data is observational, not experimental, said Trzeciak. But Trzeciak said he is convinced that compassion can improve health outcomes, decrease burnout, and lower the cost of healthcare.

How Does Compassion Help Health?

Researchers who have studied empathy and compassion say that kindness has a demonstrable and measurable effect.

Lauren Howe, PhD, a social psychologist and chair of human research management and leadership at the University of Zurich, Switzerland, told Medscape, "The work on empathy has shown that people who interact with more empathetic physicians have shorter durations of the common cold and have better outcomes when it comes to complications related to diabetes."

Howe led an experiment showing that patients fared better when their clinician was warmer and acted more competent; they felt worse when the provider acted cold and less competent. In that trial, all of the patients were given a skin prick with histamine. Both groups were given a cream with no active ingredients. The clinician set either positive expectations (cream will reduce reaction) or negative expectations (cream will increase reaction). Additionally, one group got a clinician who was chatty, smiling, making eye contact, called the patient by name, worked in a clean office, and gave the skin prick without hesitation. The other group met with a doctor who was focused on a computer screen, did not introduce herself, was in a messy office, and hesitated during the skin prick.

The results showed that the impact of patient expectations of the allergic response was enhanced when the clinician acted both warmer and more competent, and was negated when the provider acted colder and less competent.

Researchers concluded that clinicians could harness this psychological placebo effect—behaving more warmly and showing more care—to improve treatment outcomes.

"We see that when people have more trust in their healthcare provider, they're more likely to follow through on recommended care, they report that they are in better health, and they are more likely to be engaged in their health," Jessica Greene, PhD, professor of health policy at Baruch College, New York City, told Medscape.

How to Show Compassion in the Clinical Setting

Physicians may struggle with the balance of keeping a professional distance and the desire to connect with patients on a personal level. The weight of administrative tasks, such as the EHR, is also a factor; some physicians feel that they don't have time for compassion. Others simply don't know how to convey kindness.

"I was taught in medical school to maintain a distant objectivity," said Ronald M. Epstein, MD, director of the Center for Communication and Disparities Research at the University of Rochester Medical Center, Rochester, New York. "I very quickly found that when I entered practice, that didn't lead to the kind of healing relationships that I think patients need and want," he told Medscape.

Patients want to feel seen, to feel known.

"Patients want to feel seen, to feel known," said Epstein. "If you have no capacity to enter into the patient's emotional world, they really won't feel heard," he said. It's important to hear them to help them, he said. "If suffering goes unrecognized, obviously you can't do a very good job of relieving it," Epstein said. Epstein and his colleagues teach mindfulness to physicians in an effort to improve emotional regulation and, in turn, compassion skills.

In a Manner of Speaking

The way a clinician talks to a patient helps convey compassion—or lack of it, said Epstein. Epstein and colleagues documented and defined real instances of compassion by recording conversations between oncologists and patients.

The recordings were reviewed by a team that included clinicians and medical personnel with a communications or linguistics background. It became apparent "that compassion is not a quality of a single utterance but rather is made up of presence and engagement that suffuses an entire conversation," said the authors.

Clinicians expressed compassion through direct or indirect verbal statements that offered emotional resonance, softening of tone, or added emphasis, for instance.

They addressed suffering by making action statements such as "I'm going to help you through this," and they demonstrated compassion through personalization (treating someone as a unique individual), affirmation, reassurance, action, supplementary humor, non‐abandonment, and presence.

The conversations reflected a range of responses, from total absence of compassion to thoughtfulness. The authors concluded that it "confirmed others' extensive observations that physicians often respond inadequately to patients' suffering and re‐direct the topic of conversation away from the exploration of emotions."

Lack of compassion is particularly troubling for patients with advanced cancer "when medicine has relatively little to offer in terms of reversal of disease, but a lot to offer in terms of relief of suffering," Epstein said. "The research illustrated the paucity of compassion in a profession that espouses to value it."

