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“Could this Be Something Serious?”

Reassurance, Uncertainty, and Empathy in Response to Patients’ Expressions of Worry

Journal of General Internal Medicine volume 22, pages 1731–1739 (2007)Cite this article

Abstract

BACKGROUND

Previous work suggests that exploration and validation of patients’ concerns is associated with greater patient trust, lower health care costs, improved counseling, and more guideline-concordant care.

OBJECTIVE

To describe physicians’ responses to patients’ worries, how their responses varied according to clinical context (straightforward versus medically unexplained symptoms [MUS]) and associations between their responses and patients’ ratings of interpersonal aspects of care.

DESIGN

Multimethod study. For each physician, we surveyed 50 current patients and covertly audiorecorded 2 unannounced standardized patient (SP) visits. SPs expressed worry about “something serious” in 2 scenarios: straightforward gastroesophageal reflux or poorly characterized chest pain with MUS.

PARTICIPANTS

One hundred primary care physicians and 4,746 patients.

MEASUREMENTS

Patient surveys measuring interpersonal aspects of care (trust, physician knowledge of the patient, satisfaction, and patient activation). Qualitative coding of 189 transcripts followed by descriptive, multivariate, and lag-sequential analyses.

RESULTS

Physicians offered a mean of 3.1 responses to each of 613 SP prompts. Biomedical inquiry and explanations, action, nonspecific acknowledgment, and reassurance were common, whereas empathy, expressions of uncertainty, and exploration of psychosocial factors and emotions were uncommon. Empathy expressed during SP visits was associated with higher patient ratings of interpersonal aspects of care. After adjusting for demographics and comorbidities, the association was only statistically significant for the MUS role. Empathy was most likely to occur if expressed at the beginning of the conversational sequence.

CONCLUSIONS

Empathy is associated with higher patient ratings of interpersonal care, especially when expressed in situations involving ambiguity. Empathy should be expressed early after patient expressions of worry.

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Acknowledgements

We would like to express thanks to David Seaburn Ph.D. who helped with the initial conceptualization of this project. Vi Luong provided graphic design support, and Sue Palmiero and Mary Haddad provided secretarial and administrative support. Some of the results reported in this article were presented at the International Conference on Communication in Healthcare, Basel, Switzerland, September 7, 2006. This study was funded by Patient Centered Care and Health Care Costs, AHRQ R01-HS1610-01A1, Ronald M. Epstein, Principal Investigator.

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Authors and Affiliations

  1. Department of Family Medicine, Rochester, NY, USA

    Ronald M. Epstein MD, Taj Hadee MD, Jennifer Carroll MD, MPH, Sean C. Meldrum MS & Judi Lardner BA

  2. Department of Psychiatry, University of Rochester, New York, USA

    Ronald M. Epstein MD

  3. Department of Oncology, University of Rochester, New York, USA

    Ronald M. Epstein MD & Jennifer Carroll MD, MPH

  4. Rochester Center to Improve Communication In Health Care, University of Rochester, New York, USA

    Ronald M. Epstein MD, Taj Hadee MD, Jennifer Carroll MD, MPH, Sean C. Meldrum MS & Judi Lardner BA

  5. Relationships in Healthcare Research Program, Child Development and Family Studies Department, Purdue University, West Lafayette, IN, USA

    Cleveland G. Shields PhD

Authors
  1. Ronald M. Epstein MD
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  2. Taj Hadee MD
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  3. Jennifer Carroll MD, MPH
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Correspondence to Ronald M. Epstein MD.

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Epstein, R.M., Hadee, T., Carroll, J. et al. “Could this Be Something Serious?”. J GEN INTERN MED 22, 1731–1739 (2007). https://doi.org/10.1007/s11606-007-0416-9

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  • DOI: https://doi.org/10.1007/s11606-007-0416-9

KEY WORDS

  • reassurance
  • uncertainty
  • empathy
  • patients’ worry