A new study1 suggests that if clinicians respond to the emotions expressed by patients during a clinical visit by explicitly focusing on patients’ affect, they can address these emotional concerns without necessarily adding extra length to the visit.
A team of investigators at Johns Hopkins University audio recorded 41 clinicians during encounters with 342 patients and studied the time patients engaged in emotional expressions and categorized clinicians’ responses. They then evaluated the associations of the clinicians’ responses with the timing of the patient’s expressed emotion, patient repetition, and subsequent length of the visit.
They found that most clinician responses provided space for the patient to elaborate on the emotion and were nonexplicit, but as each minute passed, clinicians were less likely to provide space and more likely to be explicit. When clinicians were explicit, emotions were less likely to be repeated. Moreover, the visits were shorter when the clinician’s responses explicitly focused on the patient’s affect.
“Listening for patients’ concerns and emotions, and then explicitly responding to them, can save time in the encounter and is theoretically better for the patient,” said lead author Mary Catherine Beach, MD, MPH, Professor, Johns Hopkins Berman Institute of Bioethics and Professor of Medicine at Johns Hopkins School of Medicine, Baltimore, Maryland.
Revisiting an Old Conclusion
“There has been 1 previous study2 that suggested physicians could save time by providing a more empathetic response to patients’ emotions,” said Dr Beach, who is also a Professor in the Department of Health, Behavior and Society, Johns Hopkins School of Public Health.
The 2000 study of 116 patient-clinician encounters2 found that visits in which clinicians did not acknowledge patient’s feelings averaged 3 minutes longer than visits in which clinicians provided a more empathetic response. In 53% of these visits with “missed opportunities,” the patient brought up the same concern more than once, suggesting that “patients who have not had their emotional state adequately acknowledged and do not perceive being heard by their clinician may feel compelled to repeat themselves.”
This “landmark” study “has served as the basis for teaching clinical communication for decades and has been used to alleviate physicians’ concerns about whether they could afford the time that might be required to respond to emotional issues,” said Dr Beach.
However, “over the years, I have found that some physicians question whether the findings from that study are actually true, and so we designed this study to see if those findings could be reproduced and to see if we could gain any further precision about how different types of responses might impact [clinical] encounter length,” Dr Beach recounted.
She and her colleagues designed the study “to evaluate the relationship between the clinician’s response to a patient’s emotion and subsequent communication, including the patient’s repetition of emotional expressions and length of visit, using a comprehensive detailed emotional communication coding system.”