Epstein said many physicians—oncologists in particular—may avoid getting close to a patient because they fear that it will compound a sense of hopelessness or burnout.

"But for me, at least, and for many clinicians, trying to distance yourself and denying that you have feelings and thoughts, and that it affects you in some way, sometimes takes more effort and is more elusive than just merely recognizing it and allowing yourself to experience that stress," he said.

What If a Doctor Is Just Not a Warm Person?

Trzeciak said it takes less than a minute to show a patient compassion. "We get this idea, when we feel hurried, that we don't have time for compassion," he said. "That's a really bad place to be."

Greene said she found that whether or not a physician believed that he or she had time to be compassionate depended on how they were already practicing. "The people who do it feel like it doesn't take more time because it's how they interact with their patients," Greene said. Physicians "who do it less think that it is definitely an additional thing to do."

Lauren Howe noted that making eye contact, smiling, and listening actively does not take any more time. Howe and her colleagues also found that being compassionate didn't take extra time. In their studies, they noticed that small tweaks in the physician's existing dialogue could make patients feel more appreciated.

An example is asking someone what year they were born in instead of asking for "date of birth." Small changes like this "could help a patient feel that they interacted with a provider who was warmer," said Howe.

Compassion also combats burnout, in part because it helps you forget your own worries, said Trzeciak. "If you have low compassion for patients and you don't make that human connection with patients, then you don't have the same fulfilling experiences of taking care of people," he said. That fulfilling experience is what helps build resistance and resilience to burnout, he added.

Is America in a Compassion Crisis?

Some experts believe that America is going through a compassion crisis. Several surveys, including one published in Health Affairs, reported that half of patients and physicians believed that the US healthcare system does not consistently provide compassionate care.

"I think that people need to feel cared about in order to feel trust; and once they trust, they're much more likely to follow through with recommendations and feel comfortable in the personal relationship," Jessica Greene told Medscape. "They need that interpersonal relationship, both to be able to express what they need to share with the clinician, and for the clinician to be able to support the patient in getting to a healthier place," she said.

"More and more research is convincing me that these traits are things that can be built—that empathy isn't something that's set in stone; it can be learned and developed," said Howe.

All of the experts interviewed for this article agreed that these skills should be taught as part of the medical school curriculum and also offered as continuing education.

More people in leadership positions—hospital CEOs, medical school deans, and policymakers—need to recognize the importance of compassion, especially as the forces of frustration continue to mount for physicians, said Epstein.

It's not clear, however, how to get institutions to recognize compassion and empathy as key patient care goals, said Howe. "It's still just thought of as this extra bonus and that clinicians aren't really given credit for what they do [regarding showing compassion]," she said.

All physicians are taught to "first, do no harm," which is generally taken to apply to the physical, noted Epstein. "But there's also a harm caused by not being present," he said.

Comments

Dr. Martha Agbedo|  General Practice

I am amazed at the effects of kind words on our patients. I feel this has energized me once more. It’s worth the energy. Thanks a million times to the author of this book.

Dr. Brahmavar Amrutha

Great article. Practice of medicine is changing . It is not health care , it is wealth care . Physicians are not to be blamed. It is management . When I was growing up in a small town during my middle school inspired me to go to Med school . I will never forget that incident . I followed my passion became an MD at age 26 served poor people with kindness & compassion . I used to say my religion is medicine. My destiny was here in USA . When I finished my training I ? my soul the ans was " to serve poor" I took a job low paying went to Alabama served there for few yrs as I needed to care for my own child I was forced to join a state job . I served whole heartedly with kindness / compassion . just 15 yrs . A remarkable experience. One of my collegue once made fun of me oh U come to job with your heart ❤️ I come it is a job. I told that person it makes lot of difference. When I retired my PT's sourrounded me to thank me . I told them U all have made me a better person. They were surprised& said no dr will say this. I said I say u all have shared your suffering, etc that has made me a better person. I am happy to share with Medscape & all readers I am retired ( octagenarin) I have started a non profit " spring in to kindness & compassion" I spoke to the first batch residents who will graduate this June. They will select a best resident who shows these ualities , a small plaque will be awarded by this non profit " spring in to kindness & compassion" we all have compassion other wise we all don't go to Med school but we must practice it show it to our patients . Touch them with love , kindness . When we go home we must feel it in our heart . One must treat our patients as if they are our family , we must put ourself in their position & feel. Science with out humanity is a sin per M K Gandhi . Technology is a big help but technology cannot replace human kindness/ compassion . Now Drs are paying more time looking at their lap top rather than spending time with patients . This is a great article. I feel as retired MD's one can try to inspire young Drs or others who wants to go toned school what is important in serving our patients .

