How Can Providers Elicit Patient Perspectives and Respond with Empathy?

Calvin Chou, MD; Professor, UCSF School of Medicine

Typically what providers do in the middle of the interview is they focus in on their thinking — their cognitive processing, the clinical reasoning part of things — because that’s what we’re trained to do. And the patient-centered side is to ask about the patient’s perspective of illness. Specifically, talking about: what feelings the patient has about what’s going on with them, what ideas they might have, how it might affect function, and then what expectations they may have of the interview.

Physician: So, let me just start by asking you about the stomach pain; how did it start? Just tell me about it.

Patient: Well, I just woke up with it. I mean, I guess it started about half an hour ago maybe. That’s when I woke up. I don’t know if it woke me up, or I just woke up and it was there. And it just hasn’t gone away; it’s very persistent.

Physician: So it sounds very distressing that this happened — woke you up maybe even. Okay, yeah. I’m really glad that you’re telling me about this.

And the other thing is statements of empathy. And if the doctor or the provider is in their thinking cap mode, and they are not picking up on the fact that the patient is giving them clue after clue about their emotion, then either the patient gives up — which is the worst outcome — or, finally, the provider clues in, “Oh, the patient is saying ‘scared,’ ‘frightened,’ — I’m hearing this several different times.”

Physician: Are you afraid that this might be something? Do you have worries about what it might be?

Patient: Well, my biggest fear is that I have heard that stomach pain can actually come from the heart. And I’m afraid it’s a heart attack because so many members of my family have had heart disease or strokes. It might be a heart attack.

Physician: So that’s very, very good for me to know so that when we do the physical exam, when I ask more questions, I’ll think more about this — whether it’s your heart that’s causing this pain. Do you have other ideas about what might be causing this pain? Other than your heart?

Rather than just being a soliloquy from the doctor, a one way download, what we’re trying to encourage providers to think about instead is more of a dialogue.