I enjoyed my job I am so blessed by my patients , to day I am able to share with all of the readers of this article .it is a noble profession . Peace be in all of us Once again great article . Excuse me if any typographic errors

Dr. Dr Preeti Babu|  Family Medicine
Hello sir,

I am really touched by your life's journey. I am a MBBS doctor and have seen many senior specialist till date who are serving the management and not the humanity. I am thankful to you to show a bright light in the dense darkness. Compassion and humanity is the only best thing that is gifted to doctors. But this inner power is being neglected and visible monetary power is given much importance. But I will mark your words and follow them.

Thank you for sharing your precious experiences.

Dr. dominique Bailey|  Pediatrics, Oncology
It continues to amaze me even 30 years into practice how kindness can change the often intimated patient. Their facial expressions soften as does their body language once they know that you are invested in their well being. Smile and laugh , say kind words and they will always come back to you and

Dr. traci purath|  Neurology
I am not perfect, but when I get home at night I ask myself “did I do my best for each patient I served today” and hopefully I always say “yes”

When I no longer say “yes” or start to get bitter...I know it’s time to quit.

Dr. Victor Colon|  Gastroenterology

Great article... I can see how the US medical system overall is becoming less compassionate, and empathetic. Personally, I practice and ask of my staff to make eye contact, to speak with patients and not at the patients. With the advent of EHR and all the requirements for documentation mostly by CMS and Medicare Advantage programs, in addition to all the extra administrative work; it has become very hard to do what the authors mentioned. I totally agree with the points made.

However, in order to be able to provide the kind of care mentioned I had to incurred on extra expenses in my practice hiring staff to be documenting on the computer my encounter. This allowed me to sit with the patient and companion, focus on their problems, address their concerns, tell them my impression and plan of treatment, follow up, answer any questions, and offer them that if they have any other concerns or once they get home something is not clear, to feel free and give us a call, and I or my staff will be glad to explain again. We get in fact very few calls, but we also handle written material preprinted, or written down with the plan, or condition name.

Throughout all my encounter my nurse is filling out all the info in the EHR, which I review immediately after the patient walks out the door. This part takes me a minute. The nurse actually spent about 10-15 minutes filling the EHR with info such as meds, allergies, surgical hx etc. before I enter the room. So when I enter the room I just focus on the main problem, physical exam, any labs or xrays already scanned, impression and plan of action. I also engage in any other pertinent conversation for example if the pt is a college student I ask their major etc. And try to spend at least a few minutes listening to where pts come from, hardships, frustrations with previous treatments etc. Then, try to put in perspective their situation, and encourage them providing a positive outlook within their particular situation, telling them that I will do my best to help them.

The total time that I may spent with a patient is perhaps 10 to 15 minutes top. Sometime less or more. But this is time spent with uninterrupted attention, full focus, showing and expressing understanding, offering my help and letting them know they that I am there for them.

I believe that when the patients know and feel that you care and trust that you will try to help them, my experience is that actually few come back being worse or not better.

I feel that this type of care that the authors correctly point out not only help the patients, and the physician, but from a business stand point, helps your practice to grow as pts tell referring docs about the treatment received, and tell other pts about you. Which helps your practice. I am in a specialty that involve procedures, so having an open conversation about the procedures, explaining what they may go thru, potential outcomes including complications, and how we handle them, if they ask I provide to them my personal stats on number of procedures I’ve done, complications and outcomes. I do not sugar coat anything, my view is that if they have doubts or are not confortable with myself, they should seek another MD. However, about 96% stay, and some come back later. Again, all this is accomplished in 10-15 minutes of my time with the pt. After I leave the exam room, the nurse stays explaining, reviewing and giving written info and my sign prescriptions

To me it works well, but on the flip side it cost me an extra $92,000 to $95,000 dollars a year on extra staff to be able to implement this type of setting.

So if the goal is to practice the kind of medicine that the authors point out, and which I personally like to practice; many things will need to change in order to assist the MDs to have more freedom in the pt encounter to focus on the pt and not the computer or time clock. Not everyone is willing or able to afford what may be needed, to successfully established this.

This is more complex than just being empathic and compassionate. I have no doubts that most physicians will love the opportunity to establish the relations that the authors point out. However, many do not have the control over this, and that one big problem when hospitals, insurances, and administrators control the practice of medicine. I sincerely hope that better ways to take care of the emotional needs of our patients are found. And thru objective studies like this one, those in the real control of medicine make the necessary changes to make this possible.

Congrats to the authors and contributors for a very important aspect of the medical care.

Dr. Keith Raymond|  Family Medicine
We as patients and physicians also respond to the unkind word. Sometimes more so. Good patient relations requires a balance of kindness and strength. It signals that you care by making an emotional commitment. Indifference is the killer of a good relationship. In the ED, encounters are usually singular events, but even there creating a balance of kindness and strength can be useful. I have a saying, "If all you have to offer is kindness, it's not enough."

Dr. karl grant do|  Family Medicine
Well well imagine that a kind word or action promotes health and healing!!!! Don't let the CEO or CMS type hear that.

Dr. James Neiburger|  Allergy & Clinical Immunology

Physicians generally underestimate the power they have through the use of kind words and encouragement. A few moments during which an encouraging exchange takes place is always remembered and may have a life long effect on the patient. As I approached retirement,many long time patients would remind me of little things I said to them many years earlier which they felt had a major impact on their lives. Physicians should learn to harness that ability and use it for its full benefit. If you’re too busy, look for another job. If you’re not a warm person, take some lessons. It is not hard even if it doesn’t come naturally to you. Warmth and compassion are human qualities that separate us from the kiosks and tablets that some think will replace us as health care delivery moves into the future. Take full advantage of the good you can provide through a few kind words.

 

Dr. Frederick Pevow|  Otolaryngology

To quote from Cutting for Stone, "what medical treatment is administerd by ear"?  "Words of Comfort".

 

Dr. bruce young|  Family Medicine

Great Article. If patients get the feeling that you are enjoying being with them that makes a big difference in how they will respond to your healing plan.

Dr. Edward Klopp|  Surgery, Cardiothoracic

I believe Hippocrates first said that our job as physicians was, "sometimes to cure, usually to treat, but ALWAYS to comfort."  Not sure we should need too many more studies on that topic, but a couple of more points -- first, I have long held that at least a third of your job as a physician is "cheerleading" -- some for your staff, some for the family, and a lot for the patient.  People really do get better faster when they are encouraged, especially by their Doctor.  Finally, please speak in terms your patients can understand -- if you understand your subject, you can express your points clearly without resorting to 50 cent words.  Going back to quotations, I think it was Einstein who said that, "if you can't explain your subject to the average six year old, you probably don't understand it." 

 

Dr. nigel cairns|  General Practice

Now as a patient (I am retired) I have experienced kind words from ONE  doctor at UCSD. It made a difference to me.

Dr. D. Lynn Mickleson|  Family Medicine

Sympathy is the ability to feel compassion for someone else's problem while empathy is the ability to feel compassion for a problem you yourself have experienced.

Add new comment